Weeks Of Immobilization Research Articles

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

PurposeTo assess the accuracy and reliability of using cone beam computed tomography (CBCT) compared to X-ray six weeks after injury for predicting scaphoid union. Materials and methodsOverall; 52 patients with scaphoid fractures between April 2018 and March 2019 were prospectively included in this study. The mean age was 34.52 (13–88) years, and the gender ratio male/female 43/9. Of the fractures, 26 had occurred on the right side, and 26 on the left side. In total, 28 % of patients were manual workers. All patients underwent X-ray and CBCT six weeks after injury. Four readers, two radiologists, and two hand surgeons analyzed the findings using double-blinded X-ray and CBCT and categorized fractures as consolidated based on a 50 % visibility threshold concerning trabecular bridges. Proximal pole sclerosis, communition, cyst formation, and humpback deformity were similarly analyzed for all cases. Agreement between readers was calculated using Kappa, and sensitivity, specificity, and accuracy using RStudio software. The gold standard was the radiologic and clinical follow-up for all patients at two months. ResultsInter-reader agreement between the four readers was moderate concerning X-ray (0.543) but substantial concerning CBCT (0.641). It was almost perfect between seniors regarding CBCT (Kappa = 0.862). Sensitivity, specificity, and accuracy were 0.75–0.78, 0.4, and 0.61–0.64, respectively, for two readers regarding CBCT. The X-ray values were 0.65–0.71, 0.35–0.4, and 0.53–0.59, respectively. ConclusionCBCT proves more accurate and reliable than X-ray for diagnosing scaphoid union at an early follow-up and prevents longer immobilization and interruption of activity or work.

Bryan and Morrey Type IV intra-articular fracture: a rare situation

A 34-year-old man, a nurse with no medical history, non-smoking, and right-handed, admitted to the emergency service after a right elbow trauma. He falls on an outstretched hand on his house stairs. The patient couldn´t move his joint. The examination found a swelling and painful right elbow. Motion attempts were remarkably painful. Bony landmarks of the elbow were normal. There were no vascular or nervous abnormalities. The right wrist and shoulder exam were satisfying. Elbow X-rays revealed an articular displaced fracture of the distal humerus. 3D reconstruction affirmed the fracture. This frontal fracture takes the capitulum and the hole trochlea; It´s a was a Bryan and Morrey Type IV intra-articular fracture. Due to the displacement of this articular fracture, the staff decided to operate the patient. Within 24 hours after the trauma, the patient was in the operating room. Under loco-regional anesthesia, per operative examination of lateral ligaments was normal. An orthopedic surgeon performed the gesture by a combined approach (lateral and medial). The fragment was reduced and fixed par two Herbert screws. The articular congruity was satisfying. After three weeks of immobilization by a posterior splint, the patient debuted functional rehabilitation who been initially passive than active based on flexion-extension motion and pronation-supination motion. At 14 months following up, the patient had no pain. Ranges of motion were 150° of flexion, -10° of extension, 90° of pronation, and 80° of supination. Morrey score was 95. The limitation of extension motion had no impact on the usual activities of patient life.

Application of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger

Objective To explore the clinical efficacy of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger. Methods From January 2017 to January 2018, 14 patients with soft tissue defect of finger were treated. The super-thin venous flaps were harvested from the dorsal foot according to the area of finger defects. The wound was repaired by arterialization of veins. The dorsal cutaneous nerve of foot was incised in 4 cases. The donor site was sutured directly. The functional exercises were started after 2 weeks of immobilization. Results All the patients were follow-up for 6 to 12 months, 11 cases survived uneventfully, 2 cases had partial necrosis of skin flaps, and 1 case lost follow-up after 3 months. The partial necrosis of skin flaps healed after dressing change. 10 cases had two-point discrimination of 11 to 13 mm, and 4 cases with nerve in flaps had two-point discrimination of 7 to 9 mm. Conclusion It is simple and satisfactory to repair finger tissue defects with super-thin venous skin flap of dorsal foot. The donor site can be sutured directly and the sensory function can be reconstructed simultaneously with dorsal foot nerve excision. Key words: Finger injuries; Surgical flaps; Arterialized venous; Super-thin skin flap

The Protective Effects of Zanthoxylum bungeanum Maxim Pharmacopuncture on Disuse Muscle Atrophy in Rat Gastrocnemius Muscle

Background: This study aimed to investigate the protective effects of Zanthoxylum bungeanum Maxim pharmacopuncture on disuse muscle atrophy in the gastrocnemius muscle of rats. Methods: Thirty male 250 g Sprague-Dawley rats were distributed randomly into 3 groups. The left hindlimb immobilization was performed with casting tape for 2 weeks, and no treatment was given to the right hindlimb. Rats received pharmacopuncture and were injected daily on the BL57 with either 2 mL of Zanthoxylum bungeanum Maxim aqueous extract (ZM-W group), 1 mL pharmacopuncture of Zanthoxylum bungeanum Maxim ethanol extract (ZM-E group), or 2 mL normal saline (control group). After 2 weeks of immobilization, the weight of the whole gastrocnemius muscle was measured, and the morphology of both the left and the right gastrocnemius muscles were assessed by Hematoxylin and Eosin staining. To investigate the immobilization-induced muscular apoptosis, the immunohistochemical analysis of BAX and Bcl-2 was carried out. Results: ZM-W and ZM-E significantly inhibited the reduction in weight of the left gastrocnemius muscle, the reduction in the left myofibrils, and the cross-sectional area of gastrocnemius, as compared with the control. Moreover, the ZM-W and ZM-E groups showed significantly reduced immunoreactivity for BAX, and increased immunoreactivity of Bcl-2 in left gastrocnemius muscle compared with the control group. Conclusion: These results suggest that Zanthoxylum bungeanum Maxim pharmacopuncture has protective effects against immobilization-induced muscle atrophy by regulating the activity of apoptosis-associated BAX / Bcl-2 proteins in the gastrocnemius muscle.

Knee joint stiffness following immobilization and remobilization: A study in the rat model

Deficits in extension can limit the function and performance of the knee joint. The range of motion (ROM) deficit in knee extension is often measured and reported at a single torque value applied in the flexion-extension axis. This static measurement of ROM omits key details about the biomechanical properties of the knee, such as its mechanical stiffness. Our objectives were (1) to quantify knee extension stiffness after various periods of immobilization and remobilization, and (2) to evaluate how stiffness correlated with the length of the posterior knee capsule. Two hundred fifty-six male Sprague Dawley rats had one knee immobilized at a 45° angle in flexion using a Delrin® plate for 6 different durations ranging from 1 to 32 weeks. Remobilization was initiated by removing the plate and lasted for 0–48 weeks. The contralateral knee and unoperated age-matched rats were used as controls. An automated arthrometer extended the knee at four pre-determined torques and these data were used to calculate mechanical stiffness. The stiffness of knees immobilized for 8 or more weeks was significantly greater than controls and persisted despite remobilization (p < 0.05). Remobilization after 16 and 32 weeks of immobilization resulted in a progressive increase in mechanical stiffness (p < 0.05). The length of the posterior capsule significantly correlated with knee stiffness in extension (p < 0.05). Deficit in knee extension was characterized by increased stiffness, which was irreversible upon unassisted remobilization.

Impact of disuse muscular atrophy on the compound muscle action potential.

Disuse atrophy from immobilization is the result of decreased neural activity and muscle unloading. We studied the impact of disuse on hand intrinsic compound muscle action potentials (CMAPs) in a cohort of 39 patients with unilateral 6-week immobilization of the hand in a cast, after distal radius fracture. We excluded patients with nerve injury. We compared side-to-side CMAP characteristics at the time of cast removal and at a subsequent follow-up visit, after a mean interval of 7.8 weeks. Statistically significant reductions in CMAP amplitude were noted for the abductor pollicis brevis (29.2%), abductor digiti minimi (19.0%), and first dorsal interosseus (24.9%). There was partial repair of the relative CMAP reduction at the follow-up visit (20.1%, 10.7%, and 8.7%, respectively). There was no significant change in CMAP duration. These results provide a framework for quantifying the degree of hand intrinsic CMAP amplitude reduction attributed to disuse.

Minimally Displaced Humeral Lateral Condyle Fractures: Immobilize or Operate When Stability Is Unclear?

Either casting or in situ fixation (to prevent displacement) are recommended for minimally displaced pediatric lateral condyle fractures of indeterminate stability with ≤2 mm lateral displacement and narrowed fracture extension to the epiphyseal articular cartilage. This study compares casting only, acute prophylactic in situ pinning, and surgery if casting fails due to displacement. In total, 738 fractures at a level 1 trauma center between 2008 and 2014 were reviewed. All fractures were assigned a Song classification and Song 2 fractures followed to union were analyzed. Worsening displacement was defined as an increase in Song stage. Patients were grouped per treatment: (1) cast only; (2) in situ pinning; or (3) closed or open reduction percutaneous pinning after displacement during attempted cast treatment. In total, 139 fractures were included and 45 (32%) underwent surgery. Among 114 fractures intended for casting, only 20 (18%) displaced and needed surgery. This implies 82% of fractures prophylactically pinned in situ may have remained stable in a cast. On average, displaced fractures were noted 6.5 (2 to 13) days after presentation and required 1 extra clinic visit and week of immobilization without increased complications. Surgeons chose open reduction percutaneous pinning more often for displaced fractures. Our data estimate 82% of Song 2 fractures never meaningfully displace in a cast. Meaningful displacements occur in <2 weeks. Benefits of prophylactic pinning include 1 less x-ray and clinic visit in exchange for a clinically insignificant lateral cortex reduction and inherent surgical risks. Compliance, surgical scheduling, and a higher rate of open reduction after displacement should influence early treatment decisions. Level III.

Paediatric forearm refractures- management and outcome: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Forearm fractures are one of the commonest injuries accounting for 40% of paediatric fractures with a refracture rate of nearly 5%. Forearm refractures are increasing probably due to poor bone mineralization as a result of decreased physical activity, Vitamin D deficiency. These are treated by conservative measures with closed reduction and casting or by surgical fixation with flexible nails or plates. There are no definitive guidelines for management of forearm refracture and implant removal.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study is aimed at the epidemiology, methods and difficulties of management and functional outcome of forearm refracture treatment. A prospective study of all the cases of forearm refracture who presented to our institution from 2010 to 2016 with refractures treated either by conservative methods or by IMN. All cases were followed up for 2 years and functional outcome was assessed serially according to price et-al criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our study contained 17 males and 8 females between 6 years and 14 years. 76% refractures occurred before 16 weeks and majority had only tricortical union at this time. 42% patients underwent surgical fixation following refracture. Price et al criteria showed excellent results in 72% of patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Forearm refractures in children can be treated both conservatively and surgically like a primary fracture depending on the indications but needs 2 to 3 more weeks of immobilization. A good functional outcome was obtained in majority of the cases. We suggest using splints till quadricortical union is achieved to prevent chances of refracture.&lt;/p&gt;

P.3.11 Quality of sleep in relation to socio-demographic and clinical characteristics of the neuromuscular disease

Mechanical stimuli play an important role in the homeostasis of trabecular bone and marrow adipose tissue, particularly for the weight-bearing skeleton. Prolonged immobilization and disuse have been shown to reduce trabecular bone content and increase marrow adipose tissue in the bones of lower limb joints such as the knee. However, details on the temporal response of this relationship to prolonged immobilization and its reversibility is limited. Forty rats had one knee immobilized at 45° of flexion for 2, 4, 8, or 16 weeks and subsequently remobilized for 0 or 8 weeks. The contralateral knees were used as controls. Histomorphometric measures of trabecular bone and marrow adipose tissue (MAT) areas were conducted in the epiphysis of the proximal tibia. Knee immobilization for 4, 8, and 16 weeks significantly reduced trabecular bone area by -0.125, -0.139, and -0.161 mm2/mm2, respectively, with corresponding 95 % CIs of [-0.012, -0.239], [-0.006, -0.273], and [-0.101, -0.221]. MAT area significantly increased at 2 and 16 weeks by +0.008 and +0.027 mm2/mm2, respectively, with 95 % CIs of [0.014, 0.002] and [0.039, 0.016]. Remobilization for 8 weeks restored trabecular bone area compared to the contralateral knee and the magnitude of change was significantly greater for 8 and 16 weeks of immobilization with effect sizes of 1.69 and 1.86, respectively. The difference in MAT area between immobilized and contralateral knees were eliminated with remobilization. These results characterize the temporal response of trabecular bone and MAT in the epiphysis of the proximal tibia to joint immobilization and remobilization.

Rabbit Model of Extending Knee Joint Contracture: Progression of Joint Motion Restriction and Subsequent Joint Capsule Changes after Immobilization.

This study aimed to develop a rabbit model of knee contracture in extension and investigate the natural history of motion loss and time-dependent changes in the joint capsule after immobilization. We immobilized the unilateral knee joints of 32 rabbits by maintaining the knee joint in a plaster cast at full extension. Eight rabbits were euthanized at 2, 4, 6, and 8 weeks after casting, respectively, and the lower extremities were disarticulated at the hip joint. Eight control group rabbits that did not undergo immobilization were also examined. We assessed the progression of joint contracture by measuring the joint range of motion, evaluating the histologic alteration of the capsule, and assessing the mRNA levels of transforming growth factor β1 (TGF-β1) in the anterior and posterior joint capsules. After 2 weeks of joint immobilization, the knee joint range of motion was limited, the synovial membrane of the suprapatellar and posterior joint capsules was thickened, the collagen deposition was increased, and the mRNA levels of TGF-β1 were elevated in the anterior and posterior joint capsules. These changes progressed rapidly until 6 weeks of immobilization and may advance slowly after 6 weeks. Joint contracture developed at the early stage of immobilization and progressed over time. The changes in the anterior and posterior joint capsules after joint immobilization may contribute to the limitation in flexion. The elevated mRNA expression of TGF-β1 may be related to joint capsule fibrosis and may be one of the causes of joint contracture.

Single limb immobilization model for bone loss from unloading

Hindlimb suspension is the most used model for inducing bone loss from unloading but requires a separate ground control group. This control group cannot be used for genetic studies involving outbred mice. In this study, we evaluated a single limb immobilization (SLI) model for inducing bone loss from unloading, with the contralateral limb from the same animal used as a control. Male 10-week old C57Bl/6J mice had one limb immobilized for one, two, or three weeks. Subsequently, an additional group of male 16-week old C57Bl/6J mice had one limb immobilized for three weeks. SLI resulted in decreased tibial trabecular BV/TV, Tb Th, and Tb N compared to contralateral limbs in young mice. Femoral trabecular BV/TV, Tb Th, Tb N, and femoral cortical area fraction were also decreased. Mechanical properties were not affected after three weeks. In adult mice, femoral trabecular BV/TV, Tb Th, and Tb N were decreased. Femoral stiffness, ultimate stress, and Young’s modulus were decreased. Bone properties decreased by SLI were also decreased by hindlimb suspension previously. The results suggest SLI can be an effective model for inducing bone loss in growing and adult mice after three weeks of immobilization.

The Effects of Dokhwalgisaeng-tang against Disuse Muscle Atrophy in Gastrocnemius of Rats

Background: The purpose of this study was to examine the effect of Dokhwalgisaeng-tang on immobilization-induced muscle atrophy. Methods: Twenty young male Sprague-Dawley rats were divided into 2 groups. The rats in Dokhwalgisaeng-tang group were orally administered Dokhwalgisaeng-tang water extract, and the rats in the control group were given saline only. Hind limb immobilization was performed with casting tape to keep the left ankle joint in a fully extended position. No intervention was performed on the right leg which was used as an intact region. After 2 weeks of immobilization, all animals were sacrificed, and the gastrocnemius muscle was dissected from both legs and weighed. The morphology of the right and the left gastrocnemius muscle in both the Dokhwalgisaeng-tang and the control group was assessed by hematoxylin and eosin staining. The muscle cross sectional area was examined by image analysis (Axiovision LE software). In addition, immunohistochemical staining was carried out using the free-floating method, and the number of apoptotic related proteins were counted (anti-BAX, anti-Bcl-2). Results: Dokhwalgisaeng-tang showed a significant protective effect against the reduction of the left gastrocnemius muscle (weight and muscle cross sectional area) compared with the control group. Moreover, the treatment with Dokhwalgisaeng-tang significantly reduced protein expression of BAX and increased protein expression of Bcl-2 in the gastrocnemius muscle compared with the control group. Conclusion: Dokhwalgisaeng-tang showed protective effects against disuse muscle atrophy, potentially through altered BAX and Bcl-2 protein expression in the gastrocnemius muscle.

Surgical Treatment of Subfibular Ossicle in Children: A Retrospective Study of 36 Patients with Functional Instability.

To evaluate the surgical management of a symptomatic subfibular ossicle after severe ankle sprain with functional instability and pain sequelae in children. We analyzed 36 patients complaining of functional instability without laxity, 1 year after an ankle inversion trauma associated with the observation of a subfibular ossicle. We systematically suggested the open excision of the residual ossicles, followed by 6 weeks of immobilization and proprioceptive physiotherapy. Seventeen of them, constituting the "resection" group accepted this surgical approach. The remaining 19 patients, the "control" group, received only rehabilitative care. The American Orthopaedic Foot and Ankle Society ankle pain and function score was evaluated in both groups. The mean latest follow-up was 4 years and 4 months (range, 1 y 8 mo to 14 y 7 mo). A significant improvement of the American Orthopaedic Foot and Ankle Society score was observed and was significantly higher in the resection group with a mean gain of 31 points (SD=31.8), versus 7 points (SD=7) in the control group (P<0.001). We conclude that in the absence of objective laxity, excision of the os subfibulare appears as a simple and effective technique in the treatment of posttraumatic functional instability and ankle pain. Level IV-retrospective case-control study.

Rat Model of Adhesive Capsulitis of the Shoulder.

This proposal aims to create an in vivo rat model of adhesive capsulitis for researching potential treatment options for this condition and other etiologies of comparable arthrofibrosis. The model includes extra-articular fixation of the shoulder in rats via scapular to humeral suturing, resulting in a secondary contracture without invading the intra-articular space and resulting in decreased rotational ROM and increased joint stiffness. We used 10 Sprague-Dawley rats for the purpose of this study. Baseline ROM measurements were taken before glenohumeral immobilization. The rats were subjected to 8 weeks of immobilization before the fixation sutures were removed and changes in ROM and joint stiffness were evaluated. To evaluate whether immobilization resulted in a significant reduction in ROM, changes in kinematics were calculated. ROM was measured at each time point in the follow-up period and was compared to the baseline internal and external ROM measurements. In order to evaluate the stiffness, joint kinetics were calculated by determining the differences in torque (text and tint ) needed to reach the initial external rotation of 60° and initial internal rotation of 80°. After the removal of the extra-articular suture fixation on follow-up day 0, we found a 63% decrease in total ROM compared to baseline. We observed continuous improvement until week 5 of follow-up, with the progress slowing down around a 19% restriction. On week 8 of follow-up, there was still an 18% restriction of ROM. Additionally, on follow-up day 0, we found the torque increased by 13.3 Nmm when compared to baseline. On week 8, the total torque was measured to be 1.4 ± 0.2 Nmm higher than initial measurements. This work introduces a rat model of shoulder adhesive capsulitis with lasting reduced ROM and increased stiffness.

No Functional Difference Between Three and Six Weeks of Immobilization After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Non-Inferiority Trial

The aim of this study was to compare clinical and radiologic results among patients with 3 versus 6weeks of immobilization after arthroscopic rotator cuff (RC) repair in a prospective randomized controlled non-inferiority trial. One hundred twenty patients were included after RC surgery for a small- to medium-sized tear of supraspinatus and upper infraspinatus tendons. Group A was immobilized in a simple sling for 3weeks, and group B had a brace with a small abduction pillow with the arm in neutral position for 6weeks. All patients started active range of motion when they removed the sling/brace. One hundred eighteen (98%) patients were assessed at 1-year follow-up. They underwent magnetic resonance imaging (MRI) of the shoulder, filled out the Western Ontario Rotator Cuff (WORC) index, and were evaluated with a Constant Murley (CM) score. Statistical non-inferiority was demonstrated for the 2 groups on the basis of the WORC index, the primary endpoint at 1year. The objective for the non-inferiority test was to determine whether the expected mean WORC index for group A was at most 13% worse than standard treatment (Group B). The WORC index at 1year was similar in both groups, with mean percent scores of 83% in group A and 87% in group B (mean difference=-4; 95% one-sided CI-9,-4). Age-adjusted CM scores were also similar, with means of 86 in group A and 90 in group B (mean difference=-4; 95% CI-13, 5; P= .37). MRI after 1year showed 50 (89%) patients in each group with healed RC repair. Four patients in group A had complications: 1 acute postoperative infection, 2 cases of postoperative capsulitis treated with corticosteroid injections, and 1 repeat operation because of a loose anchor and subacromial pain. No patients in group B had complications. RC repair resulted in improved postoperative shoulder function, regardless of whether the shoulder was immobilized for 3 or 6weeks. Three weeks of postoperative immobilization with sling use was non-inferior to the commonly used regimen involving 6weeks of immobilization in a brace with regard to the WORC index at 12months' follow-up. MRI indicated similar degrees of healing between the groups. Based on these findings, it is safe to immobilize patients in a simple sling for 3 to 6weeks after repair of small to medium RC tears. Level I, high-quality randomized controlled trial with statistically significant differences.

The Effects of a Standard Postoperative Rehabilitation Protocol for Arthroscopic Rotator Cuff Repair on Pain, Function, and Health Perception.

Purpose There is still conflicting evidence to support postoperative rehabilitation protocols using immobilization following rotator cuff repair over early motion. The objective of the study was to evaluate the evolution of pain, shoulder function, and patients' perception of their health status up to 1 year after cuff rotator repair and a standard postoperative rehabilitation protocol consisting of 4 weeks of immobilization followed by a 2-week assisted controlled rehabilitation. Methods Descriptive, longitudinal, uncontrolled case-series study was performed on 49 patients who underwent arthroscopic rotator cuff repair following traumatic or degenerative lesions. VAS scale for pain, Constant–Murley score for function, and SF-12 score for quality of life were used as outcome measures and were administered before the rehabilitation treatment, at the end of the 2-week rehabilitation, 3 months, and 1 year after surgery. Results VAS pain score decreased significantly along the follow-up reaching almost a nil value after 1 year (0.2). Function as measured by Constant–Murley score had a significant improvement during follow-up, reaching a mean value of 84.6. The short form (SF)-12 score increased over time reaching 46.3 for the physical and 43.8 for the psychological dimension, respectively, at 1 year. Conclusion The present study confirmed an excellent outcome at 1 year after rotator cuff repair using a traditional 4-week immobilization followed by a 2-week rehabilitation protocol without evidence of tendon un-healing or re-tearing. Level of Evidence This is a level IV, therapeutic case series.

Volar plate avulsion fracture alone or concomitant with collateral ligament rupture of the proximal interphalangeal joint: A comparison of surgical outcomes.

BackgroundVolar plate avulsion fracture of the proximal interphalangeal (PIP) joint is one of the most common hand injuries. In this study, we divided patients into two groups: patients with pure volar plate avulsion fracture, and patients with volar plate avulsion fracture concomitant with collateral ligament rupture. The purpose of this study was to compare long-term surgical outcomes between the two groups. As a secondary measure, the Mitek bone anchoring and polydioxanone (PDS) bone suturing techniques were compared.MethodsA single-institutional retrospective review of the surgical treatment of volar plate avulsion fracture was performed. The cases were divided into those with pure volar plate avulsion fracture (group A, n=15) and those with volar plate avulsion fracture concomitant with collateral ligament rupture (group B, n=15). Both groups underwent volar plate reattachment using Mitek bone anchoring or PDS bone suturing followed by 2 weeks of immobilization in a dorsal protective splint.ResultsThe average range of motion of the PIP joint and extension lag were significantly more favorable in group A (P<0.05). Differences in age; follow-up period; flexion function; visual analog scale scores; disabilities of the arm, shoulder, and hand scores; and the grip strength ratio between the two groups were non-significant. No significant differences were found in the surgical outcomes of Mitek bone anchoring and PDS bone suturing in group A.ConclusionsOverall, the surgical outcomes of volar plate reattachment were successful irrespective of whether the collateral ligaments were torn. However, greater extension lag was observed in cases of collateral ligament injury.

Effects of neuromuscular presynaptic muscarinic M1 receptor blockade on rocuronium-induced neuromuscular blockade in immobilized tibialis anterior muscles.

SummaryThis in vivo study tested the hypothesis that the modulation of acetylcholine (ACh) release by the M1 muscarinic receptor (mAChR) in the neuromuscular junction of disused muscles may affect the tensions of the muscles during the neuromuscular monitoring of a rocuronium‐induced neuromuscular block and compared the results with those obtained from normal muscles. A total of 20 C57BL/6 (wild‐type) and 10 α7 knock out (α7KO) mice were used in this experiment. As a pre‐experimental procedure, knee and ankle joints of right hind limbs were fixed by needle pinning at the 90° flexed position. After 2 weeks, the main experiment was performed. Both tendons of the tibialis anterior (TA) muscles were obtained, and the muscle tensions were recorded while the dose‐responses of rocuronium were measured three times in the same mouse by the serial administration of pirenzepine (0, 0.001 and 0.01 μg/g). Weight losses were observed after 2 weeks of immobilization in both groups, and a decrease in the mass of TA muscles at the immobilized side was observed compared to those of the contralateral nonimmobilized side. Tension depression of the TA muscles at immobilized side of the α7KO group was faster than those of the wild‐type group, but these differences decreased after the administration of pirenzepine. The tension depressions were similar regardless of the pirenzepine doses at the same side in the group. Tension depression may become more rapid in the α7 AChR‐expressed disused muscles by the decreased release of ACh release upon neuronal firing by the blockade of facilitatory M1 mAChR

Non- or Minimally Displaced Distal Radial Fractures in Adult Patients: Three Weeks versus Five Weeks of Cast Immobilization-A Randomized Controlled Trial.

Background Patients with non- or minimally displaced distal radial fractures, that do not need repositioning, are mostly treated by a short-arm cast for a period of 4 to 6 weeks. A shorter period of immobilization may lead to a better functional outcome. Purpose We conducted a randomized controlled trial to evaluate whether the duration of cast immobilization for patients with non- or minimally displaced distal radial fractures can be safely shortened toward 3 weeks. Materials and Methods The primary outcomes were patient-reported outcomes measured by the Patient-Related Wrist Evaluation (PRWE) and Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after 1-year follow-up. Secondary outcome measures were: PRWE and QuickDASH earlier in follow-up, pain (Visual Analog Scale), and complications like secondary displacement. Results Seventy-two patients (male/female, 23/49; median age, 55 years) were included and randomized. Sixty-five patients completed the 1-year follow-up. After 1-year follow up, patients in the 3 weeks immobilization group had significantly better PRWE (5.0 vs. 8.8 points, p = 0.045) and QuickDASH scores (0.0 vs. 12.5, p = 0.026). Secondary displacement occurred once in each group. Pain did not differ between groups ( p = 0.46). Conclusion Shortening the period of immobilization in adult patients with a non- or minimally displaced distal radial fractures seems to lead to equal patient-reported outcomes for both the cast immobilization groups. Also, there are no negative side effects of a shorter period of cast immobilization. Therefore, we recommend a period of 3 weeks of immobilization in patients with distal radial fractures that do not need repositioning.

Rehabilitation Protocols After Basal Joint Surgery: All over the Map: Commentary on an article by Douglas T. Hutchinson, MD, et al.: "A Prospective, Randomized Trial of Mobilization Protocols Following Ligament Reconstruction and Tendon Interposition".

Commentary Hutchinson et al. have designed a carefully done, Level-II study that compares 2 different postoperative immobilization protocols following ligament reconstruction and tendon interposition. They found that 4 weeks of thumb-spica splint immobilization followed by 4 weeks of intermittent splinting (early mobilization group) provided outcomes that were virtually comparable with those provided by 6 weeks of immobilization with use of a forearm-based thumb-spica splint followed by 6 weeks of intermittent splinting (immobilization group). Much of what is taught and done in musculoskeletal medicine is based on what we have learned from our mentors or what we have gleaned from the literature. Unfortunately, the literature frequently falls short and therapeutic decisions are based on Level-IV or Level-V evidence. As Hageman et al. pointed out, when evidence is inconclusive, surgeons default to “works in my hands,” “familiarity with treatment,” and “what my mentor taught me.”1 To address this situation and better serve our patients, the American Academy of Orthopaedic Surgeons and many specialty societies have worked diligently to publish Clinical Practice Guidelines (CPGs) and Appropriate Use Criteria (AUC). The CPGs are based on the studies with the highest levels of evidence available in the peer-reviewed literature; unfortunately, much of the evidence is inconclusive, and hence there is the need for more Level-I and Level-II studies. AUC combine expert opinion with the findings of studies with the best levels of evidence in order to guide practitioners on when it is appropriate to perform a procedure under a specific set of circumstances. Regrettably, there are no CPGs or AUC for many of the procedures that surgeons commonly perform or for those that have, to date, not gained a great deal of traction. In one of the earliest articles about basal joint arthroplasty, Gervis reported on 15 patients who underwent trapeziectomy alone2. Only 2 patients had “inferior” results. The postoperative recommendations in the study were brief: initiate an active range of motion “at once” and use “supervision” as necessary to achieve a full range of motion. Since then, in a systematic review, Wolfe et al. pointed out that rehabilitation protocols have become more detailed but recommendations are all over the map3. The focus of most of the literature on basal joint arthritis is on surgical technique. When developing a rehabilitation program following basal joint arthroplasty, it is key to consider the length of time for complete thumb immobilization, when to initiate an active range of motion, and the total time that the splint should be worn because these factors affect cost, quality of life while recuperating, and return to full activity. In the study by Hutchinson et al., 2 secondary considerations were noted. The type of splint (forearm-based versus hand-based) did not seem to matter. The treatment in the immobilization group was supplemented by 6 weeks with a forearm-based splint whereas the early mobilization group utilized a less restrictive hand-based splint for 4 weeks. On a similar note, wrist and thumb strengthening was initiated at 8 weeks in the early mobilization group and 12 weeks in the immobilization group. Again, outcome was not affected. I was surprised to learn that simultaneous procedures—particularly those on the metacarpophalangeal joint—had no effect on outcome when comparing the 2 groups. Finally, an aspect not addressed in this study is the role of supervised hand therapy and how it affects outcome. In their systematic review, Wolfe et al. noted that some authors recommended no formal therapy whereas others endorsed a very structured rehabilitation program3.