Weight-bearing Research Articles

Beta-tricalcium phosphate combined with native bone proteins (β-TCP - NBP): a novel bone graft substitute for ankle and hindfoot arthrodesis.

The purpose of this prospective, multi-centre study was to assess the performance and safety of a combination of osteoconductive β-tricalcium phosphate and osteoinductive native bone proteins (β-TCP - NBP) used as alternative for autograft in ankle and hindfoot arthrodesis. Thirty-four patients enrolled underwent ankle or hindfoot arthrodesis with β-TCP - NBP and were evaluated radiographically, clinically, and functionally up to fifty-two weeks. The primary performance endpoint was fusion rate evaluated with CT at six months. Safety was assessed based on the severity and incidence of adverse events. Functional evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and pain was recorded using the Visual Analogue Scale (VAS). CT at 6 months showed that 85.3% had osseous bridging of the joint of ≥ 25%, 52.9% ≥50%, 8.8% <25% and 5.9% showed no bridging. The AOFAS score increased significantly from 60.4 ± 17.6 points at operation to 68.6 ± 17.2 points at six months and to 73.5 ± 17.7 points at 12 months. The group with fusion rate ≥25% showed significantly higher AOFAS score than that with fusion rate < 25% at 12 months. The mean VAS pain score at rest and during weight bearing decreased significantly (p < 0.0001) from operation to six and 12 months. This study demonstrated that β-TCP - NBP is a valuable bone graft substitute for fusion of ankle and hindfoot due to debilitating osteoarthritis and offers an alternative for autograft. Level II.

Abstract TP116: Evaluation of the Clinical Efficacy of Rehabilitation Therapy Using the Complex Upper and Lower Limb Robot Gait Rehabilitation System (GTR-A) in Stroke Patient

Background and aims: Conventional approaches for stroke rehabilitation primarily involve static muscle strengthening exercises, weight bearing and shifting by therapists. Robot-assisted gait training facilitates the learning of reproducible symmetric gait patterns and reduces expenditure. The GTR-A (HUCASYSTEM, Korea), a robotic gait rehabilitation device for both upper and lower limbs, utilizes end-effector-based movement and provides training to enhance gait function. In this study, we aim to elucidate the clinical efficacy of rehabilitation therapy using GTR-A in subacute/chronic stroke patients. Methods: This study was a prospective, randomized, controlled clinical trial. There were 14 participants in total, with 7 in each of the experimental and control groups (table. 1). The gait abilities were evaluated using the berg balance scale (BBS), 6-minute walk test (6MWT) and cardiopulmonary exercise testing. Over period of 4 weeks, the experimental group underwent 10 sessions of robot-assisted rehabilitation for 30minutes/day, 3times/week in addition to conventional physical therapy for 30min/day, 5times/week. The control group received 10 sessions of only conventional physical therapy for 60minutes/day, 5times/week. Results: In the experimental group, significant improvements were observed in both BBS and 6MWT. However, there was no significant increase in maximal oxygen consumption. In contrast, the control group did not show significant functional improvements (table. 2). Conclusion: The combination of conventional rehabilitation therapy and robotic gait training using GTR-A showed superior outcomes in the recovery of gait function compared to conventional therapy alone.

Responses of skeletal muscle to mechanical stimuli in female rats following and during muscle disuse atrophy.

The purpose of this study was to investigate the ability of mechanotherapy to enhance recovery or prevent loss of muscle size with atrophy, in female rats. Female F344/BN rats were assigned to weight bearing (WB), hindlimb suspended (HS) for 14 days with reambulation for 7 days without (RA) or with (RAM) mechanotherapy (study 1), or to WB, HS for 7 days, with (HSM) or without mechanotherapy (study 2) to gastrocnemius. Muscle fiber cross sectional area (CSA) and type, collagen, satellite cell number, and protein synthesis (Ksyn) and degradation (Kdeg) were assessed. Study 1: muscle weight, but not CSA, was higher in RAM compared to HS, but CSA was higher in RA compared to HS. Myofibrillar Ksyn was higher in RA and RAM compared to WB and HS, but not different between RA and RAM. Myofibrillar Kdeg was lower with mechanotherapy compared to HS. Study 2: muscle weight, CSA, and myofibrillar Ksyn and Kdeg were not different with mechanotherapy. Collagen content was lower with mechanotherapy, but collagen Ksyn was not. Mechanotherapy was not associated with changes in fiber type, satellite cell or myonuclear number in either study. Compared to male, female rats had less muscle loss with HS, which was associated with less loss of myofibrillar Ksyn. Recovery from atrophy was associated with higher Ksyn in female and lower Kdeg in male rats. Conclusion: Female rat muscles do not exhibit a growth response to mechanotherapy with disuse or reambulation. Furthermore, male and female rats show distinct responses to different mechanical stimuli.

Exposed digits increase weight bearing and alter sub-bandage pressures in dogs with forelimb splints.

The goal of this study was to evaluate the difference in weight bearing in a toes-in splint versus a toes-out forelimb splint and to determine the difference in sub-bandage pressures between the groups. We hypothesized that (1) weight bearing would not be different between the 2 splints and that (2) sub-bandage pressures would be distributed higher on the distal digits in the toes-out splint and pressures would be more evenly distributed across the paw in the toes-in splint. In this controlled crossover trial, a random forelimb of 10 healthy dogs was bandaged with a splint that left the digits exposed and again with a splint that encompassed the digits. The ground reaction forces and the difference in sub-bandage pressures between 2 sensor sections were compared between the toes-in and toes-out bandages. The mean (SD) of peak vertical force was 26.76% (11.86%) for the toes-in bandage and 49.85% (9.21%) for the toes-out bandage. The mean (SD) sub-bandage pressure differences between sections were -121.28 (138.28) mm Hg and 130.32 (116.40) for toes-in and toes-out bandages, respectively (P = .001). This remained significant even after weight bearing was removed as a factor (P < .001). Leaving the distal aspect of digits 3 and 4 exposed by a splint results in better weight bearing, but also creates a sub-bandage pressure increase on the toes relative to the rest of the paw. These results suggest that splint placement should be adjusted based on the needs of each patient.

Early weight bearing is not associated with short-term complications in ankle fractures.

Ankle fractures are common injuries and post-operative protocols continue to vary. We aim to compare postoperative complications between early weight bearing (EWB), intermediate weight bearing (IWB), and delayed weight bearing (DWB) in adult patients with isolated ankle fractures treated with open reduction internal fixation (ORIF). This retrospective cohort study includes 233 adult patients with isolated (medial malleolar, lateral malleolar, posterior malleolar, bimalleolar equivalent) or complex (trimalleolar, trimalleolar equivalent, bimalleolar, and Maisonneuve) ankle fractures treated with ORIF between 2020 and 2022 at a level I trauma center. Patients were weight bearing postoperatively at < 3 weeks (EWB), 3-6 weeks (IWB), or > 6 weeks (DWB). Main outcome measurements include rates of complications requiring reoperation and minor complications. Thirty-one and eight tenths percent (74/233) were EWB, 25.8 % (60/233) were IWB, and 42.5 % (99/233) were DWB. 73.0 % of patients (170/233) had complex fractures, and 27.0 % (63/233) had isolated malleolar fractures. 16.3 % of patients (38/233) developed complications, with 7.7 % (18/233) requiring reoperation. We found no differences in overall complications (14.86 % vs. 11.67 % vs. 20.20 %; p = 0.3396) or complications requiring reoperation (9.46 % vs. 3.33 % vs. 9.09 %; p = 0.3337) among the weight bearing groups for all fractures. Between the complex fracture group and the isolated malleolar fracture group, there were no differences in overall complications (7.94 % vs. 19.41 %; p = 0.0566) or complications requiring reoperation (9.41 % vs. 3.17 %; p = 0.1664). There is not statistical significance between timing to weight bear and complications in ankle fractures treated with ORIF. Level of Evidence: Level 3.

Do Cementless, Collared Stems Prevent Aseptic Loosening, Subsidence, and Periprosthetic Fracture in Total Hip Arthroplasty?

Modern total hip arthroplasty (THA) is one of the most common and successful orthopedic procedures performed, utilizing a variety of fixation methods, stem geometry and designs to provide immediate post-operative weight bearing. The purpose of this study was to determine the incidence of intraoperative periprosthetic fractures, subsidence rates and aseptic loosening between collared stems compared with non-collared tapered stems during THA. A retrospective chart review identified 983 THA cases performed by a single surgeon between 2013-2021. The average length of follow up was 1.5 years with an average duration of 533 d between initial and follow radiographs. Intraoperative fractures, subsidence and aseptic loosening were identified through chart review and X-rays. Chi square test, t-test, and descriptive statistics were conducted for both cohorts to determine statistical significance. There were 9 (2.05%) reports of intraoperative fractures in the collarless cohort and 3 (0.55%) reports of intraoperative fractures in the collared cohort. Subsidence values for those who received collarless stems ranged from 0-4.2 mm and had an average value of 0.59 mm. Those who received collared stems had subsidence values that ranged between 0-2.2 mm with an average of 0.23 mm. Patients who received collared stems had fewer incidences of intraoperative fracture within the first two weeks of surgery. Additionally, those who received collared stems had an average subsidence value of 0.23 mm, which was significantly less compared with those who received non-collard tapered stems with an average subsidence value of 0.59 mm. Utilizing cementless collared stems is beneficial in decreasing the rate of intraoperative fracture without increasing the rate of subsidence or loosening.

Human Collaborative Control of Lower-Limb Prosthesis Based on Game Theory and Fuzzy Approximation.

For leg prosthesis user, the soft tissue and skin under the stump of are not accustomed to weight bearing, excessive continuous contact pressure can lead to the risk of degenerative tissue ulceration. This article presents a novel human-robot collaborative control scheme that achieves control weight self-adjustment for robotic prostheses to minimize interaction torque. To establish the human-robot interaction relationship, we regard the contact pressure between human residual limb and the prosthetic receiving cavity as the interaction force. We aim at reducing the interaction force under the premise of minimally changing the original motion trajectory of the robotic prosthesis. The control scheme mainly includes trajectory optimization based on a dual-agent game control scheme under a cooperative relationship, and a fuzzy logic system for improving the control accuracy of trajectory tracking of robotic prostheses with unknown dynamic parameters. Experiments were carried out on two amputee participants to verify the proposed human-robot interactive control scheme in a robotic prosthesis. The results show that the interaction torque could be reduced while maintaining minimal trajectory tracking error. The proposed control scheme could potentially facilitate the dexterous manipulation of leg prostheses, thus benefiting amputees.

Functional Outcomes, Operating Time, Bleeding Rate and Weight Bearing in Short Vs Long PFNA in IT Femur Fracture

Objective: In order to manage intertrochanteric (IT) femur fractures, this study compares the functional outcomes, operating time, bleeding rate, and weight-bearing capability using short and long proximal femoral nail antirotation (PFNA). Methods: Patients who received PFNA for IT femur fractures between April and September of 2024 were the subjects of a retrospective investigation. Based on the length of the PFNA used, sixty patients were split into two groups: thirty received a short PFNA and thirty received a long PFNA. The time it took to reach full weight-bearing, operating time, intraoperative bleeding rate, and functional results as measured by the Harris Hip Score (HHS) at 6 and 12 weeks were among the important factors assessed. A statistical analysis was performed on the data to identify any noteworthy variations between the two groups. Results: There were 60 patients in the trial; 30 were in the long PFNA group and 30 were in the short PFNA group. The short PFNA group had an average operating duration of 45 minutes, which was considerably less than the long PFNA group's 65 minutes (p&lt;0.05). The short PFNA group experienced a considerably lower intraoperative blood loss (average of 140 ml) than the long PFNA group (average of 210 ml) (p&lt;0.05). The HHS's measure of functional outcomes showed no statistically significant difference in scores at 12 weeks (p=0.65) between the two groups. There was no discernible difference in the recovery period between the two groups' average time to reach full weight-bearing, which was 8 weeks. The lengthy PFNA group had slightly fewer complications, such as fixation failure, but the difference was not statistically significant (p=0.58). Conclusion: Reduced operating time and less intraoperative bleeding are two benefits of short PFNA, without sacrificing weight-bearing ability or functional results. While both short and long PFNA offer comparable functional outcomes, addressing IT femur fractures may benefit more from short PFNA's potential for greater effectiveness and safety. Additional investigation, including prospective studies, is important to corroborate these results and evaluate enduring consequences.

Preoperative difference between 2D and 3D planning correlates with difference between planned and achieved surgical correction in patient-specific instrumented total knee arthroplasty.

The goals of this study were (1) to assess whether the preoperative difference between modalities and extent of deformity are associated with a higher difference between planned and achieved surgical correction and (2) if they yield a higher probability of intraoperative adjustments. Retrospective single-centre analysis of patients undergoing patient-specific instrumented (PSI) total knee arthroplasty (TKA). Preoperative radiographic parameters were analysed on weightbearing (WB) long-leg radiographs (LLR) and nonweightbearing (NWB) computed tomography (CT). The 2D/3D difference was calculated as the difference between preoperative WB-LLR (2D) hip-knee-ankle angle (HKA), and NWB CT (3D) HKA. Surgical records were screened to retrieve intraoperative adjustments to the preoperative plan. Postoperative assessment was performed on WB LLR. Two-hundred-eighty-two knees of 263 patients were analysed. The difference of postoperative achieved to planned HKA (HKADifference) was 2.2° ± 1.7°. The preoperative 2D HKA showed the highest correlation with HKADifference (r = -0.37, 95% confidence interval [CI]: -0.48 to -0.26, p < 0.001). Intraoperative adjustments were performed in 60% (n = 170) of all knees. Patients with a preoperative coronal deformity of >7.8° had 10.55 higher odds for an intraoperative coronal adjustment (95% CI: 4.60-24.20, p < 0.001). The extent of deformity is associated with residual coronal deformity following PSI-TKA. Patients with extensive coronal malalignment may benefit from an adaptation of the preoperative surgical plan to avoid unintended postoperative coronal malalignment. Despite the advancements with 3D preoperative planning, intraoperative adjustments in PSI-TKA are frequently performed, in particular in patients with a higher preoperative varus/valgus deformity. Level III.

Minimally invasive screw fixation of the anterior pelvic ring and the distal ilium : Tips and tricks to be successful.

Minimally invasive percutaneous techniques are used to stabilize fractures of the anterior pelvic ring. Stabilization of the fracture facilitates early mobilization and rehabilitation, while percutaneous techniques reduce complications such as infection and bleeding. Indicated for patients with non- or minimally displaced fractures of the anterior pelvic ring, or if fracture displacement can be reduced using minimally invasive techniques. Contraindications include infection at the surgical site, anatomical inability to place screws, or patients unfit for surgery due to health risks. The technique involves the insertion of ante- and retrograde transpubic screws and lateral compression (LC)II screws in supine position. Precise reduction of fractures is achieved using minimally invasive techniques. In younger patients, partial weight bearing for 6weeks is recommended, with full weight bearing in older patients. Literature reports ahigh union rate of up to 95% for these procedures, with low rates of nonunion and infection (around 2%). Screw loosening or loss of reduction occurs in 8-18% of cases, with better outcomes using bicortical screws.

Acute systemic macrophage depletion in osteoarthritic mice alleviates pain-related behaviors and does not affect joint damage

BackgroundOsteoarthritis (OA) is a painful degenerative joint disease and a leading source of years lived with disability globally due to inadequate treatment options. Neuroimmune interactions reportedly contribute to OA pain pathogenesis. Notably, in rodents, macrophages in the DRG are associated with onset of persistent OA pain. Our objective was to determine the effects of acute systemic macrophage depletion on pain-related behaviors and joint damage using surgical mouse models in both sexes.MethodsWe depleted CSF1R + macrophages by treating male macrophage Fas-induced apoptosis (MaFIA) transgenic mice 8- or 16-weeks post destabilization of the medial meniscus (DMM) with AP20187 or vehicle control (10 mg/kg i.p., 1x/day for 5 days), or treating female MaFIA mice 12 weeks post partial meniscectomy (PMX) with AP20187 or vehicle control. We measured pain-related behaviors 1–3 days before and after depletion, and, 3–4 days after the last injection we examined joint histopathology and performed flow cytometry of the dorsal root ganglia (DRGs). In a separate cohort of male 8-week DMM mice or age-matched naïve vehicle controls, we conducted DRG bulk RNA-sequencing analyses after the 5-day vehicle or AP20187 treatment.ResultsEight- and 16-weeks post DMM in male mice, AP20187-induced macrophage depletion resulted in attenuated mechanical allodynia and knee hyperalgesia. Female mice showed alleviation of mechanical allodynia, knee hyperalgesia, and weight bearing deficits after macrophage depletion at 12 weeks post PMX. Macrophage depletion did not affect the degree of cartilage degeneration, osteophyte width, or synovitis in either sex. Flow cytometry of the DRG revealed that macrophages and neutrophils were reduced after AP20187 treatment. In addition, in the DRG, only MHCII + M1-like macrophages were significantly decreased, while CD163 + MHCII- M2-like macrophages were not affected in both sexes. DRG bulk RNA-seq revealed that Cxcl10 and Il1b were upregulated with DMM surgery compared to naïve mice, and downregulated in DMM after acute macrophage depletion.ConclusionsAcute systemic macrophage depletion reduced the levels of pro-inflammatory macrophages in the DRG and alleviated pain-related behaviors in established surgically induced OA in mice of both sexes, without affecting joint damage. Overall, these studies provide insight into immune cell regulation in the DRG during OA.

Immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post hoc analysis

BackgroundEarly weight bearing is crucial for fracture healing after osteosynthesis for intertrochanteric fractures (ITFs). The optimal period to start weight bearing after surgery is still under debate. The aim of this study was to compare immediate weight bearing (IWB) as tolerated with delayed weight bearing (DWB) following intramedullary fixationin elderly ITF patients.MethodsThis post hoc analysis included patients aged ≥ 65 years with X-ray-confirmed ITFs who were admitted within 21 days after injury and who underwent intramedullary fixation surgery. The primary outcome was the EQ-5D score at 120 days after surgery. The secondary outcomes included the EQ-5D score at 30 days and 365 days after surgery, the complication rate and the mortality rate.ResultsAmong 410 patients (190 IWB, 220 DWB), those in the IWB group had higher EQ-5D scores at 30 (P < 0.001) and 120 days (P = 0.002) but lower scores at 365 days (P = 0.012) than did those in the DWB group. There were no significant differences in the complication rates, reoperation rates, or one-year mortality rates between the groups.ConclusionsCompared with delayed weight bearing, immediate weight bearing improves early functional outcomes without increasing the complication or mortality rates in elderly ITF patients.

Comparison of Primal Reflex Release Technique and Positional Release Therapy on Pain, Functional Ability and Ankle Range in patients with Plantar Fasciitis: An Experimental Study

Background: Plantar fasciitis (PF) is characterized by inflammation, fibrosis and structural deterioration of foot and there is pain over heel and plantar fascia. Plantar fasciitis pain is gradual in onset, sharp and diffusely located initially which later localizes to medial calcaneal tuberosity. Typically, pain is most severe in the morning which lessens with movement but intensifies with long-standing weight bearing. Plantar fasciitis has been experienced by 10% of the non-athletic population and most typically observed in weight-bearing activities. So, the aim was to study the effects of primal reflex release technique and positional release therapy on pain, functional ability and ankle range in patients with plantar fasciitis. Method: Total 36 patients were recruited for the study as per the selection criteria and were divided into two groups (18 in each group). Group A was treated with primal reflex release technique (PRRT) along with conventional therapy and Group B was treated with positional release therapy (PRT) along with conventional therapy for 7 consecutive days. Intergroup analysis by independent t-test showed statistically significant improvement in pain and functional ability (P value ≤ 0.001). Conclusion: Primal reflex release technique along with conventional therapy was found to be more predominant in improving pain and functional ability than positional release therapy along with conventional therapy. Also, Primal reflex release technique along with conventional therapy and positional release therapy along with conventional therapy were equally effective in improving ankle range of motion.

Personalizing β-TCP porous scaffolds to promote osteogenesis: a study of segmental femoral defects in beagle models

The increasing clinical occurrence of segmental bone defects is demanding constant improvements in bone transplantation to overcome issues of limited resources, immune rejection and poor structural complement. This study aimed to develop a personalized bone defect repair modality using 3D-printed tricalcium phosphate (β-TCP) grafts and to assess its osteogenic impacts in a femoral segmental defect model in beagles, as a basis for clinical studies and application. Aβ-TCP scaffold was designed and manufactured using computer-aided design. A 3 cm segmental bone defect model was established in 27 one-year-old male beagles, and were randomly divided into three groups. The control group utilizing only intramedullary fixation, the autograft group with an added autologous bone graft andβ-TCP group using aβ-TCP scaffold. The study animals were monitored for 24 weeks postoperative and assessed for vital signs, imaging, and histological indicators periodically. All of the Beagles underwent successful modeling and experimentation, and were fully ambulatory at four weeks. Postoperative x-rays showed no evidence of loosening or displacement of the intramedullary nails. Micro-CT and histological staining indicated Osteogenesis starting from the fourth week, with the most significant growth seen using autografts (P< 0.05). New bone (NB) formation is seen adhering to the surface and proximal femur after osteotomy. Theβ-TCP group had significantly more evidence of Osteogenesis when compared to the control group (P< 0.05), characterized by NB visible throughout the porous structure and distal residual femur. The control group showed bone formation impeded by fibrosis, showing poor bone growth mainly around the distal end after osteotomy, with poor overall repair outcomes.Conclusion.Growth factor-deficientβ-TCP porous scaffolds demonstrated promising Osteoinductive properties in repairing large segment bone defects in Beagles' femurs. It effectively promoted bone growth and is structurally advantageous for weight bearing long bones.

Medial Plantar Flap for Reconstruction of Heel Defect

Heel is subjected to exceed weight bearing and shearing forces. Full-thickness defects to the plantar surface of the foot present a challenge. Variety of procedures have been described for resurfacing this site, but not all achieve normal foot function. Reporting two cases, defects of the plantar surface of the heel resurfaced with medial plantar flap, an island fasciocutaneus flap and innervated, thus provide a good replacement.One patient show good result within 4 weeks, with minimal raw surface on secondary defect. While other patient didn’t show up after 2 weeks. Medial plantar flap was successfully used for heel defect reconstruction. Donor site morbidity was minimal, and patient could walk post-operatively without special devices for the heel.

Impact of lateral ankle sprains on physical function, range of motion, isometric strength and balance in professional soccer players

ObjectiveLateral ankle sprains (LASs) are prevalent in soccer and can affect long-term performance, injury recurrence and risk for chronic ankle instability. This case–control study examined functional impairments associated with LAS...

Low Pressure Sensing Characteristics of Mechanoluminescence Film with 3D Microstructure

Mechanoluminescence (ML), which is light emitting repeatedly induced by external mechanical stimuli, has received widespread attention worldwide because it has been applied to various applications [1-3]. Among different applications, pressure sensors using a composite of ML material and organic resin have superior advantages in wireless detection using light-emitting and multi-scalable applications compared with electric devices. For this interest worldwide, we have applied an ML phenomenon into the pressure sensing technique using an ML composite sheet composed of europium doped strontium aluminate (SrAl2O4:Eu) ML material and epoxy resin. As a result of evaluating the load response of the flat ML composite sheets formed on rigid acrylic plates, it was found that the load distribution on the sole due to human weight bearing can be visualized two-dimensionally with relatively high spatial resolution. However, we also found that such a simple configuration, like a flat composite film on a rigid substance, limits detection sensitivity to several hundred newtons. Here, we conceived the improvement technique in the low-pressure response of the ML composite film. It is well-known that the ML intensity is proportional to the equivalent strain and its rate. When the same load is applied to different structures, the ML intensity of a configuration with the augmentation of stress or with the stress concentration region will be higher. Thus, it could be expected that we can control the pressure sensitivity of the ML sensor by designing a surface structure of the ML composite sheet. In this study, therefore, we challenged improving low-pressure sensing characteristics with a focus on the surface geometry of the ML composite film.In our pursuit of enhancing low-pressure sensing characteristics, we embarked on an innovative approach the use of micro-sized pillar array films. These films were prepared using a thermal imprinting method with cyclo olefin polymer (COP) or laminated poly methyl methacrylate/polycarbonate (PMMA/PC) films. The micro-pillar array pattern was transferred onto these polymer films, and an ML ink consisting of a mixture of SrAl2O4:Eu ML material and epoxy resin was directly sprayed on the surface of those polymer films with micro-pillar array patterns. Before forming the ML layer on the COP film, we introduced a SiO2 interlayer using a photo-assisted chemical solution deposition (PCSD) process [4] to enhance the adhesive strength between the ML layer and COP film. The SrAl2O4:Eu ML material was synthesized by a high-temperature solid-state reaction method [5]. We then evaluated the pressure-sensing characteristics under compression testing in the load range of 0 – 90 N using the prepared ML films with different configurations.Considering the amplified mechanism of the ML intensity for the micro-pillar array film, we can predict that the ML intensity is primarily affected by the configuration of the micro-pillar arrays, such as height, width (diameter), and pillar density, as well as the elastic modulus of the base polymer. Thus, we investigated the effect of such a configuration and mechanical factors of the micro-pillar array on the pressure-sensing characteristics. As a result, we found that high height and low elastic modulus micro-pillar array exhibited the highest ML intensity and responded even to small loads of 1 N or less. This finding suggests the potential of micro-array films for high-sensitivity pressure sensing applications. To verify the amplified mechanism of the ML intensity for the micro-pillar array film, we observed cross-sectional ML images under dynamic compression tests. The cross-sectional ML distribution image showed that the micro-pillars made of soft resin (COP) were more easily deformed and exhibited higher ML intensity than micro-pillars made of hard resin (PMMA/PC). Furthermore, since bending deformation is observed as the height of the micro-pillar increases, it is concluded that soft and tall micro-pillars produce high ML intensity by more considerable deformation and bending mode.

A Retrospective Review of Revision and Re-revision Patella Osteosynthesis Performed for Failure of Fixation of Initial Comminuted Fracture Patterns: Very High Complication Rates.

Literature on revision osteosynthesis for failed patella fracture fixation is extremely limited. This study reviews the treatment options and outcomes for revision and re-revision osteosynthesis at a Level 1 trauma center. All patella revision osteosynthesis cases between January 2021 and March 2024 were identified using Current Procedural Terminology codes at a single tertiary care academic center. Medical records, operative reports, and radiographs were reviewed to collect details regarding patient demographics, initial injury and fracture management, indications for revision surgery, revision construct, postoperative weight bearing and range-of-motion restrictions, and outcomes. The primary outcome was major failure defined as loss of fixation or further surgery for nonunion or infection. Ten patients underwent revision osteosynthesis for failed fixation. All fractures were initially comminuted fracture patterns (AO/OTA 34-C3), with nine (90%) initially treated with a 2.7-mm patella-specific variable angle locking plate (Synthes, Paoli, PA). Half (n = 5) of the patients were revised with the same patella-specific plate and half with an all suture transosseous fibertape tension band (Arthrex, Naples, FL). Additional fixation in the form of bony augmentation was performed in 20% (n = 2) of cases and soft tissue augmentation in 70% (n = 7). There was a 70% (n = 7) major failure rate, mostly due to loss of inferior pole fixation. There were four re-revision procedures performed with surgical fixation. Two of these subsequently developed infection, one united and the other had no radiographic signs of union and was lost to follow-up, but was without complication. Regardless of the chosen fixation construct, revision osteosynthesis for failed fixation of initial comminuted fracture patterns has an extremely high rate of failure. Complications increase with further revision surgery. Level of evidence: therapeutic level 3.

Permissive weight bearing versus restrictive weight bearing in surgically treated trauma patients with displaced intra-articular calcaneal fractures (the PIONEER study): study protocol for a multicenter randomized controlled trial

BackgroundFollowing successful treatment, displaced intra-articular calcaneal fractures (DIACFs) necessitate an extensive rehabilitation regimen, significantly influencing functional and socio-economic outcomes. Apart from surgical intervention, the implementation of a comprehensive rehabilitation protocol is crucial to optimize foot stability and functional recovery. The objective of this study is to ascertain the optimal rehabilitation protocol for patients with surgically treated DIACFs, either permissive weight bearing (PWB) or Restricted Weight Bearing, focusing on functional outcomes, health-related quality of life (HRQoL), radiographic parameters, cost-effectiveness, and incidence of complications.MethodsStudy design: A prospective multicenter randomized controlled trial. Study population: Presence of surgically (extended lateral, sinus tarsi, or percutaneous approach) treated unilateral DIACFs (Sanders type II to IV), aged 18–67 years (labor force). Patients must be able to understand and follow weight bearing instructions. N = 115 patients with DIACFs will be included. Interventions: Patients with DIACFs will be randomly allocated to one of the rehabilitation protocols, either PWB or RWB. Primary outcome measure: Functional outcome, measured with the American Orthopaedic Foot & Ankle Society Score (AOFAS)). Secondary outcomes: Functional outcome (Maryland Foot Score, MFS), HRQoL (EuroQol-5D, EQ-5D), differences in radiographic parameters, cost-effectiveness, and complications. Nature and extent of burden: The PWB protocol is aimed to be non-inferior to the RWB protocol. Previous analysis of this protocol in other lower extremity fractures has shown a safe complication rate. Follow-up is standardized according to current trauma guidelines, namely at time points 2, 6, 12 weeks, and 6 months. The radiation exposure for both groups will differ from standard care (one extra CT scan of the foot will be made). Therefore, the burden for participants is considered minimal, with no significant health risks.DiscussionThis study will be the first study to define an optimal rehabilitation regime for surgically treated patients with DIACFs. The limitations of this study include the absence of patient blinding, as this is impossible in rehabilitation. Additionally, the primary outcome measure (AOFAS) has limited validity for DIACFs. However, it is the most commonly used questionnaire in the literature on DIACFs. There is an apparent need since current literature is lacking on this specific topic.Trial registrationClinicalTrials.gov NCT05721378, accepted on February 7, 2023.

Effect of Weight Bearing Exercises on Pain, Leg Function, Balance and Bone Strength in Females of Postmenopausal Age with Osteoarthritis Knee

Background/Objectives: Osteoarthritis (OA) of the knee is prevalent among postmenopausal women (PMW), impacting their quality of life. This Randomized Controlled Trial (RCT) aimed to assess the effectiveness of conventional physiotherapy combined with joint-loading exercises on stable and unstable platforms in improving knee function, muscle strength, balance, and bone mineral density - an important strength of the study - in PMW with OA. Methods: Thirty PMWs with knee OA were randomly allocated to three groups (n=10): Group A got conventional physiotherapy, Group B got conventional physiotherapy plus joint-loading exercises on a stable platform, and Group C got conventional physiotherapy plus joint-loading exercises on an unstable platform. Key tools utilized in the study included the Knee Injury and Osteoarthritis Outcome Score (KOOS), Manual Muscle Test (MMT), Timed Up and Go Test (TUGT), and Dual Energy X-ray absorptiometry (DEXA) for assessing pain, function, balance, and bone strength. The interventions lasted six weeks, with pre-and post-test assessments. Mention how the analysis was done Findings: All groups showed significant improvements in KOOS (G-A: 10.9%, G-B: 18.0%, G-C: 9.3%), MMT (G-A: 3.4 to 4.2, G-B: 3.4 to 4.6, G-C: 3.5 to 4.6), TUGT (G-A: 7.5%, G-B: 6.1%, G-C: 9.9%) and DEXA (G-A at -0.077 ± 0.4, G-B at 0.225 ± 0.5, and G-C at -0.246 ± 0.5) no significant differences were found between groups, though G- B showed the highest improvements. Novelty: While all interventions effectively improved knee function, muscle strength, and balance in PMW with OA, joint-loading exercises on a stable platform demonstrated the greatest benefits. Keywords: Osteoarthritis, Postmenopausal Women, Physiotherapy, Joint-loading exercises, Muscle Strength, Balance