Flexion-lateral curvature-supination reduction for treatment of lower cervical dislocation with unilateral facet interlocking / 中华创伤骨科杂志

Objective:To investigate the efficacy of flexion-lateral curvature-supination reduction combined with primary anterior surgery for the treatment of lower cervical dislocation with unilateral facet inter-locking.Methods:A retrospective analysis was performed in the 32 patients who had been admitted to Department of Spine Surgery, Honghui Hospital for lower cervical dislocation with unilateral facet interlocking from November 2015 to October 2018. According to their treatments, they were divided into 2 groups. In the emergency group treated by flexion-lateral curvature-supination reduction combined with primary anterior surgery, there were 13 males and 3 females, aged from 24 to 63 years. In the traction group treated by cranial traction reduction combined with secondary anterior surgery, there were 12 males and 4 females, aged from 20 to 64 years. The operation time, intraoperative blood loss, hospital stay, bone graft fusion, American Spinal Injury Association (ASIA) grade and Japanese Orthopaedic Association (JOA) score were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P<0.05). All patients were followed up from 26 to 40 months. The hospital stay for the emergency group [(7.2±1.2) d] was significantly shorter than that for the traction group[(10.9±1.2) d] ( P<0.05). There was no significant difference in the operation time, blood loss, ASIA grade or JOA score between the 2 groups ( P>0.05). All patients achieved osseous fusion of intervertebral space. Conclusion:Compared with traditional methods, flexion-lateral curvature-supination reduction combined with primay anterior surgery shows no significant difference in the recovery of neurological function but leads to a shorter hospital stay.

Morphological and biomechanical implications of cuboid facet of the navicular bone in the gait / Implicaciones morfológicas y biomecánicas de la faceta cuboídea del navicular en la marcha

The cuboid facet of the navicular bone is an irregular flat surface, present in non-human primates and some human ancestors. In modern humans, it is not always present and it is described as an "occasional finding". To date, there is not enough data about its incidence in ancient and contemporary populations, nor a biomechanical explanation about its presence or absence. The aim of the study was to evaluate the presence of the cuboid facet in ancient and recent populations, its relationship with the dimensions of the midtarsal bones and its role in the biomechanics of the gait. 354 pairs of naviculars and other tarsal bones from historical and contemporary populations from Catalonia, Spain, have been studied. We used nine measurements applied to the talus, navicular, and cuboid to check its relationship with facet presence. To analyze biomechanical parameters of the facet, X-ray cinematography was used in living patients. The results showed that about 50 % of individuals developed this surface without differences about sex or series. We also observed larger sagittal lengths of the talar facet (LSAGTAL) in navicular bones with cuboid facet. No significant differences were found in the bones contact during any of the phases of the gait. After revising its presence in hominins and non-human primates, and its implication in the bipedalism and modern gait, we suggest that cuboid facet might be related with the size of talar facet and the position of the talonavicular joint. However, other factors such as geographical conditions, genetics and stressful activities probably affect its presence too.

La faceta cuboídea del hueso navicular es una carilla plana e irregular, presente en primates no humanos y en algunos de nuestros ancestros. En humanos modernos, no siempre está presente y es descrita como "un hallazgo ocasional" por la bibliografía. Hasta la fecha, no hay suficientes datos acerca de su incidencia en poblaciones antiguas y contemporáneas, ni una explicación biomecánica sobre su presencia o ausencia. El objetivo de nuestro estudio fue evaluar la frecuencia de la faceta cuboídea en poblaciones recientes y antiguas, su relación con las dimensiones de los huesos tarsales y su rol en la biomecánica de la marcha. Fueron estudiados 354 pares de naviculares y otros huesos del tarso provenientes de colecciones osteológicas de Cataluña, España. Aplicamos nueve medidas aplicadas al talus, navicular y cuboides para corroborar su relación con la presencia de la faceta. Para analizar sus parámetros biomecánicos, se empleó X-ray cinematography en pacientes hospitalarios. Los resultados mostraron que alrededor de un 50 % de los individuos desarrollaron esta carilla, sin diferencias entre sexos o series. Además, observamos que la longitud sagital de la faceta talar (LSAGTAL) es mayor en aquellas muestras con faceta cuboídea. No hay diferencias significativas en el contacto de los huesos en ninguna de las fases de la marcha. Después de revisar su presencia en primates no humanos, su implicancia en el bipedismo y en la marcha moderna, sugerimos que la faceta cuboídea podría estar relacionada con el tamaño de la faceta talar y la posición de la articulación talo-navicular. Sin embargo, otros factores como las condiciones geográficas, genética y stress ocupacional también podrían afectar su presencia.

Rare variants of Bosworth fracture-dislocation: Bosworth fracture-dislocation with medial malleolus adduction type fracture / 中华创伤杂志(英文版)

Bosworth ankle fracture-dislocation is rare, known to be an irreducible type of ankle injury, with a high incidence of complication. We present two cases of even rarer variants of Bosworth ankle fracture-dislocation. The first case is a type of supination external rotation adduction, and the second case is a type of supination external rotation adduction. These types have not been described before. In both of the cases we failed to achieve close reduction, and therefore proceeded with emergency surgeries, with open reduction and internal fixation. Both of the cases were performed with a postero-lateral approach to reduce the dislocations, and fix the fractures successfully. Unfortunately in one of the cases, acute compartment syndrome developed post-surgically. However, both cases showed good functional outcomes.

Early and mid-term results of transarticular external fixation in the treatment of supination-external rotation type IV equivalent ankle fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To investigate the early and mid-term results of open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no deltoid ligament repair (DLR) in the treatment of supination-external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B 3.1) and provide evidence for clinical practice.</p><p><b>METHODS</b>This study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014. There were 13 males and 9 females, mean age 38.9 years (range, 17-73 years). Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents (11 cases), falling from height (6 cases) and sports injuries (5 cases). The mean period of hospitalization was 9.8 days (range, 6-14 days). For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8-10 weeks. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 56.86 ± 4.400, the Medical Outcomes Short Form 36-item (SF-36) questionnaire score was 57.41 ± 4.102 and the visual analog score (VAS) was 5.50 ± 1.058. Patients' main complaints about inconvenience of daily life were also recorded.</p><p><b>RESULTS</b>All the 22 patients were followed up for 24-63 months (mean, 33.6 months). None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 ± 5.096, 79.59 ± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data (t = 26.221, p < 0.001; t = 11.910, p < 0.001; t = 11.571, p < 0.001). The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients' main complaints were inconvenience of clothing (17 cases) and extremity cleaning (5 cases).</p><p><b>CONCLUSION</b>In the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satisfactory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.</p>

Where Is the Ulnar Styloid Process? Identification of the Absolute Location of the Ulnar Styloid Process Based on CT and Verification of Neutral Forearm Rotation on Lateral Radiographs of the Wrist

BACKGROUND: The location of the ulnar styloid process can be confusing because the radius and the hand rotate around the ulna. The purpose of this study was to identify the absolute location of the ulnar styloid process, which is independent of forearm pronation or supination, to use it as a reference for neutral forearm rotation on lateral radiographs of the wrist. METHODS: Computed tomography (CT) images of 23 forearms taken with elbow flexion of 70° to 90° were analyzed. The axial CT images were reconstructed to be perpendicular to the distal ulnar shaft. The absolute location of the ulnar styloid process in this study was defined as the position of the ulnar styloid process on the axial plane of the ulnar head relative to the long axis of the humeral shaft with the elbow set in the position for standard lateral radiographs of the wrist. To identify in which direction the ulnar styloid is located on the axial plane of the ulnar head, the angle between “the line of humeral long axis projected on the axial plane of the ulna” and “the line passing the center of the ulnar head and the center of the ulnar styloid” was measured (ulnar styloid direction angle). To identify how volarly or dorsally the ulnar styloid should appear on the true lateral view of the wrist, the ratio of “the volar-dorsal diameter of the ulnar head” and “the distance between the volar-most aspect of the ulnar head and the center of the ulnar styloid” was calculated (ulnar styloid location ratio). RESULTS: The mean ulnar styloid direction angle was 12° dorsally. The mean ulnar styloid location ratio was 1:0.55. CONCLUSIONS: The ulnar styloid is located at nearly the ulnar-most (the opposite side of the humerus with the elbow flexed) and slightly dorsal aspects of the ulnar head on the axial plane. It should appear almost midway (55% dorsally) from the ulnar head on the standard lateral view of the wrist in neutral forearm rotation. These location references could help clinicians determine whether the forearm is in neutral or rotated position on an axial CT/magnetic resonance imaging scan or a lateral radiograph of the wrist.

Does Excision of Heterotopic Ossification of the Elbow Result in Satisfactory Patient-Rated Outcomes?

Introduction: Treatment of heterotopic ossification (HO) of the elbow is challenging and fraught with complications. Patients who sustain direct trauma to the elbow joint, the central nervous system, and thermal burns are at increased risk for development of HO. There is a paucity of studies and reports on patient’s self-evaluation after the excision of the heterotopic ossification. Materials and Methods: This retrospective study assessed outcomes after excision of heterotopic ossification around the elbow in a cohort of ten patients operated from 2012 to 2015. The outcome assessment was done by the Mayo Elbow Performance index (MEPI) and the American Shoulder and Elbow Surgeons-Elbow score (ASES-E scores). Results: The mean follow-up was 18.11 months after the operation. The Mayo Elbow Performance Score was excellent in two elbows, good in six and fair in two. The mean gain in flexion-extension arc after excision of HO was 80 degrees. All of the patients had residual flexion deformity postoperatively. Eight of the nine patients were able to do activities requiring flexion at final follow-up. Conclusion: Excision of HO around the elbow is associated with satisfactory patient-rated outcomes in spite of failure to regain full range of motion.

Relationship of age and type of obstetric brachial plexus paralysis in forearm pronosupination / Relação entre a idade e o tipo de paralisia obstétrica do plexo braquial com o movimento de pronossupinação do antebraço

ABSTRACT Objective: To evaluate the arc of forearm pronosupination of patients with sequelae of birth paralysis and correlate with these variables. Methods: 32 children aged between 4 and 14 years with total or partial lesions of the , brachial plexus were evaluated; measurements of pronation and supination, active and passive, were made, both on the injured side and the unaffected side. Results: A statistically significant difference was observed between the injured side and the normal side, but there was no difference between the groups regarding age or type of injury. Conclusion: The age and type of injury did not impact on the limitation of the forearm pronosupination in children with sequelae of birth paralysis.

RESUMO Objetivo: Avaliar o arco de pronossupinação do antebraço dos pacientes com sequela de paralisia obstétrica do plexo braquial e correlacionar com essas variáveis. Métodos: Foram avaliadas 32 crianças entre 4 e 14 anos, com lesões totais ou parciais do plexo braquial, foram tiradas as medidas de pronação e supinação, ativa e passiva, tanto do lado lesionado quanto do lado não afetado. Resultados: Observou-se diferença estatisticamente significativa entre o lado lesionado e o lado normal, porém não houve diferença entre os grupos por faixas etárias, nem quanto ao tipo de lesão. Conclusão: Os fatores idade e tipo de lesão não tiveram efeito sobre a pronossupinação nas crianças portadoras de sequela de paralisia obstétrica do plexo braquial.

The Radial Bow following Square Nailing in Radius and Ulna Shaft Fractures in Adults and its Relation to Disability and Function

One of the points made against nailing in radius and ulna shaft fractures has been the loss of radial bow and its impact on function. The aims of the study were to assess the change in magnitude and location of the radial bow in radius and ulna shaft fractures treated with intramedullary square nails and to assess the impact of this change on functional outcome, patient reported disability and the range of motion of the forearm. We measured the magnitude of radial bow and its location in the operated extremity and compared it to the uninjured side in 32 adult patients treated with intramedullary square nailing for radius and ulna shaft fractures at our institute. The mean loss of magnitude of maximum radial bow was 2.18 mm which was statistically significant by both student-T test and Mann-Whitney U test with p value less than 0.01. The location of maximum radial bow shifted distally but was statistically insignificant. The magnitude of maximum radial bow had a negative correlation with DASH score that was statistically insignificant (R=- 0.22, p=0.21). It had a positive, statistically significant correlation to the extent of supination in the operated extremity (R = 0.66, p = 0.0004). A loss of up to 2mm of radial bow did not influence the functional outcome as assessed by criteria reported by Anderson et al. The magnitude of radial bow influenced the supination of the forearm but not the final disability as measured by DASH score. Intramedullary nailing did decrease the magnitude of radial bow but a reduction of up to 2mm did not influence the functional outcome.

Síndrome da Morte Súbita Infantil em Pelotas de 2006 a 2013: uma análise descritiva / Sudden Infant Death Syndrome in Pelotas from 2006 to 2013: a descriptive analysis

Introdução e objetivo: A Síndrome da Morte Súbita Infantil (SMSI) ocupa a oitava posição entre as causas de anos potenciais de vida perdidos e as primeiras posições como causa de mortalidade infantil pós-neonatal em países desenvolvidos. O presente estudo objetiva conhecer as características socioepidemiológicas das crianças que foram a óbito por SMSI no município de Pelotas. Métodos: Estudo observacional, retrospectivo, descritivo baseado nos dados da Secretaria Municipal de Saúde, coletados através da aplicação de Fichas de Investigação de óbitos padronizadas pelo Ministério da Saúde de todos os casos de SMSI que ocorreram do ano de 2006 a 2013 em Pelotas/RS. Resultados: Houve 37 óbitos registrados no período, o que representa um coefi ciente de mortalidade por SMSI de 1,5 por mil. A média de idade materna foi de 23,5 anos (dp=5,2), 29 (78%) eram fumantes e 23 (62%) concederam aleitamento materno exclusivo até a data do óbito, 28 (76%) tiverem seus bebês nascidos a termo. Dentre os 37 casos, 16 (43%) vieram a falecer com menos de 1 mês de vida, 26 (70%) dormiam junto aos pais e 23 (61%) em decúbito lateral, enquanto que apenas 2 (5%) em decúbito ventral e 16 (43%) dos casos de SMSI ocorreram durante o inverno. Conclusão: O presente estudo é o único que abrange tamanha amostra (37 casos) de SMSI na cidade de Pelotas, a qual apresenta um coefi ciente de mortalidade por essa patologia semelhante aos mais altos encontrados na literatura. Portanto, políticas públicas que visem à prevenção de SMSI em Pelotas são necessárias.

Introduction and aim: Sudden Infant Death Syndrome (SIDS) ranks eighth among the causes of potential years of life lost and is among the leading causes of post-neonatal infant mortality in developed countries. This study aimed to evaluate the social and epidemiological characteristics of children who died of SIDS in the city of Pelotas. Methods: An observational, retrospective, and descriptive study based on Municipal Health Department data collected by applying Research Sheets standardized by the Ministry of Health to all cases of SIDS occurring from 2006 to 2013 in Pelotas, South Brazil. Results: A total of 37 deaths were recorded in the studied period, placing the SIDS mortality rate at 1.5 per thousand. The mean maternal age was 23.5 years (SD = 5.2), 29 (78%) were smokers, 23 (62%) granted exclusive breastfeeding until the date of death, 28 (76%) had term infants. From the 37 cases, 16 (43%) died under 1 month of age, 26 (70%) were sleeping with their parents, and 23 (61%) in the lateral position, while only 2 (5%) in the prone position, and 16 cases (43%) of SIDS occurred during the winter. Conclusion: This study is the only one that covers such sample (37 cases) of SIDS in the city of Pelotas, whose mortality rate from this disorder is close to the highest in the literature. Therefore, public policies for the prevention of SIDS in Pelotas are required.

Treatment of gradeⅡsupination adduction ankle fractures with impaction of tibial plafond using double-plate fixation / 天津医药

Objective To evaluate the effect of double-plate treatment on grade Ⅱsupination adduction ankle frac? tures with impaction of tibial plafond. Methods A total of 17 patients of gradeⅡsupination adduction ankle fractures with impaction of tibial plafond were treated surgically in our hospital. Anteromedial approach to the medial malleolus was taken to expose the tibial plafond and the vertical medial malleolus fractures. One distal radius plate was placed on the anteromei?dal tibial plafond, and another buttress plate was placed on the medial malleolus. Bone grafting was used to restore the height of the collapsed tibia. Lateral malleolus fractures were treated with reconstruction plate. The fracture union after operation was detected by X-ray examination. American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score was used to assess the ankle function. Results Sixteen of 17 patients were followed up postoperatively for a mean period of 2.6 ± 0.9 years. CT cross-sectional study found that the collapsed articular surface of 12 (70.6%) patients was mainly located in the an?teromedial one-fourth area, with the worst at anterior margin. Bony fusion was achieved in all patients after an average peri?od of 2.9±0.5 months. No internal fixation loosening or fracture redisplacement was found by X-ray. The average range of an?kle joint activity was 16.4°±2.8° for dorsiflexion, and was 39.2°±5.3° for plantarflexion. According to AOFAS ankle hindfoot scale, ankle function was excellent in 14 patients and good in 2, with excellence rate of 100%. Conclusion The application of double-plate fixation to treat gradeⅡsupination adduction ankle fractures with impaction of tibial plafond can play a key role in reducing fracture redisplacement and osteoarthritis.

Pronation versus supination maneuvers for the reduction of radial head subluxation：A Meta-analysis / 中国组织工程研究

BACKGROUND:Supination maneuver is mainly used for reduction of radial head subluxation in children, but recently, pronation maneuver has also achieved good results in the treatment of radial head subluxation. OBJECTIVE:To objectively evaluate the efficacy of pronationversus supination maneuvers for the reduction of radial head subluxation by using Meta-analysis. METHODS:PubMed, Cochrane Central Register of Controled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from database establishment to December 2014 for colecting the randomized controled trials (RCTs) about pronationversus supination maneuvers for the reduction of radial head subluxation, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction were conducted by two reviewers independently. Meta-analyses were performed by using the RevMan 5.2 software. RESULTS AND CONCLUSION:Five studies involving 436 patients were included. The results of Meta-analyses showed that: compared with the supination maneuvers group the pronation maneuvers group had a higher rate of successful reduction at the first attempt [RR=1.17, 95%CI (1.08, 1.28),P=0.000 3] and lower rate of failed reduction [RR=0.25, 95%CI(0.09, 0.65),P=0.005]. There was no significant difference in the rate of successful reduction at the second attempt [RR=1.39, 95%CI (0.75, 2.58),P=0.30]. Based on the results of systemic assessment, the level of evidence assessed by the GRADE system showed that the outcome indicators of the rate of successful reduction at the first attempt and rate of failed reduction were graded as intermediate level; the outcome indicator of the rate of successful reduction at the second attempt was graded as low level. For the poor quality of the original studies, a prudent choice is suggested; and more highly-quality, large-sample studies are needed.

Clinical comparative study of two different surgical techniques for supination external rotation trimalleolar fractures / 国际外科学杂志

Objective To assess the outcomes of the surgical treatment of supination external rotation trimalleolar fractures,comparing the techniques of lateral plating and antiglide plating as described previously.Methods This is a retrospective review.A total of 31 patients meeting our inclusion criteria,with supination external rotation trimalleolar fractures surgically treated between 2009 and 2011,were studied.17 patients were treated with antiglide plating,whereas the remaining 14 patients underwent traditional lateral plating.They were followed up by a period ranging from 14 to 38 months(average,26 months).The functional results were evaluated with olerud and molander scoring system described previously.All the data including time to surgery,operating room time,tourniquet time,hospital stay and ankle joint function scores,were respectively analyzed in accordance with the complete randomized design t-test.Results There was no statistically significant in time to surgery,operating room,tourniquet time,hospital stay and ankle joint functional scores.Conclusions The outcome of the surgical management of supination external rotation trimalleolar fracture is comparable with both techniques.Our data do not support one technique over the other.

Análise das forças de reação do solo durante a marcha de indivíduos sadios com e sem uso de calcanheiras corretivas / Ground reaction forces analyses during the gait of healthy individuals with and without the use of a calcaneus insole

O pé constitui a base de apoio e propulsão para a marcha. É conhecido que a supinação e a pronação excessiva ou prolongada podem alterar a mecânica da marcha. Assim, o uso de calcanheiras corretivas para o desvio do calcâneo (valgo/varo) tem sido recomendado. Objetivo: Deste estudo foi analisar a influência do uso de calcanheiras na marcha de indivíduos normais através da Força de Reação do Solo (FRS). Método: Participaram do estudo dez adultos (31,9 ± 6,7 anos, 65,9 ± 15,4 kg e 1,7 ± 0,1 m) sem alterações aparentes de marcha ou patologias com reflexo sobre o aparelho locomotor. Foram comparadas as seguintes condições de marcha: descalça, tênis e tênis com calcanheira. As variáveis dependentes foram as componentes vertical, médio-lateral e ântero-posterior da FRS. Para a análise estatística a ANOVA one-way com medidas repetidas no fator condição (descalço, tênis e calcanheira) foi empregada (? < 0,05). Foram reveladas diferenças estatisticamente significativas entre as condições descalço e calçado com tênis e calcanheira para a componente vertical da FRS na fase de contato inicial Fz1 (F2,59 = 3,4; p < 0,0406) e na fase de apoio terminal para a componente antero-posterior Fy2 (F2,59 = 3,63; p < 0,0332). Resultados: Esses indicam que o uso de calcanheiras aumenta o impacto vertical sobre o aparelho locomotor na fase de resposta à carga, provavelmente devido a sua maior rigidez comparada ao pé descalço ou calçado com tênis. A calcanheira alterou também o padrão de resposta da componente antero-posterior da FRS na fase de terminal do apoio, que corresponde à fase de aceleração/propulsão na marcha. Conclusão: Baseado apenas na análise das variáveis dinâmicas foi possível concluir que o uso de calcanheira não induziu aumento significativo de forças laterais que poderiam indicar redução da pronação ou supinação excessiva durante a fase de resposta à carga. O uso da calcanheira produziu efeito dinâmico significativo sobre a pronação/supinação apenas na fase propulsiva da marcha.

The foot forms the base of propulsion and balance during the gait. It is well known that excessive or prolonged pronation and supination changes the gait?s mechanical movement. Hence, the use of corrective insoles is recommended when calcaneus alterations (valgus and varun) are present. Objetive: The main purpose of this article was to analyze the effects of a calcaneus insole on normal individuals on the Ground Reaction Force variables. Method: The experiment used ten adults (31.9 ± 6,7 years, 65.9 ± 15.4 kg and 1.7 ± 0.1 m) and registered no apparent changes in gait or pathologies that have an effect on the locomotor system. The following gait conditions were analyzed and compared: barefoot, using a sport shoe, and using the sport shoe with insole. The variables analyzed were vertical, medial lateral, and anterior-posterior dynamic ground reaction forces. An ANOVA one-way was used in order to compare the three different conditions. Statisticallysignificant differences were revealed between the conditions of barefoot and sport shoe with insole for the vertical GRF during initial contact Fz1 (F2,59 = 3.4; p < 0.0406) and for the GRF anterior-posterior in the terminal stance phase Fy2 (F2,59 = 3.63; p < 0.0332). Results: These results indicated that the use of an insole increased the vertical impact on the locomotor system during the response to load phase, probably because of its greater stiffness compared to the barefoot or sport shoe trials. The insole also changed the GRF anterior-posterior during the terminal stance that corresponded with the acceleration/propulsion gait phase. Conclusion: Just based on the analysis of the dynamic variables, it was concluded that the use of insoles did not induce any significant increase in lateral forces that would indicate the reduction of excessive pronation or supination during the response load phase. The use of an insole produced a significant dynamic effect on the pronation/supination only in the propulsive gait phase.

Finite element modeling and mechanical analysis on supination-external rotation ankle injury / 医用生物力学

Objective To simulate the supination-external rotation ankle injury and establish a 3D finite element model of the ankle. Methods Based on CT images of the normal human ankle joint, the 3D model of the ankle with ligaments was established. The supination-external rotation ankle injuries with four different degrees of Lauge-Hanson were analyzed by finite element method. Distributions of the ankle joint stress and tibial articular surface pressure were obtained. Results The maximum stress was at the anterior tibiofibular ligament attachment point of the tibial under supination-external rotation loading. When the anterior tibiofibular ligament was ruptured, the maximum stress was at the interosseous membrane. After the interosseous membrane was ruptured, the high stress was at the posterior ligament of the ankle. When the posterior tibiofibular ligament was ruptured, the high stress was at the deltoid ligament. The high pressure was at the distal fibula or the rear of tibial articular surface. Conclusions The established ankle-foot 3D numerical model can be used for the mechanical analysis of supination-externalrotation ankle injury. The calculated distributions of the ankle stress and the tibial articular surface pressure were in agreement with the description of Lauge-Hanson classification.

Treatment strategies for grade Ⅱ supination adduction ankle fractures / 中华创伤杂志

Objective To explore the treatment strategies for grade Ⅱ supination adduction ankle fracture. Methods From March 2003 to September 2008, 32 patients with grade Ⅱ supination adduction ankle fractures were treated surgically. There were 21 males and 11 females, at a mean age of 44.5 years (range, 21-76 years). Three patients had open ankle fractures. Anteromedial approach to the medial malleolus was taken to expose the vertical medial malleolus fractures and tibial plafond for exploring damage to distal articular surface of the tibia and that to cartilage of the talus. Open reduction and internal fixation with impaction of the articular fragment and possible bone grafting were applied to restore the height of the collapsed tibia. Medial mallcolus fractures were anatomically reduced and the intra-articular cartilage debris removed under direct vision. Repair of the lateral ligament injuries was decided acoording to the stability of the ligament. Different internal fixation was chosen according to fracture displacement of the block size and degree of lateral malleolus fractures. Fracture union, internal fixation and osteoarthritis were detected by X-ray examination. The range of ankle motion was measured. Maryland foot score was taken to assess the ankle function.Results Twenty-three patients were followed up postoperatively for a mean period of 27.9 months ( range, 6-47 months). Two prominent screws were removed from one patient five months after operation because of loosening. Bony fusion was achieved in all patients after an average period of 2.9 months ( range, 2.3-5.1 months). X-ray examination revealed no other internal fixation loosening or osteoarthritis. The average range of motion was 13 degrees of dorsiflexion (range, 6-17 degrees) and 36 degrees of plantarflexion (range, 27-46 degrees). According to Maryland foot score, ankle function was excellent in 19 patients and good in four, with excellence rate of 100%.Conclusions Understanding injury mechanism of supination adduction ankle fracture, strengthening the diagnosis and treatment of damage of tibial plafond articular surface height, cartilage and talar articular surface cartilage can effectively reduce the incidence of complications such as osteoarthritis. Anteromedial incision allows excellent exposure of the medial tibial plafond for clearance of intra-articular cartilage pieces, recovery of distal tibial articular surface height and placement of internal fixation.

Importância da realização de radiografias em posição ortostática na avaliação inicial de pacientes com fraturas toracolombares / Importance of performing weight-bearing radiographs in the initial evaluation of patients with thoracolumbar fractures / Importancia de la realización de radiografías en posición ortostática en la evaluación inicial de pacientes con fracturas toraco-lumbares

OBJETIVO: o manejo das fraturas toracolombares estáveis é controverso, especialmente em pacientes sem déficit funcional. Este estudo questiona o motivo de ser realizada uma avaliação das imagens apenas na posição supina, uma vez que, paradoxalmente, o tratamento conservador inclui o ortostatismo precoce. O propósito deste estudo é determinar se a realização de radiografias em posição ortostática influencia na definição do tratamento dos pacientes com fraturas torácicas e lombares classificadas como tipo "A" da AO-ASIF. MÉTODOS: de janeiro de 2007 a novembro de 2008, foram avaliados pacientes portadores de fraturas torácicas e lombares por meio de radiografias em decúbito e tomografia computadorizada, visando identificar sinais de instabilidade. As fraturas classificadas radiograficamente como tipo "A" da AO-ASIF, inicialmente por tratamento conservador, foram submetidas à realização de radiografias em ortostatismo sem o colete ortótico na fase aguda e seus parâmetros radiológicos foram reavaliados. RESULTADOS: foram incluídos neste estudo 59 pacientes com fraturas toracolombares estáveis (T11 a L4), e todos toleraram o exame. A cifose vertebral aumentou 46,8 por cento. O colapso anterior aumentou 15,52 por cento. Três destes pacientes (5,1 por cento) receberam a indicação cirúrgica após radiografias em ortostatismo por apresentarem critérios de instabilidade. CONCLUSÕES: a realização das radiografias em ortostatismo mostrou-se eficiente na identificação de pacientes com instabilidade ainda não manifesta e capaz de predizer a evolução satisfatória durante o tratamento conservador, além de ser um exame diagnóstico seguro, de fácil aplicabilidade e com baixo custo. Neste estudo, um total de 5,1 por cento dos pacientes tiveram seu tratamento conservador alterado para o cirúrgico.

OBJECTIVE: the management of stable thoracolumbar fractures is controversial, especially in patients without functional deficits. This study questions the reason of doing images study only in supine position since, paradoxically, nonoperative treatment includes early orthostatism. The purpose of this study is to determine the influence of weight-bearing radiographs on defining the treatment of patients with thoracolumbar fractures classified as type "A" of AO-ASIF. METHODS: from January 2007 to November 2008, patients with thoracolumbar fractures were evaluated by radiographs in supine position and computed tomography to identify signs of instability. Fractures classified radiographically as type "A" of AO-ASIF, initially treated with nonoperative care, were submitted to weight-bearing radiographs without bracing in acute phase and their radiographic parameters were re-evaluated. RESULTS: 59 patients with stable thoracolumbar fractures (T11 to L4) were included in this study,and all of them tolerated the weight-bearing radiographs. The vertebral kyphosis increased 46.8 percent. The anterior collapse increased 15.52 percent. Three of these patients (5.1 percent) were submitted to surgical treatment after weight-bearing radiographs due to instability criteria. CONCLUSIONS: weight-bearing radiographs were efficient in identifying patients with instability not established yet. This exam is able to predict the satisfactory evolution during the nonoperative treatment and it is a safe and low cost diagnostic examination with easy applicability. In this study, a total of 5.1 percent of the patients had their treatment changed from conservative to surgical.

OBJETIVO: el manejo de las fracturas toraco-lumbares estables es controvertido, especialmente en pacientes sin déficit funcional. Este estudio cuestiona el motivo por realizarse una evaluación de las imágenes apenas en la posición supina, una vez que paradoxalmente el tratamiento conservador incluye el ortatismo precoz. El propósito de este estudio es determinar si la realización de radiografías en posición ortostática influye en la definición del tratamiento de los pacientes con fracturas torácicas y lumbares, clasificadas como tipo "A" de la AO-ASIF. MÉTODOS: de enero de 2007 a noviembre de 2008 fueron evaluados pacientes portadores de fracturas torácicas y lumbares, por medio de radiografías en decúbito y tomografía computarizada, visando identificar señales de inestabilidad. Las fracturas clasificadas radiográficamente como tipo "A" de la AO-ASIF, inicialmente de tratamiento conservador, fueron sometidas a la realización de radiografías en ortostatismo sin chaleco ortótico, en la fase aguda, y sus parámetros radiológicos fueron reevaluados. RESULTADOS: fueron incluidos en este estudio 59 pacientes con fracturas torácicas y lumbares estables (T11 a L4). Todos los pacientes toleraron el examen. La cifosis vertebral aumentó 46.8 por ciento. El colapso anterior aumentó 15.56 por ciento. Tres de estos pacientes (5.1 por ciento) recibieron la indicación quirúrgica después de las radiografías en ortostatismo, ya que criterios de inestabilidad fueron reconocidos. CONCLUSIONES: la realización de las radiografías en ortostatismo mostró eficiencia en la identificación de pacientes con inestabilidad, aun no manifiesta, y capaz de predecir la evolución satisfactoria durante el tratamiento conservador, además de ser un examen de diagnóstico seguro, fácil aplicabilidad y bajo costo. En este estudio, un total de 5.1 por ciento tuvo un tratamiento conservador alterado para el quirúrgico.

Efeito da posição da articulação do cotovelo no controle de torque de supinação do antebraço em jovens adultos / Effects of elbow joint position on forearm supination torque control among young adults

INTRODUÇÃO: Inúmeros casos de patologias em antebraço e cotovelo reportados na literatura estão associados com tarefas que envolvem esforço e movimentos repetitivos do braço e mão. A posição do cotovelo é conhecida por afetar a produção de torque máximo de supinação do antebraço, assim como é um fator crítico na determinação de exercícios terapêuticos apropriados. No entanto, baseado no que se conhece, não existem evidências sobre os efeitos da posição do cotovelo em tarefas que requerem controle de níveis submáximos de torque. OBJETIVO: Este estudo investigou o efeito da posição do cotovelo na produção de torque isométrico máximo de supinação do antebraço e no controle constante e contínuo de torque em diferentes níveis submáximos de torque. MÉTODOS: Dezesseis jovens adultos (24,7 ± 2,2 anos de idade) foram solicitados a realizar duas tarefas: produção de torque máximo em pinça lateral (polegar e indicador) e controle constante de torque em pinça lateral. Ambas as tarefas foram avaliadas em quatro posições do cotovelo (livre, 0º, 45º e 90º de flexão) e três níveis submáximos de produção de torque em pinça lateral (20 por cento, 40 por cento e 60 por cento). Torque máximo, variabilidade, irregularidade e precisão da resposta motora foram usados como variáveis dependentes. RESULTADOS: Maiores valores de torque foram encontrados quando a articulação do cotovelo não foi restringida. O controle de torque não foi influenciado pela posição da articulação do cotovelo. Maior variabilidade, irregularidade e menor precisão na resposta de torque foram registradas com o aumento progressivo dos níveis submáximos de torque. CONCLUSÃO: Os resultados sugerem que a posição do cotovelo não é um fator determinante para exercícios de reabilitação que incluam torque em supinação do antebraço.

BACKGROUND: Large numbers of cases of pathological conditions in the forearm and elbow that have been reported in the literature are associated with tasks involving effort and repetitive movements of the arms and hands. Elbow position is known to affect the production of maximum forearm supination torque, and is a critical factor in designing appropriate therapeutic exercises. However, to our knowledge, there are no data on the effects of elbow position on tasks requiring control over submaximal torque levels. OBJECTIVE: This study investigated the effects of elbow position on the production of maximum isometric forearm supination torque, and on constant and continuous torque control at different submaximal torque levels. METHOD: Sixteen young adults (24.7 ± 2.2 years old) were asked to perform two tasks: production of maximum lateral pinch torque (thumb and index finger) and controlled lateral pinch constant torque. Both tasks were evaluated at four different elbow positions (free position, 0º, 45º and 90º of elbow flexion) and three submaximal levels of lateral pinch torque production (20 percent, 40 percent and 60 percent). Maximal torque, variability, irregularity and accuracy of the motor response were used as dependent variables. RESULTS: Greater torque values were found when the elbow joint was not restricted. The torque control tasks were not affected by the elbow position. However, greater variability and irregularity and lower accuracy in torque response were recorded with progressively increased submaximal torque levels. CONCLUSION: The results suggest that elbow position is not a determining factor for rehabilitation exercises that include torque control, in relation to forearm supination.

Defining Inversion/Eversion of the Foot : Is it a Triplane Motion or a Coronal Plane Motion? / The Japanese Journal of Rehabilitation Medicine

The purpose of this study was to resolve the confusion existing in the terminology for describing foot motion, particularly the definitions of inversion and eversion. First, the definitions of foot motion used by the Japanese Association of Rehabilitation Medicine and the Japanese Orthopedic Association were compared with those used by the American Orthopaedic Foot and Ankle Society (AOFAS) and with those used by the International Society of Biomechanics (ISB), to identify agreements and differences. Next, the terminology utilized in the literature was explored by examining several major textbooks and related academic papers retrieved through a search of the PubMed medical literature database. In the definitions of AOFAS and ISB, inversion and eversion, which correspond to triplane motions in the definition used in Japan, were regarded as motions in the coronal plane. Terminology in the textbooks was very diverse. Of the 141 academic papers explored, 92 papers (66%) regarded inversion/eversion as coronal plane motion, and 4 papers (3%) regarded it as a triplane motion. In the remaining 43 papers (31%), the definition was unspecified. In academic articles addressing foot motions, to avoid confusion in terminology, the definitions of inversion and eversion need to be specified.

Conservative management of supination-eversion fractures of ankle / 中华创伤骨科杂志

Objective To study middle-and-long-term results of the conservative management of the supination-eversion fractures of ankle. Methods A retrospective study was done for the 43 patients with supination-eversion fracture of ankle who were treated from February 1999 to August 2004 in our department, and followed up. Five patients belonged to stage Ⅰ , 10 to stage Ⅱ , none to stage Ⅲ and 28 to stage Ⅳ . The average duration of follow-up was 69 months (16 to 84 months). Results The middle-and-long-term results were graded according to the Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot & Ankle Society(AOFAS). Of the stageⅠ patients, five got satisfactory results. Of the stage Ⅱ patients, nine got satisfactory results and one unsatisfactory. Of the stage Ⅳ patients, 26 got satisfactory results and two unsatisfactory. Conclusions The middle-and-long-term follow-ups show that most of the supination-eversion fractures of ankle can be treated conservatively with a satisfactory result. Surgical treatment should be indicated for those whose conservative management cannot reach satisfactory results.

A Comparison of Two Methods in the Reduction of Radial Head Subluxations

PURPOSE: This study was conducted to compare the efficiencies of the supination to the hyperpronation method in reducing radial head subluxations. METHODS: This randomized, prospective study was done in a tertiary urban emergency medical center from January 2003 through December 2003. Inclusion criteria included age < 7 years with a clinical diagnosis of radial head subluxation. Exclusion criteria included point tenderness, echymosis, edema, deformity, and persistent pain. Patients were randomized for trearment by using either the supination or the hyperpronation method. The initial method was repeated if elbow function did not return 15 minutes after the reduction attempt. If the second attempt also failed, radiography of the elbow was performed. If the patient revisited the emergency medical center or orthopedic outpatient department within 24 hours with same complaint, we considered the attempt to be a failure. RESULTS: A total of 140 patients were enrolled in the study. The demographic characteristics of the two groups were similar. Seventy-two of the 75 patients (96%) randomly chosen for hyperpronation were reduced successfully on the first attempt versus 53 of 65 patients (81.5%) randomly chosen for supination (p=0.043). Seventy-four of 75 patients (98.7%) in the hyperpronation group were reduced successfully versus 61 of 65 patients (95.4%) in the supination group (p=0.183). For five patients, 4 patients in the supination group and 1 patient in the hyperpronation group, the reduction failed. CONCLUSION: Overall, in the reduction of radial head subluxations, there was no difference of success rate between the supination method and the hyperpronation method. However, the success rate of the hyperpronation method on the first attempt was superior to that of the supination method. We suggest that emergency physicians had better use the hyperpronation method rather than the supination method.