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1.
Rev. bras. ortop ; 55(4): 404-409, Jul.-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1138059

ABSTRACT

Abstract Tibial plateau fractures are a risk to the functional integrity of the knee, affecting the axial alignment and capable of leading to pain and disability of the individual. Early weight bearing and joint mobilization can prevent these functional deficits. the goal of the present study was to conduct a systematic review of the literature about studies that quote the beginning, evolution, and progression criteria for weight-bearing in postoperative period of tibial plateau fractures. We selected articles published in the last 12 years, in Portuguese and English, that described the time of onset and progression of weight-bearing, considering the severity of the fracture. Thirty-six articles were selected. There is no consensus in the literature as to the beginning and evolution of weight-bearing in the postoperative period of tibial plateau fractures; however, a relationship between the severity of the fracture and the fixation method has been observed.


Resumo As fraturas do planalto tibial constituem risco à integridade funcional do joelho, afetando o alinhamento axial e podendo levar à dor e à incapacidade do indivíduo. O suporte de carga e a mobilização articular precoce podem prevenir esses déficits e acelerar o processo de reabilitação. O objetivo do presente trabalho foi realizar uma revisão da literatura sobre estudos que citam o início, evolução e critérios de progressão do suporte de carga no pós-operatório das fraturas de planalto tibial. Foram selecionados artigos publicados nos últimos 12 anos, nos idiomas português e inglês, que descrevessem o tempo de início e progressão do suporte de carga, considerando a gravidade da fratura. Foram selecionados 36 artigos na literatura. Não há consenso na literatura quanto ao início e evolução do suporte de carga no pós-operatório das fraturas do planalto tibial. Contudo, observa-se relação entre a gravidade da fratura e o tempo de início da carga.


Subject(s)
Pain , Rehabilitation , Tibial Fractures , Physical Therapy Modalities , Weight-Bearing , Fractures, Bone
2.
Rev. bras. ortop ; 55(3): 304-309, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1138021

ABSTRACT

Abstract Objective To analyze a series of cases of complex fractures of the sacrum with spinopelvic dissociation surgically treated with iliolumbar fixation, and to review the existing medical literature. Methods For the analysis, the medical records of the cases operated using the Schildhauer et al technique for fixation were retrospectively evaluated, and followed up for at least 12 months. The functional results were assessed using the visual analog scale (VAS) for pain and the Oswestry disability index, version 2.0. The data were compared with those of the existing medical literature. Results Six cases were analyzed, four of which evolved with moderate disability, one, with minimal disability, and one, with severe disability. Three cases that presented neurological deficits obtained significant improvement. Only one case evolved with pulmonary thromboembolic complications. Conclusion The Schildhauer et al technique is an efficient technique for the fixation of complex sacral fractures with spinopelvic dissociation. The patients evolved with good functional results. Early weight-bearing has been shown to be safe with the use of this treatment.


Resumo Objetivo Analisar uma série de casos de fraturas complexas do sacro com dissociação espinopélvica tratados cirurgicamente com fixação iliolombar, e revisar a literatura médica existente. Métodos Para a análise, foram avaliados retrospectivamente os prontuários médicos de casos operados utilizando a técnica de Schildhauer et al para fixação. O período de acompanhamento foi de pelo menos 12 meses. Os resultados funcionais foram avaliados por meio da escala visual analógica (EVA) de dor e do índice de incapacidade de Oswestry, versão 2.0. Os dados foram comparados com os da literatura médica existente. Resultados Seis casos foram analisados, sendo que quatro evoluíram com incapacidade moderada, um, com incapacidade mínima, e um, com incapacidade grave. Três casos que apresentavam déficit neurológico obtiveram melhora significativa. Apenas um caso evoluiu com complicação tromboembólica pulmonar. Conclusão A técnica de Schildhauer et al é eficiente para a fixação de fraturas complexas de sacro com dissociação espinopélvica. Os pacientes evoluíram com bons resultados funcionais. A liberação precoce de sustentação de carga demonstrou-se segura com o uso deste tratamento.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pain , Sacrum , Sacrum/surgery , Spinal Injuries , Medical Records , Weight-Bearing , Dissociative Disorders , Fractures, Bone
3.
Fisioter. Pesqui. (Online) ; 27(1): 16-21, jan.-mar. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1090412

ABSTRACT

RESUMO O objetivo deste estudo foi verificar se a formação do arco longitudinal do pé interfere na distribuição da pressão plantar e na flexibilidade dos músculos posteriores da coxa. O método de estudo foi transversal e as impressões plantares foram obtidas usando o plantígrafo e analisadas segundo o método Viladot. A distribuição plantar e a flexibilidade foram avaliadas pela baropodometria e pelo banco de Wells, respectivamente. Foi observado que crianças com pés cavos apresentam maior flexibilidade quando comparadas às que têm o pé normal (p=0,02); e também que pés cavos apresentam maior pressão, ou seja, maior sobrecarga em calcâneo quando comparados àqueles com o arco plantar normal (p=0,02 membro inferior direito e p=0,03 membro inferior esquerdo). A avaliação do arco longitudinal medial mostra que crianças com pés cavos apresentam maior flexibilidade dos músculos posteriores de membro inferior. Os pés cavos também estão associados com maior descarga de peso em região de calcâneo.


RESUMEN El objetivo de este estudio fue verificar si la formación del arco longitudinal del pie interfiere con la distribución de la presión plantar y la flexibilidad de los músculos posteriores del muslo. El método de estudio fue transversal y las huellas plantar se obtuvieron utilizando el plantigraph y se analizaron según el método de Viladot. La distribución plantar y la flexibilidad se evaluaron mediante baropodometría y el banco de Wells, respectivamente. Se observó que los niños con pies huecos tienen mayor flexibilidad en comparación con aquellos con pies normales (p=0,02); y también que los pies huecos tienen una mayor presión, es decir, una mayor sobrecarga del talón en comparación con aquellos con arco plantar normal (p=0,02 miembro inferior derecho y p=0,03 miembro inferior izquierdo). La evaluación del arco longitudinal medial muestra que los niños con pies huecos tienen una mayor flexibilidad en los músculos posteriores de la extremidad inferior. Los pies huecos también están asociados con una mayor descarga de peso en la región del talón.


ABSTRACT Objective: To evaluate whether the formation of the longitudinal arch of the foot interferes with the distribution of plantar pressure and the pliability of the posterior thigh muscles. Methodology: a cross-sectional study and the footprints were obtained using the footprinting mat and analyzed according to the Viladot method. Plantar distribution and pliability were assessed by baropodometry and Wells' bank, respectively. Results: It was observed that children with cavus feet present greater pliability when compared to those with normal feet (p=0.02). Also, the cavus feet exhibit higher pressure, that is, a greater heel overload compared to those with normal plantar arch (p=0.02 lower right limb and p=0.03 lower left limb). Conclusions: The evaluation of the medial longitudinal arch shows that children with cavus feet have greater pliability of the lower limb posterior muscles. The cavus feet are also associated with higher pressure in the calcaneal region.


Subject(s)
Humans , Male , Female , Child , Thigh/physiology , Range of Motion, Articular/physiology , Muscle, Skeletal/physiology , Foot/physiology , Biomechanical Phenomena/physiology , Body Height , Body Weights and Measures , Body Mass Index , Cross-Sectional Studies , Weight-Bearing/physiology , Postural Balance/physiology , Talipes Cavus/physiopathology
4.
Biosci. j. (Online) ; 36(1): 142-151, jan./feb. 2020. ilus, tab
Article in English | LILACS | ID: biblio-1049225

ABSTRACT

The intensive agricultural machinery traffic to which soils under coffee crops are exposed may cause significant changes in soil structure. The goals of this study were to: a) characterize the spatial variability of precompression stress (σp) and volumetric water content (θ) of a Red-Yellow Latosol (Oxisol) and determine their spatially dependent structures using ordinary kriging semivariograms; b) using this date to construct a load-bearing capacity (LBC) map for the site, identifying the depth with higher ; and c) use the map as a decision support tool regarding agricultural machinery logistic management in coffee plantations. The research was conducted on an experimental farm of the Agricultural Research Company of Minas Gerais (Epamig), Patrocinio, MG, on a clayey Oxisol. Samples were collected from 2.0 × 1.5 m sampling pits at intersections of a rectangular 40 × 150 m grid, totaling 28 sampling points. The soil samples were collected with metal rings (0.0254 m in height and 0.0630 m in diameter) using an Uhland sampler. Sampling at each pit was at 3 layers: 0.00­0.03 m, 0.10­0.13 m, and 0.25­0.28 m, and seven samples arranged in a matrix form were collected at each layer, totaling 588 samples. The σp and θ showed a spatially dependent structure. The depth of 0.00­0.03 m showed higher LBC, indicating that this depth was more compacted compared to other depths. Based on the σp maps, the tractor and the combine should not traffic into the areas at water content of 0.45 m3 m-3, because the soil has a LBC of 200 kPa. If this condition is not respected, additional compaction will occur. Tractor traffic is permissible when the water content reaches values less than 0.36 m3 m-3, whereas for combine traffic, the water content values must be less than 0.30 m3 m-3.


O tráfego intenso de máquinas agrícolas sobre solos cultivados com cafeeiro pode causar alterações significativas na estrutura do solo. Os objetivos deste estudo foram: a) avaliar e identificar a variabilidade espacial da pressão de preconsolidação (σp) e a umidade volumétrica (θ) de um Latossolo Vermelho-Amarelo (LVA) e determinar a estrutura de dependência espacial através de semivariogramas utilizando a krigagem ordinária; b) verificar no mapa, a profundidade com maior capacidade de suporte de carga (CSC) do solo ; c) dar suporte a tomada de decisão no manejo do maquinário agrícola da cultura cafeeira e utilizar esses mapas para a logística de manejo de trafego de máquinas. O experimento foi conduzido num LVA textura muito argilosa na Fazenda da Epamig (Empresa de Pesquisa Agropecuária de Minas Gerais), em Patrocínio-MG. A amostragem foi realizada numa malha retangular (150 m x 40 m), onde foram coletadas amostras indeformadas em anéis metálicos de 0,0254 m de altura por 0,0630 m de diâmetro com auxílio do amostrador tipo Uhland em 28 trincheiras. Cada trincheira possui três degraus que correspondem às profundidades de (0.00-0.03; 0.10-0.13 e 0.25-0.28 m) e as dimensões dos degraus foram de 2,0 x 1,5 m, coletaram-se sete amostras (disposta em forma matricial) para cada degrau, totalizando 588 amostras. A σp e θ apresentaram estrutura de dependência espacial. A profundidade de 0.00-0.03m apresentou maior CSC indicando que esta profundidade está mais compactada em relação as demais profundidades. Com base nos mapas da σp, o trator e a colhedora não devem trafegar na área para umidade volumétrica igual a 0.45 m3 m-3, pois o solo possui CSC de 200 kPa. Se essa condição for desrespeitada, a compactação adicional poderá ocorrer. Para o tráfego do trator, deve-se esperar por um período, para que a θ atinja um valor menor que 0.36 m3 m-3, enquanto que para o tráfego da colhedora deve-se esperar a θ atingir valor menor que 0.30 m3 m-3.


Subject(s)
Soil , Solid Waste Compaction , Weight-Bearing , Coffee
5.
Article in Chinese | WPRIM | ID: wpr-828301

ABSTRACT

OBJECTIVE@#To study and analyze the clinical effect of the self-developed new adjustable weight-bearing rehabilitation brace in the rehabilitation of the femoral intertrochanteric fracture after the operation of PFNA.@*METHODS@#From July 2015 to June 2017, 62 patients with typeⅡ (Evans-Jensen classification) intertrochanteric fracture of femur were treated with PFNA internal fixation. There were 11 males and 19 females in the routine rehabilitation group, with an average age of (70.73± 6.09) years;17 males and 15 females in the brace rehabilitation group, with an average age of (71.25±6.60) years. Among them, the patients in the routine rehabilitation group recovered according to the routine method, and the patients in the support rehabilitation group used the self-developed new adjustable weight-bearing rehabilitation support of lower limbs to assist the early rehabilitation. The pain intensity(VAS score), weight-bearing of affected limb, clinical healing time of fracture, Harris score and complications were recorded and analyzed.@*RESULTS@#Nine patients lost their visit half a year later, the other 53 patients were followed up for 9 to 18 months. The VAS score at 1, 3, 6 months after operation of brace rehabilitation group was lower than that of routine rehabilitation group(<0.05). The weight bearing of the limbs in the rehabilitation group was significantly higher than that in the conventional rehabilitation group(<0.05), but the clinical healing time of fracture in the brace rehabilitation group was shorter than that in the routine rehabilitation group(<0.05). In addition, the Harris score of the postoperativebrace rehabilitation group was better than that of the conventional rehabilitation group(<0.05). The incidence of complications was lower than that of the conventional rehabilitation group(=0.048).@*CONCLUSION@#In the rehabilitation of Evans Jensen typeⅡintertrochanteric fracture after PFNA internal fixation, the new self-developed adjustable weight-bearing rehabilitation brace can significantly relieve postoperative pain, regulate and moderately increase the stress stimulation at the fracture end, so as to promote fracture healing, accelerate the recovery of hip joint function, reduce the incidence of complications, and its clinical effect is safe and reliable.


Subject(s)
Aged , Bone Nails , Braces , Female , Fracture Fixation, Intramedullary , Hip Fractures , Humans , Lower Extremity , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Weight-Bearing
6.
Braz. oral res. (Online) ; 34: e035, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1100934

ABSTRACT

Abstract Although fiber-reinforced composites are commonly used in dental practice, whether fiber-reinforced crowns and fixed partial dentures can be used as definitive prostheses remains to be determined. This study used scanning electron microscopy to evaluate the load-bearing capacity of non-reinforced and fiber-reinforced composite (FRC) molar crowns prepared by computer-aided design/computer-aided manufacturing (CAD/CAM). The crowns were fabricated from three empirical FRC blocks, one empirical composite block, and one commercial ceramic block. The FRC resin was prepared by mixing BaO silicate particles, E-glass fiber, and dimethacrylate resin. Specimens were divided into five groups (n = 10), differing in the amounts of filler, resin, and fiber. Crowns were statically loaded until fracture. One-way analysis of variance and Tukey's post hoc multiple comparison tests were used for statistical analyses. The groups showed significant differences in load-bearing capacity; empirical bidirectional FRC resin blocks had the highest capacity, while commercial ceramic blocks had the lowest capacity. Molar crowns formed from FRC resin blocks had higher load-bearing capacity compared to non-reinforced composite resin and ceramic blocks. These results show that fiber reinforcement increased the load-bearing capacity of molar crowns.


Subject(s)
Humans , Weight-Bearing , Computer-Aided Design , Composite Resins/chemistry , Crowns , Reference Values , Surface Properties , Materials Testing , Microscopy, Electron, Scanning , Ceramics/chemistry , Reproducibility of Results , Dental Prosthesis Design , Evaluation Study , Molar
7.
Article in Korean | WPRIM | ID: wpr-766424

ABSTRACT

PURPOSE: The prevalence of osteoporotic sacral fractures is increasing. Traditionally, conservative treatment is the 1st option, but it can increase the risk of comorbidity in the elderly. To reduce the complications and allow early mobility, iliosacral screw fixation with cement augmentation will be one of the treatment options for patients with osteoporotic sacral fractures. MATERIALS AND METHODS: This study reviewed 25 patients (30 cases) who had undergone percutaneous iliosacral screw fixation with cement augmentation for osteoporotic sacral fractures from July 2012 to December 2018 with a minimum follow up of six months. The clinical outcomes were assessed using the measures of pain (visual analogue scale [VAS] score), hospital stay and the date when weight-bearing started. All patients were evaluated radiologically for pull-out of screw, bone-union, and cement-leakage. RESULTS: Bone union was achieved in 30 cases (100%). The mean duration of the hospital stay was 24 days (4–66 days); weight-bearing was performed on an average nine days after surgery. The VAS scores immediately (3.16) and three months after surgery (2.63) were lower than that of the preoperative VAS score (8.3) (p<0.05). No cases of cement-leakage or neurologic symptoms were encountered. Two patients (6.7%) experienced a pulling-out of the screw, but bone-union was accomplished without any additional procedures. CONCLUSION: Percutaneous iliosacral fixation with cement augmentation will be an appropriate and safe surgical option for osteoporotic sacral fractures in the elderly in terms of early weight-bearing, pain reduction, and bone-union.


Subject(s)
Aged , Comorbidity , Follow-Up Studies , Humans , Length of Stay , Neurologic Manifestations , Osteoporotic Fractures , Prevalence , Sacrum , Weight-Bearing
8.
Article in Korean | WPRIM | ID: wpr-766409

ABSTRACT

Periprosthetic acetabular fracture (PAF) is an uncommon complication following hip arthroplasty. However, as the number of people needing hip prostheses continues to rise, the absolute number of PAF is expected to increase as well. These fractures may occur either intraoperatively or postoperatively. Postoperative fractures can be caused by traumatic events or by pathologic conditions related to periacetabular osteolysis. The management of PAF usually depends on the degree of displacement and the stability of the acetabular component. While most of non-displaced fractures can be managed nonoperatively by protected weight bearing, displaced fractures with unstable implants require surgical intervention, which is often technically challenging. This review summarized the latest findings on the epidemiology, the diagnosis, the classification, and the treatment of PAF.


Subject(s)
Acetabulum , Arthroplasty , Classification , Diagnosis , Epidemiology , Hip Prosthesis , Hip , Osteolysis , Periprosthetic Fractures , Weight-Bearing
9.
Article in Korean | WPRIM | ID: wpr-765446

ABSTRACT

Most athletes with anterior cruciate ligament (ACL) ruptures undergo a surgical ACL reconstruction (ACLR) and rehabilitation. On the other hand, controversy still exists because neither a reconstruction nor rehabilitation have been proven to be superior in the management of ACL injury. This study reviewed the success rates of interventions to provide recommendations for the optimal management after an ACL injury. One of the most important considerations after an ACL injury is the timing and type of intervention. At the early stages, which involve the loss of volume and strength of quadriceps femoral muscle, weight bearing (closed kinetic chain) exercises with pain management followed by high velocity resistance exercises in an open kinetic chain environment are recommended to improve the quadriceps function. After that, it is important to apply intensive isokinetic exercise with a lower extension rate. In this case, it is important to apply overload to the muscles and to simultaneously lead the co-contraction of the hamstrings. Standards are essential because the timing and type of interventions are crucial to prevent re-injury and complications, such as osteoarthritis, as well as to confirm the successful outcome of the treatment. Different interventions recommended for ACL damage have yet to reach consensus. Further studies will be needed to observe the effects of the intervention through multidisciplinary approaches.


Subject(s)
Anterior Cruciate Ligament , Athletes , Consensus , Exercise , Hand , Humans , Muscle Strength , Muscles , Osteoarthritis , Pain Management , Rehabilitation , Rupture , Weight-Bearing
10.
Article in English | WPRIM | ID: wpr-765319

ABSTRACT

OBJECTIVE: Corpectomy of the first lumbar vertebra (L1) for the management of different L1 pathologies can be performed using either an anterior or posterior approach. The aim of this study was to evaluate the usefulness of a retroperitoneal extrapleural approach through the twelfth rib for performing L1 corpectomy. METHODS: Thirty consecutive patients underwent L1 corpectomy between 2010 and 2016. The retroperitoneal extrapleural approach through the 12th rib was used in all cases to perform single-stage anterior L1 corpectomy, reconstruction and anterior instrumentation, except for in two recurrent cases in which posterior fixation was added. Visual analogue scale (VAS) was used for pain intensity measurement and ASIA impairment scale for neurological assessment. The mean follow-up period was 14.5 months. RESULTS: The sample included 18 males and 12 females, and the mean age was 40.3 years. Twenty patients (67%) had sensory or motor deficits before the surgery. The pathologies encountered included traumatic fracture in 12 cases, osteoporotic fracture in four cases, tumor in eight cases and spinal infection in the remaining six cases. The surgeries were performed from the left side, except in two cases. There was significant improvement of back pain and radicular pain as recorded by VAS. One patient exhibited postoperative neurological deterioration due to bone graft dislodgement. All patients with deficits at least partially improved after the surgery. During the follow-up, no hardware failures or losses of correction were detected. CONCLUSION: The retroperitoneal extrapleural approach through the 12th rib is a feasible approach for L1 corpectomy that can combine adequate decompression of the dural sac with effective biomechanical restoration of the compromised anterior load-bearing column. It is associated with less pulmonary complication, no need for chest tube, no abdominal distention and rapid recovery compared with other approaches.


Subject(s)
Asia , Back Pain , Chest Tubes , Decompression , Female , Follow-Up Studies , Humans , Lumbar Vertebrae , Male , Osteoporotic Fractures , Pathology , Ribs , Spinal Fusion , Spine , Transplants , Weight-Bearing
11.
Article in English | WPRIM | ID: wpr-764825

ABSTRACT

Septic arthritis is a serious medical condition that can lead to significant complications if misdiagnosed or mismanaged. A rare case of a 1st metatarso-phalangeal joint septic arthritis in a native joint is presented in a patient with no significant risk factors. A 41-year-old patient was referred by his general practitioner owing to ongoing pain and swelling over his native 1st metatarso-phalangeal joint with difficulty on weightbearing for three months. After a series of investigations, including blood tests and a foot magnetic resonance imaging, which were inconclusive, the patient was led to the operating theatre for sampling and washout of his joint. The samples taken in the theatres revealed septic arthritis with Streptococcus mitis as the causative microorganism. The patient was treated with six weeks of oral antibiotics with a good functional outcome. This case report illuminates this rare condition and makes foot and ankle surgeons aware of its existence. A high suspicion for this condition can prevent misdiagnosis and mismanagement.


Subject(s)
Adult , Ankle , Anti-Bacterial Agents , Arthritis, Infectious , Diagnostic Errors , Foot , General Practitioners , Hematologic Tests , Humans , Joints , Magnetic Resonance Imaging , Risk Factors , Streptococcus mitis , Surgeons , Weight-Bearing
12.
Article in Chinese | WPRIM | ID: wpr-774167

ABSTRACT

In order to study the mechanical behavior of degeneration and nucleotomy of lumbar intervertebral disc, compression experiments with porcine lumbar intervertebral discs were carried out. The lumbar intervertebral discs with trypsin-treated and nucleus nucleotomy served as the experimental group and the normal discs as the control group. Considering the effects of load magnitude and loading rate, the relationship between stress and strain, instantaneous elastic modulus and creep property of intervertebral disc were obtained. The creep constitutive model was established. The results show that the strain and creep strain of the experimental group increase significantly with the increase of compression load and loading rate, whereas the instantaneous elastic modulus decreases obviously, compared with the control group. It indicates that the effect of load magnitude and loading rate on load-bearing capacity of intervertebral disc after nucleotomy is larger obviously than that of normal disc. The creep behavior of the experimental group can be still predicted by the Kelvin three-parameter solid model. The results will provide theoretical foundation for clinical treatment and postoperative rehabilitation of intervertebral disc disease.


Subject(s)
Animals , Biomechanical Phenomena , Intervertebral Disc , Physiology , General Surgery , Lumbar Vertebrae , Stress, Mechanical , Swine , Weight-Bearing
13.
Article in Chinese | WPRIM | ID: wpr-773853

ABSTRACT

OBJECTIVE@#To investigate clinical effect of partly weight-bearing walking and functional exercise immediatly after operation for Achilles tendon rupture(ATR) on function of ankle joint and rate of fragmentation of Achilles tendon, through comparing effect of partly weight-bearing walking and functional exercise immediatly at 2 weeks after operation for Achilles tendon rupture.@*METHODS@#Sixty-four patients with ATR selected from March 2012 to March 2013 were randomly divided into two groups. There were 34 patients in treatment group, including 18 males and 16 females with an average age of 41.4±7.6, they began to do functional exercise and walk on fields with partly weight-bearing at two days after operation; there were 30 patients in control group, including 16 males and 14 females with an average age of 39.9±7.6, and they were immobilized with plaster in plantar flexion at two weeks after operation, and started to do functional exercise and walk on fields with partly weight-bearing at two weeks after operation. Two groups were performed by the same doctor with the same operation. The rate of fragmentation of Achilles tendon, and AOFAS score and complications between two groups were observed and compared.@*RESULTS@#AOFAS score in treatment group at two weeks after operation was 74.3±3.9, which in control group was 71.7±4.2, and had statistical differences between two groups; AOFAS score in treatment group at one year after operation was 93.3±3.9, which in control group was 92.0±4.1, and had no statistical significance. No Achilles tendon fragmentation in treatment group occurred at three years after operation, and 1 patient occurred in control group. Two patients in treatment group occurred complications after operation, and 1 patient occurred in control group, however, there was no statistical significance between two groups.@*CONCLUSIONS@#Functional exercise immediate after operation for Achilles tendon rupture(ATR) patients in the early days, the AOFAS scores is higher than the fixing for two weeks, and does not increase the rate of fragmentation of Achilles tendon and complication after operation, and benefits for function recovery.


Subject(s)
Achilles Tendon , Adult , Female , Humans , Male , Middle Aged , Rupture , Tendon Injuries , Treatment Outcome , Weight-Bearing
14.
Hip & Pelvis ; : 75-81, 2019.
Article in English | WPRIM | ID: wpr-763968

ABSTRACT

PURPOSE: There are concerns that administration of bisphosphonate (BP) can substantially suppress bone turnover, potentially interfering with fracture healing. We investigated the effects of preoperative BP administration before internal fixation of intertrochanteric femoral fractures using fracture healing and clinical outcomes. MATERIALS AND METHODS: We retrospectively analyzed data from 130 patients who underwent internal fixation for osteoporotic intertrochanteric femoral fractures between March 2012 and July 2016. Patients previously treated with BPs for at least 3 months (BP group; n=29) were compared with the remaining patients (BP-naïve group; n=101). Radiographs were used to assess and compare fracture healing 3 months and 1 year postsurgery. The primary clinical outcome measure assessed was change in Koval score. RESULTS: Fracture union at 3 months after surgery was verified in 72.4% of patients (21/29) in the BP group and 90.1% of patients (91/101) in the BP-naïve group (P=0.027). Fracture union at 1 year postsurgery (BP group, 93.1% [27/29] vs. BP-naïve group, 97.0% [98/101], P=0.310) and change in Koval score (1.1 vs. 1.0, P=0.694) were not significantly different between the groups. Multivariable logistic regression analysis revealed that a history of BP administration was associated with an increased risk of delayed union at 3 months postsurgery (P=0.014). CONCLUSION: Preoperative administration of BP was associated with a decreased fracture healing rate 3 months after internal fixation, compared with BP-naïve patients. Therefore, patients previously treated with a BP should be carefully allowed to wean off walking aids and transition to full weight-bearing in the early postoperative period.


Subject(s)
Bone Remodeling , Diphosphonates , Femoral Fractures , Fracture Healing , Hip Fractures , Humans , Logistic Models , Osteoporosis , Outcome Assessment, Health Care , Postoperative Period , Retrospective Studies , Walking , Weight-Bearing
15.
Article in English | WPRIM | ID: wpr-763603

ABSTRACT

BACKGROUND: Traditionally, conservative management with an offloading orthosis, such as total contact cast (TCC), has been the standard of care for midfoot Charcot arthropathy. Considering complications of TCC and surgery, we treated midfoot Charcot arthropathy without TCC in our patients. The purpose of this study was to report clinical and radiological outcomes of conservative management of midfoot Charcot arthropathy. METHODS: A total of 34 patients (38 feet) who were diagnosed as having midfoot Charcot arthropathy between 2006 and 2014 were included. Patients started full weight bearing ambulation in a hard-soled shoe immediately after diagnosis. Outcomes such as progression of arch collapse, bony prominence, ulcer occurrence, limb amputation, and changes in Charcot stage were evaluated. RESULTS: Of 38 feet, arch collapse was observed in four while progression of bottom bump of the midfoot was observed in five feet. Foot ulcers related to bony bumps were found in two feet. CONCLUSIONS: Conservative treatment without restriction of ambulation is recommended for midfoot Charcot arthropathy because it is rarely progressive, unlike hindfoot-ankle arthropathy. In some cases, simple bumpectomy can be required to prevent catastrophic infection.


Subject(s)
Amputation , Arthropathy, Neurogenic , Diagnosis , Extremities , Foot , Foot Ulcer , Humans , Orthotic Devices , Shoes , Standard of Care , Ulcer , Walking , Weight-Bearing
16.
Asian Spine Journal ; : 377-385, 2019.
Article in English | WPRIM | ID: wpr-762955

ABSTRACT

STUDY DESIGN: Between-session reliability of a magnetic resonance imaging (MRI) based experimental technique to quantify lumbar inter-vertebral motion in humans. PURPOSE: We have developed a novel, dynamic, MRI-based approach for quantifying in vivo lumbar inter-vertebral motion. In this study, we present the protocol's reliability results to quantify inter-vertebral spine motion. OVERVIEW OF LITERATURE: Morphometric studies on intervertebral displacements using static, supine MRI and quantification of dynamic spine motion using different X-ray based radiography techniques are commonly found in the literature. However, reliability testing of techniques assessing real-time lumbar intervertebral motion using weight-bearing MRI has rarely been reported. METHODS: Ten adults without a history of back pain performed a side-bending task on two separate occasions, inside an open-MRI, in a weight-bearing, upright position. The images were acquired during the task using a dynamic magnetic resonance (MR) sequence. The MRI imaging space was externally calibrated before the study to recreate the imaging volume for subsequent use in an animation software. The dynamic MR images were processed to create side-bending movement animations in the virtual environment. Participant-specific three-dimensional models were manually superimposed over vertebral image silhouettes in a sequence of image frames, representing the motion trials. Inter-vertebral axes and translation and rotational displacements of vertebrae were quantified using the animation software. RESULTS: Quantification of inter-vertebral rotations and translations shows high reliability. Between-session reliability results yielded high values for the intra-class correlation coefficient (0.86–0.93), coefficient of variation (13.3%–16.04%), and Pearson's correlation coefficients (0.89–0.98). CONCLUSIONS: This technique may be developed further to improve its speed and accuracy for diagnostic applications, to study in vivo spine stability, and to assess outcomes of surgical and non-surgical interventions applied to manage pathological spine motion.


Subject(s)
Adult , Back Pain , Humans , Intervertebral Disc , Low Back Pain , Lumbar Vertebrae , Magnetic Resonance Imaging , Radiography , Spine , Translations , Weight-Bearing
17.
Ultrasonography ; : 236-245, 2019.
Article in English | WPRIM | ID: wpr-761982

ABSTRACT

PURPOSE: The purpose of this study was to present a technique for measuring physiologic distal tibiofibular syndesmosis widening using 3-dimensional ultrasonography (3D-US) with an evaluation of its reliability, and to determine whether there were differences in the measurements between different dynamic stress tests. METHODS: We retrospectively evaluated 3D-US of 20 subjects with normal ankle syndesmosis. 3D-US was performed in neutral (N), dorsiflexion with external rotation (DFER), and weight-bearing standing (WB) positions at the anterior inferior tibiofibular ligament level in both ankles for comparison. Using 3D-US volume data, axial images were reconstructed at the level of the lateral prominence of the anterior tibial tubercle to ensure consistent measurements of the tibiofibular clear space (TFCS) by two radiologists. RESULTS: There was a wide range of TFCS values among the subjects (N, 1.2 to 4.2 mm; DFER, 2.3 to 4.8 mm; WB, 1.7 to 4.6 mm). When both ankles of each subject were evaluated, the side-to-side differences were less than 1 mm in all positions, with high intraclass correlation coefficient (ICC) values between both ankles (ICC, 0.85 to 0.93). The inter-rater agreement for all TFCS measurements between the two radiologists was excellent (ICC, 0.81 to 0.96). In comparisons between the two dynamic stress tests, the TFCS was significantly wider in the DFER position than in the WB position (DFER vs. WB, 3.3 mm vs. 2.9 mm; P<0.001). CONCLUSION: Using 3D-US, we were able to consistently evaluate the TFCS with good reliability. In a comparison of the two dynamic tests, there was more significant widening of the TFCS in the DFER position than in the WB position.


Subject(s)
Ankle Joint , Ankle , Diagnosis , Exercise Test , Lateral Ligament, Ankle , Retrospective Studies , Ultrasonography , Weight-Bearing
18.
Article in English | WPRIM | ID: wpr-761925

ABSTRACT

BACKGROUND: Most tendon injuries are occurring from a gradual wearing and tearing of the tendon tissues from overuse. Such injuries are usually seen in sports, exercising, or daily activities that involve a high mechanical load and weight bearing. However, owing to the lack of both cellularity and blood vessels in tendons, the process of tendon repair is slow and inefficient. Although various conservative (non-surgical) and surgical management options are conducted by the clinicians, a gold standard of these approaches does not exist. In this regard, the treatment of tendon injuries is challenging. METHODS: Here, we describe the recent advances of biomaterial-based approaches for the treatment of injured tendons. RESULTS: Regenerative medicine is an emerging multidisciplinary research that specializes in the repair of damaged tendon tissues through the delivery of regenerative factors by biomaterials. CONCLUSION: Although current biomaterial-based treatment strategies have shown their potential for tendon healing, future research and clinical applications should focused on finding the optimum combinations of regenerative factors with ideal biomaterials for the repair of tendons.


Subject(s)
Biocompatible Materials , Blood Vessels , Regenerative Medicine , Sports , Tears , Tendon Injuries , Tendons , Weight-Bearing
19.
Article in English | WPRIM | ID: wpr-760342

ABSTRACT

Animal models of osteoarthritis (OA) have played a key role in understanding the etiology of OA and in the development of new therapeutic strategies. Although pigs have an advantage as an animal disease model due to their similarity to humans, there are few studies on the induction of OA in minipigs. Therefore, this study aimed to characterize disease progression of OA in total medial meniscectomy (TMM)-operated skeletally mature minipigs, up to day 180 postoperatively. There were no significant alterations in vital signs or hematological indices throughout the observation period. However, clinical manifestations of OA in the medial femoral condyles of TMM-operated minipigs were progressive, depending on postoperative duration, with respect to osteophytes formation and roughened surfaces on radiological observation, cartilage erosion under macroscopic examination, and severe cartilage defects including fibrillation, vertical fissures, and cartilage denuding on histopathological observation, with the highest score indicating late-stage OA on day 180 and without indicating apparent variation between subjects. In particular, the lateral femoral condyles were also degenerated, possibly due to localization of weight-bearing from both menisci to the lateral meniscus. Therefore, TMM in minipigs is suitable for reproducible induction of degenerative changes in the femorotibial joints that closely resemble late-stage OA, and is suitable for use in further research.


Subject(s)
Cartilage , Disease Models, Animal , Disease Progression , Humans , Joints , Menisci, Tibial , Models, Animal , Osteoarthritis , Osteophyte , Swine , Swine, Miniature , Vital Signs , Weight-Bearing
20.
Article in English | WPRIM | ID: wpr-759372

ABSTRACT

PURPOSE: We aimed to determine whether navigated opening wedge high tibial osteotomy (HTO) is superior to the conventional technique in terms of accuracy of the coronal and sagittal alignment correction, functional outcome, and operative time. METHODS: Studies comparing navigated and conventional HTO were included in this meta-analysis. We compared the incidence of radiological outliers in coronal alignment and tibial slope maintenance, mean differences in functional outcome scales, and operative time. Subgroup analyses were performed on coronal alignment accuracy based on the intraoperative method of alignment confirmation: fluoroscopy vs. gap measurement method. RESULTS: Twelve studies were included: there were 434 knees in the navigated HTO studies and 405 knees in the conventional HTO studies. The risk of outlier was lower in navigated HTO than in conventional HTO; however, the difference was not significant when navigated HTO was compared with conventional HTO performed using the gap measurement method. Tibial slope maintenance was comparable or better in navigated HTO. No difference was found in the American Knee Society function and Lysholm scores. Navigated HTO necessitated a longer operative time of approximately 10 minutes. CONCLUSIONS: The use of navigation in HTO can improve accuracy in both coronal and sagittal alignments, but its clinical benefit is unclear.


Subject(s)
Fluoroscopy , Incidence , Knee , Methods , Operative Time , Osteoarthritis , Osteotomy , Surgery, Computer-Assisted , Tibia , Weight-Bearing , Weights and Measures
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