Effect of adduction during glenohumeral external rotation exercises in the scapulohumeral muscles / Efecto de la adducción durante ejercicios de rotación externa glenohumeral en los músculos escapulohumerales

SUMMARY: The effect of adduction during glenohumeral external rotation (ER) exercises on the scapulohumeral muscles is controversial. The aim of this study was to evaluate the effect of carrying out adduction during external rotation exercises in low and high shoulder positions on the electromyographic (EMG) activity of the infraspinatus (IS), middle deltoid (MD), and posterior deltoid (PD) muscles. EMG activity of the IS, MD, and PD muscles of 20 healthy participants was evaluated. Subjects performed 6 ER exercises that combined two factors: i) different adduction pressures according to biofeedback unit (0, 5 and 10 mmHg), and ii) low and high shoulder position. The pressure was controlled using a biofeedback unit. The low and high shoulder positions were 20? and 90? of abduction. In the low shoulder position, the activity of the IS muscle increased as the pressure on the biofeedback unit increased and the MD and PD muscles presented the highest activity at 10 mmHg. In the high shoulder position, the activity of the IS muscle was higher at 0 and 10 mmHg, the MD muscle presented higher activity at 5 mmHg, and PD muscle activity did not vary with the pressure. The addition of adduction at a pressure of 5 mmHg in the low shoulder position promotes is activity. Likewise, adduction at a pressure of 10 mmHg will promote activity of the IS, MD, and PD.

RESUMEN: El efecto de la aducción durante los ejercicios de rotación externa (RE) glenohumeral sobre los músculos escapulohumerales es controversial. El objetivo de este estudio fue evaluar el efecto de la realización de la aducción durante los ejercicios de rotación externa en posiciones bajas y altas del hombro sobre la actividad electromiográfica (EMG) delos músculos infraespinoso (IS), deltoides medio (DM) y deltoides posterior (DP). Se evaluó la actividad EMG de los músculos IS, MD y PD de 20 participantes sanos. Los sujetos realizaron 6 ejercicios de RE que combinaron dos factores: i) diferentes presiones de aducción de acuerdo con la unidad de biorretroalimentación (0, 5 y 10 mmHg), y ii) posición del hombro baja y alta. La presión se controló mediante una unidad de biorretroalimentación. Las posiciones del hombro baja y alta fueron de 20? y 90? de abducción. En la posición del hombro bajo, la actividad del músculo IS aumentó a medida que aumentaba la presión sobre la unidad de biorretroalimentación y los músculos MD y PD presentaron la actividad más alta a 10 mmHg. En la posición del hombro alto, la actividad del músculo IS fue mayor a 0 y 10 mmHg, el músculo MD presentó mayor actividad a 5 mmHg y la actividad del músculo PD no varió con la presión. La adición de aducción a una presión de 5 mmHg en la posición baja del hombro promueve la actividad del músculo IS. Asimismo, la aducción a una presión de 10 mmHg promoverá la actividad del IS, MD y PD.

Clinical analysis of full-repair strategy under small incision for closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture / 中国修复重建外科杂志

Objective: To investigate the safety, feasibility, and efficacy of full repair strategy under small incision in the treatment of closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture. Methods: The clinical data of 57 patients with closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture treated by full repair strategy (fracture, ligament, and cartilage repair) under small incision between January 2012 and January 2017 were retrospectively analyzed. There were 31 males and 26 females, with an average age of 41.1 years (range, 21-65 years). The causes of injury included traffic accident injury in 33 cases and falling injury in 24 cases. All of them were closed fractures, including 20 cases of medial malleolus fracture, 37 cases of complete medial malleolus but deep and shallow rupture of deltoid ligament. The average time from injury to admission was 9.6 hours (range, 3-34 hours). The quality of reduction of distal tibial articular surface (based on Ketz-Sanders standard), the reduction of tibiofibular syndesmosis (the anterior and posterior distances of distal tibiofibular syndesmosis and the lateral ankle twist angle measured by CT scan at 10 mm above the ankle joint line), and the fracture healing were evaluated. The medial clear space (MCS), tibiofibular clear space (TFCS), and distal fibular tip to lateral process of talus (DFTL) were measured on the X-ray films of ankle points. Before and after operation, the pain and functional improvement of ankle joint were evaluated by visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Association (AOFAS) score, and the activities of ankle dorsiflexion and plantar flexion were measured. Results: Three cases with osteochondral lesions of the talus were found during operation and all were treated with microfracture techniques. Tournament paralysis occurred in 2 cases after anesthesia. The surgical incisions healed by first intention in all patients. All the 57 patients were followed up 24-84 months, with an average of 38.6 months. All patients achieved bone healing without bone nonunion and malunion at 12 months after operation. The reduction quality of distal tibial articular surface was excellent in 56 cases and good in 1 case at 3 months after operation, the excellent and good rate was 100%. There was no significant difference in the MCS, TFCS, DFTL, anterior distance of distal tibiofibular syndesmosis, posterior distance of distal tibiofibular syndesmosis, and lateral ankle twist angle between the affected and healthy sides at 12 months after operation ( P>0.05). At last follow-up, the VAS score, AOFAS score, ankle dorsiflexion and plantar flexion activities of the affected side were significantly improved when compared with preoperative ones ( P0.05). Conclusion: Full-repair strategy under small incisions for the treatment of Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture is effective and safe. It can not only reduce wound complications, but also improve the quality of joint reduction of the ankle joint and distal tibiofibular syndesmosis. Full repair of ligaments and cartilage can improve the internal fixation strength and joint stability of the ankle joint.

Reducing shoulder dislocation without anaesthesia or assistant: Validation of a new reduction manoeuvre / 中华创伤杂志(英文版)

PURPOSE@#Shoulder dislocation comprises 60% of all major joint dislocations worldwide and a number of reduction techniques are described in the literature with varying degrees of success. The description of a large number of techniques speaks for itself that no method is effective all the times and one should be acquainted with more than one technique. An ideal method of reduction should be simple, easily reproducible, relatively painless that can be performed unassisted without sedation or anaesthesia with minimal or no further complications. We report our results of using a novel method of anterior shoulder reduction described recently in the literature that claims to fulfil most of the characteristics of an ideal method if not all.@*METHODS@#This prospective study was conducted in a tertiary care centre. All the cases of primary anterior shoulder dislocation presenting within three days of injury without any associated fracture or spine trauma with or without greater tuberosity fracture were included. The reduction was done using a novel method by orthopaedic residents in all cases. The need for a second reduction attempt or anaesthesia was considered a treatment failure. Time taken for reduction, pain felt during reduction and complications if any were noted.@*RESULTS@#There were 47 (77.04%) males and 14 (22.95%) females with a mean age of (37.04 ± 12.63) years. The new technique was effective in locating a shoulder dislocation on the first attempt in 58 of the 61 dislocated shoulders (95.08%). The remaining three shoulders were reduced on second attempt by the same technique. Sedative, pre-medication or anaesthesia was not used in any case. The average time taken for the shoulder reduction was (130.5 ± 25.8) seconds and confidence interval (95%) 124-137 s. Iatrogenic complications were not seen in any of the patients.@*CONCLUSION@#This relatively painless technique of shoulder reduction is easy to acquire and practice in emergency department. The advantages of this manoeuvre and its associated safety may justly lead surgeons to select it as their primary method for reduction of anterior shoulder dislocations.

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>

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws: A Retrospective Comparative Cohort Study / 中华医学杂志(英文版)

<p><b>Background</b>In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type of pronation-external rotation (PER) fractures with supracollicular medial malleolar (SMM) fractures. This study was designed to assess the 3-year functional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies.</p><p><b>Methods</b>This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients (Group 1) were treated without a supplemental syndesmotic screw fixation, according to the negative intraoperative stress test after bony fixation, while 32 patients (Group 2) were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Visual Analog Scale (VAS) for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and one-way analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models.</p><p><b>Results</b>We observed no difference in the distribution of age, sex, presence of associated posterior malleolus (PM), fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS (Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27) and VAS (Group 1 vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P = 0.12) in association with two strategies.</p><p><b>Conclusions</b>The present study indicates no difference to the use of the syndesmotic screw in terms of the functional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fracture patients with SMM fracture after 3-year follow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.</p>

Finite Element Analysis on Manual Reduction with Inverse Shift for Pronation-Extorsion Trimalleolar Fracture / 医用生物力学

Objective To investigate the feasibility of manual reduction with inverse shift for pronation-extorsion trimalleolar fracture by applying the finite element method combined with clinical experience. Methods Based on CT images and anatomical features of bone, ligaments and other tissues as well as material parameters, a normal ankle model with completed muscles and bones for a Chinese young male was established. According to the related characteristics of the pronation-extorsion trimalleolar fractures, fracture was simulated in the proper position to make osteotomy model. The finite element model of pronation-extorsion trimalleolar fractures was thus established and then applied with mechanical loading to simulate manual reduction with inverse shift. Results The established finite element model of pronation-extorsion trimalleolar fractures was effectively restored by the displacement loading. Conclusions The finite element analysis on pronation-extorsion trimalleolar fractures by inverse shift maneuver could further prove the feasibility, effectiveness and scientificity of manual reduction with inverse shift based on clinical experience.

The Advantages of Navigation for a Novice Surgeon in Performing Total Knee Replacement Surgery / 대한정형외과학회잡지

PURPOSE: To compare the outcomes of navigation-assisted total knee replacement conducted by a skilled surgeon and novice surgeon, as well as to evaluate the usefulness of the navigation assistance to a novice surgeon. MATERIALS AND METHODS: We retrospectively made a comparison between 60 total knee replacement surgeries conducted by skilled surgeon and 60 total knee replacement surgeries by a novice surgeon during the 2015. Scanograms were taken both preoperatively and at 3-month postoperatively to measure the accuracy of bone cutting and alignment. As for external rotation of the femur, we checked the values of the distal femur surgical epicondyle axis, and the posterior condyle axis displaced by the navigator after bone registration for both novice and skilled groups. For postoperative functional examination, Knee Society Score (KSS) were evaluated at 1-year follow-up. RESULTS: Forty-nine knees in the skilled group, and 51 knees in the novice group achieved coronal axis alignment of hip knee ankle values of 0°±3°. The mean external rotation degree of the femoral epicondyle axis against the posterior condyle axis, measured by the navigator, was 3.8°±2.9° in skilled group, and 1.2°±3.0° in novice group. When regarding femoral epicondyle axis, which showed a more internal rotation than the posterior condylar axis as an outlier, six cases were outlier in skilled group, while, 18 cases were outlier in novice group. After revising external rotation value of femoral implants comparing values navigation displaced and values using 3° external rotation manual jig against femoral posterior condylar axis, the skilled group showed 0 case of outlier and the novice group showed 10 cases of outlier. The mean KSS knee assessed at 1 year postoperatively was 83.2±6.8 in skilled group, and 83.1±7.0 in novice group, with no statistically significant difference. CONCLUSION: Navigation provides advantages to novice surgeon to achieve stabilized coronal plane axis, as well as accurate resection of the femur and tibia. However, the navigation does not provide any advantages in achieving the aimed amount of femoral external rotation to novice surgeons.

TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS / 中国修复重建外科杂志

OBJECTIVE: To evaluate the difference between using and not using syndesmotic screw to treat pronation external rotation (PER) ankle fracture combined with separation of distal tibiofibular syndesmosis. METHODS: Between April 2011 and October 2014, 46 cases of PER ankle fracture combined with separation of distal tibiofibular syndesmosis were treated, and syndesmotic screw was used in 24 cases (fixation group) and syndesmotic screw was not used in 22 cases (non-fixation group). There was no significant difference in gender, age, weight, cause of injury, side, injury to operation time, and fracture type between 2 groups (P>0.05). The time for full weight-bearing, fracture healing time, and complications were recorded after operation. Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap (TBOL) and tibiofibular clear space (TBCS). Baird-Jackson score was used to evaluate functional recovery of the ankle. RESULTS: All incision healed by first intention without complications. The cases were followed up 13-18 months (mean, 15.2 months) in 2 groups. The time for full weight-bearing was 8-12 weeks (median, 11 weeks) in fixation group, which was significantly later than that in non-fixation group (range, 6-10 weeks; median, 8 weeks) (Z=-5.049, P=0.000). X-ray examination showed reduction of separation of distal tibiofibular syndesmosis. All fractures healed. The fracture healing time was (13.83±1.37) weeks in fixation group, and was (13.91±1.31) weeks in non-fixation group, showing no significant difference (t=-0.191, P=0.945). No separation of distal tibiofibular syndesmosis, delayed union, nonunion, loosening, or breakage of fixation devices was observed in 2 groups. There was no significant difference in TBOL, TBCS, Baird-Jackson score and the excellent and good rate between 2 groups (P>0.05). CONCLUSIONS: If the medial, lateral, and posterior structures of the ankle could be repaired according to injury, no significant influence on functional outcome of ankle or radiologic findings could be detected whether syndesmotic fixation is given or not in treating PER ankle fracture (exclude Maisonneuve fracture) combined with separation of distal tibiofibular syndesmosis.

The biomechanical effect of bilateral unloading knee brace with internal-external rotation on knee joint / 医用生物力学

Objective Aiming at reducing the restrictions on lower limbs imposed by traditional knee brace, a design scheme for knee brace complying with internal-external rotation is proposed. Methods By adding the internal-external hinge, the knee brace could help to release the degree of freedom (DOM) of internal-external rotation of the knee. In the experimental group, the subject was required to wear the bilateral unloading knee brace with or without internal-external hinges, respectively, while in the control group, the subject did not wear the knee brace. Then gait experiment and mechanical testing were conducted. Results In gait experiment, the bilateral unloading knee brace with internal-external hinges imposed less restriction on the knee than that from the knee brace without internal-external hinges, and it could also provide some distractive force for the knee joint. Conclusions The internal-external hinge design can help to reduce restrictions on the knee imposed from bilateral unloading knee brace.

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.

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 of the Resistant Idiopathic Clubfoot with Toe-in Gait / 대한정형외과학회잡지

PURPOSE: We evaluated the degree of femoral and tibial torsion in, and the efficacy of two operative procedures for, resistant idiopathic clubfoot with toe-in gait. MATERIALS AND METHODS: Thirty one feet in 23 patients (average age at the time of revision surgery 4.3 years) were studied. CT was used to determine femoral anteversion and tibial torsion. Two different operative procedures were applied, depending on the degree of toe-in gait: group 1 (10 feet whose toe-in gait was not severe) - soft tissue release, anterior tibial tendon transfer and mid-foot (cuboid closing and cuneiform opening) osteotomy; group 2 (21 feet which had relatively severe toe-in gait) - supramalleolar external rotation osteotomy of the distal tibia (SEROT), along with the same procedure as group 1. Mean follow-up period after revision surgery was 6.3 years. Results were assessed radiologically and clinically with the Dimeglio classification and Clubfoot Assessment Protocol. RESULTS: The mean femoral anteversion and external-tibial torsion of the affected side were increased. Twenty eight of 31 feet (90.3%) demonstrated excellent or good results. In group 2, we obtained 19 excellent (90.5%) and 2 good (9.5%) results. Group 1 had 6 excellent (60%), one good (10%) and 3 fair (30%) results. CONCLUSION: Surgical treatment of the relapsed clubfoot with toe-in gait including soft-tissue release, tendon transfer and mid-foot osteotomy, along with SEROT in cases of severe toe-in gait, is effective in correcting residual clubfoot deformities.

PROPORTION OF JOINT ANGLES IN SHOULDER COMPLEX TO SHOULDER MAXIMUM EXTERNAL ROTATION ANGLE IN THROWING / 体力科学

The purpose of this study was to identify the angles of the shoulder complex which consist of glenohumeral joint, scapulothracic joint, and thoracic joint at the maximum external rotation (MER) of the shoulder complex during throwing in baseball players, and to analyze the correlation of each angle.The subjects were 19 collegiate baseball players. Throwing motion data was collected by three high-speed cameras and the three-dimensional (3D) coordinates of the shoulder complex were established by direct leaner translation method for the MER calculation. A 3D analysis was performed to obtain the external rotation (ER) angle of the glenohumeral joint, the posterior tilt angle of the scapula, and the extension angles of thoracic at MER of shoulder complex. The mean (±SD) value of the MER was 145.5±10.3°. The mean (±SD) values of the glenohumeral ER, the scapula posterior tilt angle and the thoracic extension angle at MER were 105.3±16.0°, 24.3±15.0°, and 9.1±7.2°respectively. Multiple linear regression analysis was used to relate the MER angle to each joint angle. The final linear regression model included the posterior tilting angle of scapula ( r=0.56, p＜0.05), and external rotation of the glenohumeral joint ( r=0.40, p＜0.05). Significant negative correlation was observed between the posterior tilting angle of the scapula and external rotation of the glenohumeral joint ( r=-0.52, p＜0.05). This finding suggested that scapula motion could be very important for the prevention of throwing injuries.

FACTORS CORRELATED WITH SHOULDER MAXIMUM EXTERNAL ROTATION ANGLE DURING THROWING / 体力科学

The magnitude of mechanical stress at the shoulder and elbow appears to be directly correlated with the degree of maximum shoulder external rotation (MER) during throwing. Therefore, it is very important to prevent excessive MER to minimize the risk of throwing injuries. The purpose of this study was to investigate the relationships between MER during throwing and the kinematic parameters of throwing mechanics, shoulder muscle strength, and shoulder range of motion in high school baseball players. The subjects were 40 male high school baseball players with no elbow or shoulder joint problems. Three-dimensional analysis was performed to calculate the MER angle. Then, the shoulder and elbow angles at initial foot contact (IFC) were computed. ROM and muscle strength of shoulder joint were also measured in each subject. Multiple linear regression analysis was used to relate the MER angle to these factors. Significant correlations were observed between the MER angle and the external rotation (ER) angle (r=−0.51, p<0.001) at IFC, and the ER range of motion (r=0.84, p<0.01). The MER angle significantly correlated with shoulder internal rotation (IR) at IFC. This finding suggests that stress on the shoulder and elbow could be increased by the degree of shoulder IR angle at the moment of IFC. Further, excessive ER range of motion may also be a risk factor.

The Shoes Designed to Inhibit Excessive External Rotation of Hemiplegic Foot with Plastic Ankle Foot Orthosis: A case report

Hemiplegic patients with an ankle foot orthosis (AFO) has a tendency to show external rotation of affected side foot. External rotation inhibiting shoes (ERIS) were designed to inhibit excessive rotation of hemiplegic foot. ERIS were applied to two hemiplegic patients who were able to walk independently with a plastic AFO. Both of them showed an excessive external rotation of hemiplegic foot after AFO apply. Each patient tried to walk with a pair of common shoes first and ERIS later. The external rotation angle, step length, stride length, cadence, speed were measured by footprint method. The external rotation angle of hemiplegic foot was significantly decreased with ERIS than with common shoes. However they did not show consistent improvement in the step length, stride length, cadence and speed. We reported that hemiplegic patients who walked with ERIS showed remarkable reduction in excessive external rotation of hemiplegic foot.

Electromyographic Activity of Shoulder Muscle at Different Positions During External Rotation / 体力科学

Electromyographic activity of the shoulder muscle at 20 and 90°abduction (20 Abd, 90 Abd) during external rotation was investigated in seven healthy men with no history of injury or instability of the shoulder joint.<BR>Electromyography (EMG) was recorded using intramuscular fine-wire electrodes inserted into the M. Supraspinatus, M. Infraspinatus and M. Teres minor, and with bipolar surface electrodes on the middle and posterior parts of M. Deltoid anti the upper and middle parts of M. Trapezius. To compare activity in different muscles, the integrated EMG (iEMG ) activity of each muscle was normalized.<BR>M. Infraspinatus and M. Teres minor showed significantly higher activity at both the 20 Abd and 90Abd compared with the middle and posterior parts of M. Deltoid and upper parts of M. Trapezius. M. Supraspinatus, the middle and posterior parts of M. Deltoid, and upper and middle parts of M. Trapezius all showed a difference in activity level between the two positions.<BR>These findings suggest that when M. Infraspinatus and M. Teres minor contribute to external rotation as a stabilizer and prime mover, consecutively, M. Supraspinatus, the middle and posterior parts of M. Deltoid, and upper and middle parts of M. Trapezius function according to the positions. Moreover, the activity of the upper and middle parts of M. Trapezius in 90Abd should influence stabilization, adduction and upward rotation of the scapula. Therefore, we conclude that the external rotation position is closely related to shoulder muscle activity and coordination.

Electromyographic analysis of shoulder muscles during shoulder external rotation with reference to load magnitude / 体力科学

Electromyographic muscle activities of the shoulder muscles during shoulder external rotation with reference to load magnitude were studied in 8 healthy male subjects without history of shoulder injuries. In addition, we discussed the relationship between rotator cuff muscles and superficial muscles. The subjects performed shoulder external rotation from 60°internal rotation to 45° external rotation at 20° of shoulder abduction and 20° of flexion. A Cybex dynamometer used to prescribe angle and velocity of the shoulder movement. At the same time, intramuscular wire electrodes were inserted into the supraspinous, infraspinous and teres minor muscles, and then surface electrodes were placed over the posterior deltoid and middle trapezius muscles. The load magnitude ranged 2-18 Nm and the angle velocity was set at 15 deg/sec. The rotator cuff muscles became significantly to be activated from 2 Nm (the supraspinous and infraspinous m.) and from 4-5 Nm (the teres minor m.) compared with the muscle activity during non-load. The superficial muscles became significantly to be activated from 4-7 Nm (the posterior deltoid m.) and from 3-6 Nm (the middle trapezius m.) compared with the muscle activity during non-load. Within the load range (18 Nm 46.8% MVC), %iEMG of the rotator cuff muscles was always larger than that of the superficial muscles. Therefore, we concluded that the contribution of the rotator cuff muscles was larger than that of the superficial muscles up to 3-4 Nm, and activities of the superficial muscles increased gradually from 3-4 Nm during shoulder external rotation.

A simple procedure for reducing anterior shoulder dislocation without anesthesia: Traction, abduction and external rotation.

General anaesthesia is normally used for facilitating reduction of anterior dislocation of the shoulder. To avoid anaesthesia or other medication, a simple technique of reduction of the shoulder dislocation by applying gentle traction along the extremity in elbow extension and continuing abduction with external rotation of the shoulder has been used. Since 1975, this simple procedure has been used in 32 patients who sustained anterior dislocation of the shoulder. The dislocation was a recurrence in 11 of the patients and a primary in 21 patients. The mechanism of reduction was studied by observing the relationship of the humeral head and glenoid using portable X-ray in anteroposterior and transaxillary views of the shoulder in nine patients. The results showed that there was no need for anaesthesia. All shoulder joints were successfully reduced without the need for assistance or the use of instruments. The mechanism of reduction showed that when the shoulder was 0-90 degree abducted during applying the traction, the humeral head rose upwards and closed outwards to the centre of the glenoid fossa, but remained anterior to the glenoid . When the shoulder was externally rotated during continuing abduction from 90 to 110 degrees, there was disengagement of the posterolateral aspect of the humeral head from the anterior aspect of the glenoid rim. Under those conditions, successful reduction of the shoulder was achieved.

The Surgical Treatment of the Unstable Pronation / 대한정형외과학회잡지

Pronation-external rotation ankle fractures are divided into four stages by Lauge-Hansen who placed the individual components of an ankle injury in their correct sequence in time so that, when the end point is represented by a fracture, the presence of intermediary ligament injuries may be inferred. Pronation-external rotation stages 3 and 4 injuries have severe soft tissue injuries and may be too difficult to reduce with closed method and to maintain with plaster immobilization. They also require attention because of a high level fraeture of the fibula and rupture of all ligaments of the syndesmosis or a avulsion fracture of their bone insertion. If anatomical reductions and rigid internal fixations were not performed. the results were worse than other types of ankle injuries. We reviewed the results of 31 patients with pronation external rotation ankle fractures who were followed from 18 months to 7 years. All cases were managed with open reduction and internal fixation with a plate, a screw or screws, a tension band wiring and multiple K-wires. All patients were treated and followed at the Department of Orthopaedic Surgery, Keimyung University, School of Medicine, Daegu, Korea and their results were rated on a clinical and roentgenological basis. The results obtained from this study were as followings:1. Most of the patients were in the age range between 20 and 39 (64.7% ) and 58.1% of the injuries occured in traffic accidents. 2. A plating considered as an effective method to obtain maintenance of appropriate anatomical reduction and rigid internal fixation of the distal fibula was used. 3. The accuracy of the reduction affected the degree of the arthrosis in long term follow-up. 4. A degree of initial displacement is considered as one of the important factors affecting the clinical results. 5. 80.7% were rated good to excellent.