Establishing regions of interest of the lower leg and ankle for perioperative volumetric assessment with a portable 3D scanner in orthopedic and trauma surgery - a pilot study.

BACKGROUND: Soft tissue swelling assessment benefits from a reproducible and easy to use measurement method. Monitoring of the injured lower extremity is of clinical import during staged soft tissue management. Portable 3D scanners offer a novel and precise option to quantify and contrast the shapes and volumes of the injured and contralateral uninjured limbs. This study determined three regions of interest (ROI) within the lower extremity (lower leg, ankle and foot), that can be used to evaluate 3D volumetric assessment for staged soft tissue management in orthopedic and trauma surgery. METHODS: Twelve healthy volunteers (24 legs) were included in this cohort study. Scans of all three ROI were recorded with a portable 3D scanner (Artec, 3D scanner EVA) and compared between the right and left leg using the software Artec Studio (Arctec Group, Luxemburg). RESULTS: Mean volume of the right leg was 1926.64 ± 308.84 ml (mean ± SD). ROI: lower leg: 931.86 ± 236.15 ml; ankle: 201.56 ± 27.88 ml; foot: 793.21 ± 112.28 ml. Mean volume of the left leg was 1937.73 ± 329.51 ml. ROI: lower leg: 933.59 ± 251.12 ml; ankle: 201.53 ± 25.54 ml; foot: 802.62 ± 124.83 ml. There was no significant difference of the overall volume between right and left leg (p > 0.05; overall volume: △ difference: 29.5 ± 7.29 ml, p = 0.8; lower leg: △ difference: 21.5 ± 6.39 ml, p = 0.8; ankle: △ difference: 5.3 ± 2.11 ml, p = 0.4; △ difference: 16.33 ± 4.45 ml, p = 0.8. CONCLUSION: This pilot study defines three regions of interest of the lower leg and demonstrates no difference between the right and left side. Based on these ROI, further studies are needed to evaluate the clinical applicability of the scanner.

Volumetry of Hand and Forearm: A 3D Volumetric Approach.

BACKGROUND: Swelling and edema of the hand and forearm may occur in various traumatic and degenerative diseases. So far, no precise measurement protocol exists. The objective of this study was to evaluate an examination protocol with relevant regions of interest (ROIs) measured by a 3-dimensional (3D) scanner to achieve precise, reproducible, and objective measurements for an optimized detection of volumes of the hand and forearm. METHODS: A 3D scan protocol was developed using an Artec, 3D scanner EVA to measure discrete hand volumes of healthy volunteers. Five areas were defined as ROIs, representing volumes of the finger, metacarpus, wrist, hand, and distal forearm. Contralateral limbs were used for volume comparisons and calculation of volume differences. RESULTS: For this study, 12 individuals (58.3% women, 24 hands and forearms) with a mean age of 27.1 ± 3 years were included. Mean volume values for left and right ROIs correlated with each other, with slightly higher volumes for the right upper extremity. Volume differences showed statistically significant results for the finger region (ROI I; P = .009), the metacarpal region (ROI II; P < .001), hand region (ROI IV; P = .001), and forearm region (ROI V; P = .006), with the exception of the wrist region (ROI III; P = .722). CONCLUSIONS: Our results demonstrate that this 3D volumetric approach is a reliable and objective tool for measuring volumes and circumferences in hand and forearm. Based on our determined ROIs, further studies are needed to explore the significance for clinical applications.

Defining the region of interest of the knee for perioperative volumetric assessment with a portable 3D scanner in orthopedic and trauma surgery.

BACKGROUND: The aim of this study was to characterize three regions of interest (ROI) around the knee with a portable 3D scanner (Artec 3D scanner EVA). Soft tissue topography assessment with an optimized, precise, and reproducible method may assist surgeons when managing soft tissue swelling in the post traumatic setting. METHODS: 12 healthy volunteers (24 legs, 7 women, 5 man) were included in this study. The patient cohort showed a mean age of 27.1 years (SD±3), a mean weight of 70 kg (SD±13) and a mean height of 171 cm (SD±8.8). All scans were recorded by the same examiner in the same room and with the same scanner (Artec, 3 D scanner EVA). Three volume regions of interest (ROI) were defined: the distal femur (circumference measured between the of superior extent of the patella to 10 cm proximal), the knee joint (measured from the top of the patella to the tibial tuberosity) and the proximal tibia (tibial tuberosity to 10 cm distal). RESULTS: The mean volume of the right leg was 3.901 l (I. distal femur: 1.63 l, knee joint: 1.33 l, proximal tibia: 1.10 l) and mean volume of the left leg was 3.910 l (I. distal femur: 1.66 l, knee joint: 1.34 l, proximal tibia: 1.12 l). The volume difference between the right and left leg was 0.094 l (SD ± 0.083 l) The Wilcoxon-Mann-Whitney test showed no significant differences of the volumes between the right and left leg. CONCLUSIONS: This study demonstrates that portable 3D scanning could be an accurate and reliable tool for orthopedics and trauma surgeons. Based on the ROIs of this pilot study, further studies are needed to test the significance for clinical applications for patients with an injured knee.

Doctor, when can I drive? - Range of functional ankle motion during driving.

BACKGROUND: Driving a motor vehicle needs a specific joint mobility and yet only limited knowledge exists regarding the necessary ankle range of motion. The goal of this study is to characterize the sequence and range of ankle motion. METHODS: The arc of plantarflexion/dorsiflexion and supination/pronation was recorded in the right and left ankle using electrogoniometers while thirty laps were driven by fifteen healthy participants around a course in a manual transmission car with a left sided steering wheel. The driver was required to perform the following maneuvers during each lap: (I) Vehicle acceleration and gear change, (II) Sudden evasion, (III) Routine turning, (IV) Rapid turning, (V) Vehicle acceleration followed by emergency braking. RESULTS: Driving required the right ankle to plantarflex 13±9 and dorsiflex 22±7 while supinating 15±7 degrees and pronating minimally. The left ankle plantarflexed 19±10and dorsiflexed 17±10 while supinating 15±7 degrees and pronating minimally. The right ankle dorsiflexed significantly more (p=0.00), and yet the left ankle had a significantly higher maximum plantarflexion and range of plantarflexion/dorsiflexion (p=0.00). Emergency braking resulted in a significantly higher maximum plantarflexion as well as plantarflexion/dorsiflexion range when compared to other maneuvers. CONCLUSION: This study describes the range of ankle motion identified to drive a car with a manual transmission and a left-sided steering wheel. The right and left ankle exhibit different arcs of motion during driving. This knowledge may assist when evaluating a patient's driving capability. Further studies are needed to investigate whether movement restrictions impair driving. LEVEL OF EVIDENCE: Basic science study.

Doctor, when can I drive?-the range of elbow motion while driving a car.

BACKGROUND: Immobilization of the upper extremity after an acute injury or postoperatively affects an individual's ability to safely operate a motor vehicle. The elbow is particularly sensitive to immobilization, with subsequent stiffness leading to functional limitations. Most activities of daily living are successfully achieved within a "functional arc" of elbow motion between 30° and 130° of flexion. No objective guidelines exist regarding the range of motion needed to safely operate a vehicle. In this study, we measured the range of motion of right and left elbows while driving a manual-transmission car. MATERIALS AND METHODS: Using electro-goniometers, we measured the flexion and extension, as well as pronation and supination, of the right and left elbows in 20 healthy, right hand-dominant subjects while driving a car. These measurements were recorded on (1) city streets, (2) country roads, and (3) highways. RESULTS: For city streets, the range of motion in terms of flexion and pronation/supination was 15°-105° and 0°-45°/0°-35°, respectively, for the right elbow and 20°-95° and 0°-45°/0°-40°, respectively, for the left. For country roads, it was 10°-100° and 0°-40°/0°-35°, respectively, for the right elbow and 20°-95° and 0°-30°/0°-30°, respectively, for the left. For highways, it was 5°-100° and 0°-40°/0°-35°, respectively, for the right elbow and 20°-90° and 0°-30°/0°-25°, respectively, for the left. Mean pronation was significantly higher for the right elbow (P < .01). CONCLUSION: This study describes the range of elbow motion identified to drive a car with a manual transmission and a left-sided steering wheel. Mean pronation of the right elbow is significantly higher than that of the left. Further studies are needed to investigate the relevance of movement restrictions as they relate to handedness, steering-wheel side, and driving impairment.

Influence of Wrist Position on the Metacarpophalangeal Joint Motion of the Index Through Small Finger.

BACKGROUND: The metacarpophalangeal joints exhibit range of motion that is influenced by wrist position. Synergistic motion occurs between the wrist and the metacarpophalangeal joints with different static wrist positions affecting joints' motion capability. The aim of this study was to determine how different wrist positions influence the active range of motion of the index through small finger metacarpophalangeal joints. METHODS: The active range of motion of the index through small finger metacarpophalangeal joints of 31 healthy subjects was measured in flexion/extension and radial/ulnar deviation in 5 different flexion/extension wrist positions, using biaxial electrogoniometers. RESULTS: There was a difference in range of motion of all fingers depending on the wrist position. The minimum metacarpophalangeal joint range of motion was found in 80° wrist extension, the maximum in neutral wrist position. For the index finger, flexion/extension was 84.7° (±8.6°) to 25.9° (±10.2°) and radial/ulnar deviation was 32.1° (±11.3°) to 22.6° (±12.8°). For the middle finger, flexion/extension was 84.8° (±8.5°) to 25.9° (±10.1°) and radial/ulnar deviation 28.8° (±11.1°) to 22.1° (±8.9). The fourth finger showed a range of motion for flexion/extension of 87.2° (±11.5°) to 22.8° (±11.6°) and radial/ulnar deviation of 8.1° (±5.8°) to 32.3° (±12.4°). The highest range of motion was measured at the fifth finger with flexion/extension of 84.0° (±8.6°) to 32.1°(±16.8°) and radial/ulnar deviation of 15.1° (±12.9°) up to 54.6° (±18.7°). CONCLUSIONS: The range of motion of the index through small finger metacarpophalangeal joints was significantly influenced by wrist position. The highest metacarpophalangeal joint range of motion of all fingers was conducted in neutral wrist positions. Apart from ergonomic implications, we conclude that metacarpophalangeal joint motion should be assessed under standardized wrist positions.

Doctor, when can I drive? - Range of motion of the knee while driving a car.

BACKGROUND: One of the most important activities of daily living is operating a motor vehicle. With increasing age the prevalence of musculoskeletal disorders such as knee osteoarthritis may interfere with an individual's ability to do so safely. Physicians are tasked with determining a patient's ability to drive and yet the necessary joint range of motion required for driving a car has not been characterized. METHODS: The range of motion of the right and left knees was recorded using electrogoniometers in 20 healthy subjects while driving a car on three route types (a) city streets, b) country roads and c) highways). Special emphasis was placed on the left knee associated with changing a gear. RESULTS: The range of motion while driving is 40-80° for the right and 20-85° flexion for the left knee. A significant difference was noted for each side (p < 0.01) with a higher flexion occurring in the left knee (p < 0.01). The average position of the knee while changing a gear (beginning, maximum, ending) was: right: 55°±10°, 62°±10°, 53°±10°; left: 67°±7°, 39°±8°, 66°±8° (mean flexion±standard deviation). CONCLUSION: This study characterized the knee range of motion that occurs while driving a car. Our data suggests that common driving activities such as accelerating a vehicle or braking can be achieved with the right knee through a limited range of motion. The greater range of motion and the higher flexion of the left knee are mainly attributed to the gear changing. The present data may benefit physicians in their evaluation of driving capability.

[Transtrapezoid carpal dislocation: a case report]. / Transtrapezoidale Luxation: Ein Fallbericht.

Fracture dislocations of the STT joint are extremely rare. We present the case of a 50-year-old worker, who sustained a crush injury of his left hand with a dorsal fracture dislocation of the trapezoid bone and the associated second metacarpal bone at the STT, and a concomitant compartment syndrome of the hand. The fracture was reduced immediately and compartment release was performed, followed by percutaneous stabilisation using three K-wires. Material removal after six weeks was followed by intensive physical therapy. At the final follow-up examination after three months, we observed a good recovery of hand function compared to the unaffected right side with 75 % grip strength, 90 % ROM in extension/flexion and full thumb opposition (Kapandji score 9/10). Immediate surgical treatment of this rare injury can lead to a good functional result of the hand.