Low-frequency electrically induced exercise after spinal cord injury: Physiologic challenge to skeletal muscle and feasibility for long-term use.

CONTEXT: Skeletal muscle has traditionally been considered a "force generator": necessary for purposes of locomotion, but expendable for non-ambulators who use wheelchairs, such as people with a spinal cord injury (SCI). Active skeletal muscle plays an indispensable role in regulating systemic metabolic functions, even in people with paralysis, but because of severe osteoporosis, high tetanic muscle forces induced with high frequency electrical stimulation may be risky for some individuals. The purpose of this study was to compare the physiologic muscle properties incurred by two low force/low frequency repetitive stimulation protocols (1 and 3 Hz); and, to assess the acceptability of each protocol among people with SCI. METHODS: Ten individuals with chronic SCI (12.9 years) and 11 individuals without SCI (NonSCI) participated in the study. Participants received either 1 or 3 Hz stimulation to the quadriceps muscle on Day 1, then the converse on Day 2. Each session consisted of 1000 stimulus pulses. RESULTS: The initial and maximum forces were similar for the 1 and 3 Hz frequencies. The fatigue index (FI) for SCI and NonSCI groups were lower (P < 0.007) for 3 Hz than for 1 Hz (0.34 ± 0.17 versus 0.65 ± 0.16 and 0.72 ± 0.14 versus 0.87 ± 0.07, respectively). CONCLUSION: The 3 Hz stimulation offered the greatest physiological challenge and was perceived as more acceptable for long term use among people with SCI.

Comparison of Participation in Strength Activity Among People With and Without Disabilities: 2013-2017 Behavioral Risk Factor Surveillance System.

BACKGROUND: The current physical activity guidelines recommend engagement in strength activities at least 2 days per week. Currently, there is a lack of literature examining strength activities among people with disabilities. The purpose of this study is to estimate and compare the prevalence of engagement in strength activities and adherence to strength activity guidelines among adults with and without disabilities in the United States. METHODS: A total of 1,005,644 adults (18-80 y old) with and without disabilities from the 2013 to 2017 Behavioral Risk Factor Surveillance System were included in this secondary data analysis. Descriptive analyses were performed to describe the prevalence of strength activity behaviors of adults with and without disabilities. Logistic and Poisson regression models were performed to evaluate the relative contribution of disability status on strength activity behaviors. RESULTS: A higher proportion of participants without disabilities (46.42%, 95% CI, 46.18-46.65) reported engaging in strength activities compared with participants with disabilities (30.68%, 95% CI, 30.29-31.08; P < .01). Participants with disabilities were less likely to engage in strength activities (odds ratio = 0.51, 95% CI, 0.50-0.52; adjusted odds ratio = 0.75, 95% CI, 0.73-0.77) and meet strength activity guidelines (odds ratio = 0.56, 95% CI, 0.54-0.57; adjusted odds ratio = 0.75, 95% CI, 0.73-0.77) than participants without disabilities. CONCLUSION: Experiencing a disability is associated with lower engagement in strength activities; thus, it is important to identify effective and efficient approaches to promoting strength activities among people with disabilities.

Effectiveness of Acupotomy Combined with Epidural Steroid Injection for Lumbosacral Radiculopathy: A Randomized Controlled Pragmatic Pilot Study.

Background and Objectives: This pilot study aimed to evaluate the clinical effectiveness, cost-effectiveness, and safety of acupotomy combined with epidural steroid injection (ESI) in lumbosacral radiculopathy and examine its feasibility for the main study. Materials and Methods: This randomized, controlled, two-arm, parallel, assessor-blinded, pragmatic study included 50 patients with severe lumbosacral radiculopathy who had insufficient improvement after an ESI. Patients were randomized (1:1 ratio) into a combined treatment (acupotomy + ESI, experimental) and an ESI single treatment (control) group. Both groups underwent a total of two ESIs once every 2 weeks; the experimental group received eight additional acupotomy treatments twice a week for 4 weeks. Types of ESI included interlaminar, transforaminal, and caudal approaches. Drugs used in ESI comprised a 5-10 mL mixture of dexamethasone sodium phosphate (2.5 mg), mepivacaine (0.3%), and hyaluronidase (1500 IU). The primary outcome was the difference in changes from baseline in the Oswestry Disability Index (ODI) scores between the groups at weeks 4 and 8. The incremental cost-utility ratio (ICUR) was calculated to evaluate the cost-effectiveness between the groups. Adverse events (AEs) were assessed at all visits. Results: Mean ODI scores for the experimental and control groups were -9.44 (95% confidence interval [CI]: -12.71, -6.17) and -2.16 (95% CI: -5.01, 0.69) at week 4, and -9.04 (95% CI: -12.09, -5.99) and -4.76 (95% CI: -7.68, -1.84) at week 8, respectively. The difference in ODI score changes was significant between the groups at week 4 (p = 0.0021). The ICUR of the experimental group versus the control group was as economical as 18,267,754 won/quality-adjusted life years. No serious AEs were observed. Conclusions: These results demonstrate the potential clinical effectiveness and cost-effectiveness of acupotomy combined with ESI for lumbosacral radiculopathy and its feasibility for a full-scale study. Larger, long-term follow-up clinical trials are needed to confirm these findings.

Reliability Analysis of Vertebral Landmark Labelling on Lumbar Spine X-ray Images.

Vertebral landmark labelling on X-ray images is important for objective and quantitative diagnosis. Most studies related to the reliability of labelling focus on the Cobb angle, and it is difficult to find studies describing landmark point locations. Since points are the most fundamental geometric feature that can generate lines and angles, the assessment of landmark point locations is essential. The aim of this study is to provide a reliability analysis of landmark points and vertebral endplate lines with a large number of lumbar spine X-ray images. A total of 1000 pairs of anteroposterior and lateral view lumbar spine images were prepared, and 12 manual medicine experts participated in the labelling process as raters. A standard operating procedure (SOP) was proposed by consensus of the raters based on manual medicine and provided guidelines for reducing sources of error in landmark labelling. High intraclass correlation coefficients ranging from 0.934 to 0.991 verified the reliability of the labelling process using the proposed SOP. We also presented means and standard deviations of measurement errors, which could be a valuable reference for evaluating both automated landmark detection algorithms and manual labelling by experts.

Multifractal Nonlinearity Moderates Feedforward and Feedback Responses to Suprapostural Perturbations.

An adaptive response to unexpected perturbations requires near-term and long-term adjustments over time. We used multifractal analysis to test how nonlinear interactions across timescales might support an adaptive response following an unpredictable perturbation. We reanalyzed torque data from 44 young and 24 older adults who performed a single-leg squat task challenged by an unexpected mechanical perturbation and a secondary visual-cognitive task. We report three findings: (a) multifractal nonlinearity interacted with pre-perturbation torque production and task error to presage greater pre-voluntary feedforward increases and greater voluntary reductions, respectively, in post-perturbation task error; (b) multifractal nonlinearity presaged relatively smaller task error than standard deviations of both pre-perturbation torques and pre-perturbation task error; and (c) increased task demand (e.g., age-related changes in dexterity and dual-task settings) led to multifractal nonlinearity presaging reduced task error. All these results were consistent with our expectations, except that a pre-perturbation knee torque-dependent increase in post-perturbation task error appeared later for older than for younger participants. This correlational multifractal modeling offered theoretical clarity on the possible roles of nonlinear interactions across timescales, moderating both feedforward and feedback processes, and presaging greater stability when the standard deviation is relatively large and task demands are strong. Thus, multifractal nonlinearity usefully describes movement variability even when paired with classical descriptors like the standard deviation. We discuss potential insights from these findings for understanding suprapostural dexterity and developing rehabilitative interventions.

The self-annealing phenomenon of electrodeposited nano-twin copper with high defect density.

Electroplated copper was prepared under typical conditions and a high defect density to study the effect of the defects on its self-annealing phenomenon. Two conditions, grain growth and stress relaxation during self-annealing, were analyzed with electron backscattered diffraction and a high-resolution X-ray diffractometer. Abnormal grain growth was observed in both conditions; however, the grown crystal orientation differed. The direction and relative rate at which abnormal grain growth proceeds were specified through textured orientation, and the self-annealing mechanism was studied by observing the residual stress changes over time in the films using the sin2Ψ method.

Comparison of Concordance between Chuna Manual Therapy Diagnostic Methods (Palpation, X-ray, Artificial Intelligence Program) in Lumbar Spine: An Exploratory, Cross-Sectional Clinical Study.

Before Chuna manual therapy (CMT), a manual therapy applied in Korean medicine, CMT spinal diagnosis using palpation or X-ray is performed. However, studies on the inter-rater concordance of CMT diagnostic methods, concordance among diagnostic methods, and standard CMT diagnostic methods are scarce. Moreover, no clinical studies have used artificial intelligence (AI) programs for X-ray image-based CMT diagnosis. Therefore, this study sought a feasible and standard CMT spinal diagnostic method and explored the clinical applicability of the CMT-AI program. One hundred participants were recruited, and the concordance within and among different diagnostic modalities was analyzed by dividing them into manual diagnosis (MD), X-ray image-based diagnosis (XRD) by experts and non-experts, and XRD using a CMT-AI program by non-experts. Regarding intra-group concordance, XRD by experts showed the highest concordance (used as a gold standard when comparing inter-group concordance), followed by XRD using the AI program, XRD by non-experts, and then MD. Comparing diagnostic results between the groups, concordance with the gold standard was the highest for XRD using the AI program, followed by XRD by non-experts, and MD. Therefore, XRD is a more reasonable CMT diagnostic method than MD. Furthermore, the clinical applicability of the CMT-AI program is high.

Sympathetic Vagal Balance and Cognitive Performance in Young Adults during the NIH Cognitive Test.

Compromised cognitive function is associated with increased mortality and increased healthcare costs. Autonomic nervous system arousal, as measured by an electrocardiogram (ECG), has received recent attention because of its association with the blood perfusion of brain regions involved with cognitive function. The purposes of this study were to determine whether the ECG HR variation, as measured by the standard deviation of the heart rate N-to-N intervals (SDNN), and sympathetic vagal tone, as estimated by the low-frequency/high-frequency ratio (LF/HF), are increased with cognitive performance during the NIH Cognitive Test (Picture Sequence, Dimensional Change Card Sort, Flanker, and List Sorting). A total of 62 young people without cognitive impairment participated in this study. We discovered that the ECG LF/HF ratio was increased in the top 50% of participants who could: (1) inhibit information and stay attentive to a desired task during the Flanker Test; (U = 329, p = 0.03; R2 = 0.76); and (2) promote cognitive function flexibility during the DCCS Test; (U = 55, p = 0.007; R2 = 0.98). Taken together, these findings support that the arousal level influences performance during a cognitive test.

A comparative study of a nerve block therapy with and without a deeply inserted acupotomy applied to hyeopcheok points for lumbosacral radiculopathy: Safety, effectiveness, cost-effectiveness (a randomized controlled, two-arm, parallel study, pilot study, assessor-blind).

INTRODUCTION: The prevalence of lumbosacral radiculopathy is estimated to be approximately 3% to 5% in patient populations. Lumbosacral radiculopathy is largely caused by a complex interaction between biomechanical and biochemical factors. Nerve block therapy (NBT) mainly treats lumbosacral radiculopathy by improving the biochemical factors, whereas acupotomy mainly focuses on improving the biomechanical factors. Therefore, it is thought that synergistic effects may be obtained for the treatment of lumbosacral radiculopathy when both NBT and acupotomy are combined. However, no study in China and Korea, where acupotomy is majorly provided, has reported the effects of such a combination treatment. Therefore, this study aimed to evaluate the safety, effectiveness, and cost-effectiveness of the concurrent use of a deeply inserted acupotomy and NBT for the treatment of lumbosacral radiculopathy. METHODS/DESIGN: This is an open-label, parallel, assessor-blinded, randomized controlled trial, which will include 50 patients with lumbosacral radiculopathy. After patients voluntarily agree to participate in the study, they will be screened, and will undergo necessary examinations and tests according to the protocol. Those who satisfy the selection criteria will be randomly assigned to either the NBT + acupotomy or NBT groups in a 1:1 ratio. Both groups will undergo 2 NBTs once every 2 weeks from 1 week after the screening test. The treatment group will receive additional acupotomy twice a week for 4 weeks. The primary endpoint is the Oswestry Disability Index, whereas the secondary endpoints are the Numeral Rating Scale, European Quality of Life 5-dimension, McGill pain Questionnaire, Roland-Morris Disability Questionnaire, safety assessment, and economic feasibility evaluation. The measurements will be made at 0, 2, 4, and 8 weeks. ETHICS AND DISSEMINATION: This trial has received complete ethical approval from the Ethics Committee of Catholic Kwandong University International St. Mary's Hospital (IS20OISE0085). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences.

Extracellular to Intracellular Body Water and Cognitive Function among Healthy Older and Younger Adults.

Compromised cognitive function is associated with increased mortality and increased healthcare costs. Physical characteristics including height, weight, body mass index, sex, and fat mass are often associated with cognitive function. Extracellular to intracellular body water ratio offers an additional anthropometric measurement that has received recent attention because of its association with systemic inflammation, hypertension, and blood−brain barrier permeability. The purposes of this study were to determine whether extracellular to intracellular body water ratios are different between younger and older people and whether they are associated with cognitive function, including executive function and attention, working memory, and information processing speed. A total of 118 healthy people (39 older; 79 younger) participated in this study. We discovered that extracellular to intracellular body water ratio increased with age, was predictive of an older person's ability to inhibit information and stay attentive to a desired task (Flanker test; R2 = 0.24; p < 0.001), and had strong sensitivity (83%) and specificity (91%) to detect a lower executive function score. These findings support that extracellular to intracellular body water ratio offers predictive capabilities of cognitive function, even in a healthy group of elderly people.

Cognitive function, quality of life, and aging: relationships in individuals with and without spinal cord injury.

Background: Correlations between aging, cognitive impairment and poor quality of life (QOL) have been observed for many patient populations.Objective: The purpose of this study was to examine these correlations in individuals with and without spinal cord injury (SCI).Methods: 23 individuals with complete SCI and 20 individuals without SCI ("NON") underwent assessment of cognitive function via the NIH Toolbox for Neurological and Behavioral Function. Participants self-rated QOL via global and symptom/domain-specific measures.Results: SCI rated global QOL to be lower than NON for the EQ-5D QALY (p < .001), but not the EQ-5D VAS, which imposes no penalty for wheeled mobility. Low QOL clustered mainly in domains pertaining to physical function/symptoms. Participants with SCI reported high QOL for positive affect/well-being and resilience. Cognitive function in SCI did not differ from NON. However, strong correlations between age and cognition observed in NON (all R2 > 0.532) were absent in SCI. Significant correlations between cognition and QOL were prevalent for NON but not for SCI.Conclusions: Dissociation of age, cognition and QOL occurred with SCI. Divergence between EQ-5D QALY and VAS suggests that individuals with SCI may recalibrate personal assessments of QOL in ways that minimize the importance of mobility impairment.

Comparison of concordance between chuna manual therapy diagnosis methods (palpation, X-ray, artificial intelligence program) in lumbar spine: An exploratory, cross-sectional, prospective observational study protocol.

INTRODUCTION: Chuna manual therapy (CMT) is a type of manual medicine practiced by Korean medical doctors in South Korea. Spinal diagnosis in CMT uses a system that applies manual diagnostic and X-ray tests to detect specific vertebral malpositions, based on the relative alignment across vertebral bodies. Recently, artificial intelligence (AI) programs have been developed to assist in the radiological diagnosis of CMT using X-ray images. Nevertheless, a few clinical studies have reported on the concordance between diagnosticians, diagnostics methodologies, and the use of AI programs for diagnosing CMT. At present, the evidence to support CMT diagnosis is insufficient. This study thus aims to overcome such limitations by collecting and comparing CMT diagnostic data from experts and non-experts through manual diagnosis, X-ray test, and images obtained using an AI program. The study aims to search for CMT diagnosis methods with more outstanding rationality and consistency and to explore the potential use of AI-based CMT diagnosis programs. METHODS/DESIGN: This study will be conducted as an exploratory, cross-sectional, prospective observational study that will recruit 100 non-specialist subjects. Each subject will submit a signed consent after the screening test and undergo L-spine standing AP & lateral X-ray imaging. Manual CMT diagnosis will be performed by 3 CMT experts according to the standard operation procedure (SOP). The X-ray images of the 100 subjects will subsequently be used to make the CMT radiological diagnoses according to the same SOP by the CMT expert group (n = 3) and CMT non-expert group (n = 3). Among the subjects, those in the non-expert group will receive another CMT radiological diagnosis with spinal data obtained using the AI program, approximately 1 month from after initial diagnosis.Based on the collected diagnostic data, within- and between-group concordance levels will be assessed for each diagnostic method. The verified level of concordance will be used to test the potential use of CMT diagnostic method and CMT AI programs with high levels of rationality and consistency. ETHICS AND DISSEMINATION: This trial has received complete ethical approval from the Wonkwang University Korean Medicine Hospital (IRB 2021-8). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences. TRIAL REGISTRATION: https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&search_page=M&pageSize=10&page=undefined&seq=20613&status=5&seq_group=20613, Identifier: KCT0006707.

Study of Cu Electrochemical Polishing Mechanism With Observation of Water Acceptor Diffusion.

The salt-film and water acceptor mechanisms were generally accepted mechanisms for Cu electrochemical polishing (ECP) theory. These mechanisms of Cu ECP are still controversial for a long time. Conventional and new electrochemical analysis methods were used to investigate the mechanisms and behaviors of Cu electrochemical polishing. Two cases of Cu dissolution, with and without polishing, were classified by results of linear scan voltammetry (LSV) and scanning electron microscopy (SEM). The electrochemical impedance spectroscopy (EIS) results showed the main difference in these two cases was in the low-frequency region. However, it was hard to distinguish between the salt-film and water acceptor mechanisms by conventional electrochemical analysis. A scanning electrochemical microscopy (SECM) system, a new electrochemical analysis method that measures the electrolysis currents of the water acceptors along with a set distance from the substrate, was used to investigate the Cu ECP mechanism. Accordingly, the diffusion of the water acceptors was successfully confirmed for the first time. Finally, the mechanisms of the Cu ECP are definitively described by using all analysis results.

Efficacy and safety of acupuncture treatment as an adjunctive therapy after knee replacement: Single-center, pragmatic, randomized, assessor blinded, pilot study.

INTRODUCTION: Total knee replacement (TKR) is a surgical procedure that is being increasingly performed as a result of population aging and the increased average human life expectancy in South Korea. Consistent with the growing number of TKR procedures, the number of patients seeking acupuncture for relief from adverse effects, effective pain management, and the enhancement of rehabilitative therapy effects and bodily function after TKR has also been increasing. Thus, an objective examination of the evidence regarding the safety and efficacy of acupuncture treatments is essential. The aim of this study is to verify the hypothesis that the concurrent use of acupuncture treatment and usual care after TKR is more effective, safe, and cost-effective for the relief of TKR symptoms than usual care therapy alone. METHODS/DESIGN: This is an open-label, parallel, assessor-blinded randomized controlled trial that includes 50 patients with TKR. After screening the patients and receiving informed consent, the patients are divided into two groups (usual care + acupuncture group and usual care group); the patients will then undergo TKR surgery and will be hospitalized for 2 weeks. The patients will receive a total of 8 acupuncture treatments over 2 weeks after surgery and will be followed up at 3, 4, and 12 weeks after the end of the intervention. The primary outcome is assessed using the Korean version of the Western Ontario and McMaster Universities Arthritis Index (K-WOMAC), and the secondary outcome is measured using the Numerical Rating Scale (NRS), Risk of Fall, and Range of Motion (ROM). Moreover, the cost per quality-adjusted life years (QALYs) is adopted as a primary economic outcome for economic evaluation, and the cost per NRS is adopted as a secondary economic outcome. ETHICS AND DISSEMINATION: This trial has received complete ethical approval from the Ethics Committee of Catholic Kwandong University International St. Mary's Hospital (IS17ENSS0063). We intend to submit the results to a peer-reviewed journal and/or conferences. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03633097.

Motor demands of cognitive testing may artificially reduce executive function scores in individuals with spinal cord injury.

Objective: To determine whether the motor demands of cognitive tests contribute to differences in cognitive function scores in participants with and without spinal cord injury (SCI).Design: Cohort study.Setting: Rehabilitation research laboratory.Participants: 68 individuals without SCI ("NON") and 22 individuals with motor complete SCI ("SCI").Interventions: None.Outcome Measures: NIH Toolbox cognitive assessments, including two with motor demands and reaction-time based scoring (Dimensional Change Card Sort (DCCS), Flanker Inhibitory Control and Attention (Flanker) and two without timed scoring (List Sorting Working Memory (List Sorting), Picture Sequence Memory Test (Picture Sequence). Tests were administered with and without the assistance of a proctor on two randomly-determined days (>24 hr interval). For DCCS and Flanker, the motor-task score offset was estimated as the difference between the proctored and non-proctored scores.Results: For demographically-corrected data, proctoring reduced DCCS and Flanker scores (P < 0.001) but mitigated apparent differences between SCI and NON (all P > 0.403). SCI and NON did not differ for List Sorting (P > 0.072) but did differ significantly for Picture Sequence (P < 0.001). Significant practice effects existed for memory-based tests (List Sorting and Picture Sequence); all P < 0.015, effect size>0.645.Conclusions: DCCS and Flanker scores for individuals with SCI may be artificially reduced consequent to secondary motor demands of the tests. Proctoring and computation of a motor-response score offset enables comparisons to be made between individuals with SCI and a Non-SCI control cohort; however, further work is needed to determine whether offset-adjusted scores can be compared to standardized normative values.

Effect of Pulse Current and Pre-annealing on Thermal Extrusion of Cu in Through-Silicon via (TSV).

Thermal stress induced by annealing the Cu filling of through-silicon vias (TSVs) requires further investigation as it can inhibit the performance of semiconductor devices. This study reports the filling behavior of TSVs prepared using direct current and pulse current Cu electrodeposition with and without pre-annealing. The thermal extrusion of Cu inside the TSVs was studied by observing the extrusion behavior after annealing and the changes in grain orientation using scanning electron microscopy and electron backscatter diffraction. The bottom-up filling ratio achieved by the direct current approach decreased because the current was used both to fill the TSV and to grow bump defects on the top surface of the wafer. In contrast, pulse current electrodeposition yielded an improved TSV bottom-up filling ratio and no bump defects, which is attributable to strong suppression and thin diffusion layer. Moreover, Cu deposited with a pulse current exhibited lesser thermal extrusion, which was attributed to the formation of nanotwins and a change in the grain orientation from random to (101). Based on the results, thermal extrusion of the total area of the TSVs could be obtained by pulse current electrodeposition with pre-annealing.

A systematic review and meta-analysis of the efficacy of acupuncture and electroacupuncture against chemotherapy-induced peripheral neuropathy.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) occurs in 68.1% of patients within the first month of undergoing chemotherapy; however, standardized treatment for CIPN has not been established yet. The efficacy of acupuncture, a widely used treatment for CIPN in South Korea, has not been studied sufficiently. This study aimed to review the studies that evaluated the efficacy of acupuncture or electroacupuncture (EA) in treating CIPN. METHODS: A literature search was performed on relevant international databases - MEDLINE, Embase, the Allied and Complementary Medicine Databases, and China National Knowledge Infrastructure - as well as Korean databases - the National Digital Science Library, Oriental Medicine Advanced Searching Integrated System, DBpia, and Korean Studies Information Service System. Randomized controlled trials (RCTs) that aimed to treat CIPN symptoms with acupuncture or EA and set not only a control group with a conventional pharmacological treatment or injection, but also a placebo control or sham-acupuncture group, were included. Meta-analysis was conducted to elucidate the efficacy of acupuncture/EA on the basis of symptom score. RESULTS: Of the 13 studies included in the literature review, 12 RCTs compared acupuncture and pharmacological treatments. There were 3 EA RCTs, but only 1 RCT compared EA and sham-EA. A total of 832 participants were included in these studies. Five RCTs showed that acupuncture was more effective than pharmacological treatment in terms of efficacy rate. Regarding the risk of bias summary, the quality of included studies was poor. Only 1 study compared the efficacy of EA and sham EA; therefore, the specific efficacy of acupuncture could not be elucidated. CONCLUSION: Acupuncture is safe, but the symptom-alleviating effect on CIPN can hardly be determined because of methodological deficiencies of the included studies. In terms of the clinical efficacy rate, acupuncture was more effective than conventional pharmacological treatments. PROSPERO REGISTRATION NUMBER: CRD42018111509.

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint.

PURPOSE: The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation. PATIENTS AND METHODS: Between January 2007 to December 2016, nineteen patients - 14 men and 5 women with an average age of 40.9 (19 to 64) years - were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed. RESULTS: All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10-83° in the screw group, 8-87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis. CONCLUSION: Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.