ABSTRACT
Virtual reality (VR), coupled with motion tracking, can investigate walking in a controlled setting while applying various walking challenges. The purpose of this review was to summarize the evidence on consequences of VR on biomechanical gait parameters in children with cerebral palsy. MEDLINE, Embase and Web of Science were searched. Among 7.574 studies, screened by two independent reviewers, seven studies were included, analyzing treadmill (n = 6) or overground walking (n = 1) under VR. Most frequently reported were the spatiotemporal parameters walking speed, stride length, step width, stance phase, and the kinematic parameters range of knee flexion and peak ankle dorsiflexion. However, methodological approaches and reporting of the results were inconsistent among studies. This review reveals that VR can complement information gained from clinical gait analysis. However, this is still an emerging field of research and there is limited knowledge on the effect of VR on gait parameters, notably during overground walking.
Subject(s)
Cerebral Palsy , Virtual Reality , Child , Humans , Gait , Walking , Biomechanical PhenomenaABSTRACT
Fractures of the anterior tibial tuberosity are uncommon, ranging from 0.4% to 2.7% of all epiphyseal lesions reported. Bilateral sequential fractures are even rarer, with less than twenty-eight cases described to date and, as such, there is very little consensus data on their treatment as a whole. We report the first two documented cases of bilateral tibial tuberosity avulsions of the anterior tubercle in Switzerland, treated by open reduction and internal fixation. Both cases were 14-year-old healthy males with no previous medical history, who both suffered extra-articular fractures after falling from a height. The first case was treated in 2012 with a four-year long clinical follow-up and full recovery. The second, treated in 2019, was clinically followed for one year with a complete recovery and has returned to sporting activity at a pre-injury level. Due to the rarity of the condition, a lack of consensus on the optimal therapy, we believe the documentation of these two cases treated by the same team may be of clinical relevance.
ABSTRACT
Clavicular fractures are some of the most common bone injuries in the paediatric population, yet the rates of nonunion are very low under 18 years. To the best of our knowledge, posttraumatic nonunion of the clavicle in a paediatric population is rarely reported. We report the case of an 11-year-old girl who presented with a nondislocated fracture of the midshaft to the proximal third of the right clavicle. Initial conservative treatment by sling immobilization demonstrated radiologically confirmed healing at 3 months. However, at 1-year follow-up, she presented with painful nonunion. Diagnostic MRI and CT exams confirmed a pseudoarthrosis, requiring elective open reduction and internal fixation with the aid of an ipsilateral iliac crest bone graft.
ABSTRACT
BACKGROUND: Neglected osseous glenoid defects are thought to be one of the reasons for the reported high rates of recurrent instability at long-term follow-up after Bankart repair. We hypothesized that open Bankart repair for the treatment of anterior glenohumeral instability in the absence of a substantial osseous glenoid defect would result in a lower long-term recurrence rate than has been reported in previous long-term studies. METHODS: Forty-seven patients were treated with a primary modified open Bankart repair for recurrent anterior shoulder instability between 1989 and 1994. Double-contrast computed tomography scanning was used to exclude patients with a substantial osseous glenoid defect. Forty patients (85.1%) were available for subjective and objective follow-up at a minimum of twenty years (maximum, twenty-five years). Twenty-six patients (65%) underwent clinical examination as well as bilateral shoulder radiography, and fourteen (35%) completed a self-assessment questionnaire and were interviewed by telephone. RESULTS: Seven patients (17.5%) had a recurrence of instability, and six of them had the instability occur after more than eight years without symptoms. The mean Western Ontario Shoulder Instability Index score (and standard deviation) was 256.7 ± 284.8 points; the mean Rowe score, 88.7 ± 12.0 points; and the mean Subjective Shoulder Value, 90.1% ± 10.5%.The mean range of motion of the affected shoulder was decreased by 4° of abduction (p = 0.009), two levels of internal rotation (p = 0.003), 5° of internal rotation in 90° of abduction (p = 0.005), 7° of external rotation in neutral position (p < 0.001), and 7° of external rotation in 90° of abduction (p = 0.004) compared with the contralateral side. The collective instability arthropathy (CIA) index was 0.92 for the affected side and 0.35 for the contralateral side. CONCLUSIONS: Open Bankart repair provides good results twenty years after surgery in terms of subjective and objective outcome measurements. However, the long-term failure rate remains high despite the exclusion of substantial osseous glenoid defects. Recurrence of instability seems to be associated with an increased shoulder-specific activity level. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
