ABSTRACT
STUDY DESIGN: Observational cross-section study. OBJECTIVES: The objective of our study was to determine if the influence of a community environment would impact on ASIA D spinal cord injured (SCI) gait performance patients. Our main hypothesis is that an outdoor community environment may influence gait speed and endurance on community ambulating patients. METHODS: Ten-Meter Walking (10MWT) and Six-Minute Walking (6MWT) tests were performed on community ambulating SCI research participants (n=18) in two different environmental conditions: (1) Experimental (indoors Gymnasium) and (2) Natural (community setting). Average gait speed and endurance values were obtained for the two different conditions and analyzed for statistical significance on the nonparametric two-tailed Wilcoxon signed rank test. RESULTS: While no difference was observed on the 10MWT we found an improvement on gait performance on the 6 MWT on a community setting. CONCLUSIONS: Our study showed mixed results on environmental influence on gait speed and endurance on ASIA D patient population. While there is no difference on the 10 MWT, there is an improvement on gait performance on the communitary 6MWT.
Subject(s)
Exercise Therapy/methods , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/rehabilitation , Spinal Cord Injuries/complications , Adult , Aged , Chronic Disease/psychology , Chronic Disease/rehabilitation , Cross-Sectional Studies , Disability Evaluation , Environment , Environment, Controlled , Exercise Therapy/statistics & numerical data , Exercise Tolerance/physiology , Gait/physiology , Gait Disorders, Neurologic/psychology , Humans , Middle Aged , Physical Endurance/physiology , Physical Therapy Modalities/psychology , Physical Therapy Modalities/statistics & numerical data , Social Facilitation , Treatment OutcomeABSTRACT
Many different techniques have been reported for the treatment of clavicular nonunions. Those techniques involving screws and plate generally position the plate on the superior (subcutaneous) surface of the clavicle. To decrease the risk of screw pull-out and prominence of the instrumentation, we currently perform anteroinferior plating using a 3.5-millimeter pelvic reconstruction plate with a lag screw and bone graft. A consecutive group of twelve patients with midshaft clavicular nonunions was treated with this technique. All nonunions united after an average of 3.6 months (range 2 to 8 months). All patients regained full function and mobility of the shoulder. The technique as described in this article illustrates a successful modification of the traditional plating technique of midshaft clavicular nonunions. We conclude that anteroinferior plating is a reliable and safe technique that leads to high rates of bony union in midshaft clavicular nonunions.
Subject(s)
Bone Plates , Clavicle/injuries , Fractures, Ununited/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Orthopedic Procedures/methods , Retrospective StudiesABSTRACT
OBJECTIVE: To determine the relative amount of fixation of self-reinforced poly-L-lactide (SR-PLLA) rods and Kirschner wires in bovine cancellous bone by comparing their pullout strength DESIGN: An in vitro laboratory study was performed using bovine femurs. Ten two-millimeter-diameter pins of each type were inserted into cancellous bone and then pulled out, using a material testing machine. The maximum force (pullout strength) was selected over other measurements to compare the amount of fixation of the two types of pins. All of the pins were retrieved for microscopic analysis. A paired t test was performed to analyze the differences between the pullout strength of the two types of pins. SETTING: Orthopaedic Bioengineering Laboratory, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A. SPECIMENS: Two young fresh bovine distal femurs, ten two-millimeter-diameter Kirschner wires, ten two-millimeter-diameter bioabsorbable SR-PLLA rods MAIN OUTCOME MEASUREMENTS: Pullout strength in Newtons, and microscopic pin surface aspect after insertion. RESULTS: Significant differences were noted between the maximum force required to remove the two types of pins (p < 0.01) The K-wire mean pullout force was 37.7 N (SD 13.6), and the SR-PLLA rod mean pullout force was 53.6 N (SD 19.3). Microscopic analysis indicated surface modification only on the SR PLLA rods. DISCUSSION: SR-PLLA composites have shown comparable clinical results to their metallic counterparts. In this study, the pullout strength of SR-PLLA rods was compared with that of conventional K-wires. A significant difference (p < 0.01) favoring bioabsorbable pullout strength was noted. The bioabsorbable pin surface modification during insertion is an interesting finding that warrants further investigation as a potential source of improved fixation. CONCLUSION: SR-PLLA rods retain their hold in bovine cancellous bone better than K-wires. This finding offers to the orthopaedic surgeon more information about new pin fixation methods.
Subject(s)
Biomechanical Phenomena , Fracture Fixation/instrumentation , Polyesters/pharmacology , Animals , Bone Nails , Bone Wires , Bony Callus/physiopathology , Cattle , Equipment Safety , Femur , Models, Animal , Probability , Sensitivity and Specificity , Tensile StrengthABSTRACT
Fractures of the pelvic ring in children behave differently than in adults. In children, bone elastic properties allow for plastic deformation instead of complete breaks. To the best of our knowledge no reports of this bony behavior have been described in the sacrum, and this could explain the presence of single displaced anterior breaks without evident posterior pelvic disruption. The objective of this paper is to document a rare type of posterior pelvis trauma: the green-stick fracture of the sacrum.
Subject(s)
Sacrum/injuries , Spinal Fractures/etiology , Adolescent , Humans , MaleABSTRACT
Breakage of an interlocking screw is a known complication in tibial fractures treated by intramedullary nailing. This happens most often in delayed union or nonunion because of the lack of progressive load transference from the nail to the healing bone. To treat this problem, the nail and screws need to be removed. This article describes a simple technique for the removal of broken interlocking screws.
