The relationship of hip loading asymmetry and radiological parameters of the spine in Lenke type 1 idiopathic scoliosis.

BACKGROUND: Idiopathic scoliosis does not only cause structural changes in the spine, but also functional changes of the musculoskeletal system. RESEARCH QUESTION: Does idiopathic scoliosis lead to asymmetric hip loading in severe Lenke type 1 deformity? METHODS: 23 patients (18 girls, 5 boys) aged 15 ± 2.8 years with an adolescent idiopathic main thoracic curve (Cobb angle 48.8°+/- 9.2°) were included. Measured X-ray parameters were: Cobb angle of primary thoracic and secondary lumbar curve, translation of the C7- plumb line, apical thoracic vertebra and apical lumbar vertebra from the central sacral vertical line. Subjects were examined by means of kinematic and kinetic gait analysis. The symmetry index (SI) was calculated as a ratio of hip frontal moments during a single stance for both sides when the symmetrical load was considered SI = 0 + /- 29.36 (0 +/- 1 SD of the mean SI of the healthy population). The Pearson correlation coefficient was used to show the relation between hip loading and radiologic measures of spinal deformity. RESULTS: Only 34.8% of subjects with Lenke type 1 deformity showed symmetrical hip loading. Significant negative correlation was proved between SI and apical thoracic vertebra translation (R = - 0541; p < 0,05) as well as between SI and coronal imbalance (R = -0,5197; p < 0,05). There was no correlation between SI and the magnitude of the primary thoracic curve (R = -0.19; p = 0.385). Coronal imbalance correlates positively with translation of apical thoracic vertebra (R = 0,7255; p < 0,05). SIGNIFICANCE: Two-thirds of subjects with Lenke type 1 deformity showed asymmetrical hip loading. This asymmetry is related to the translation of the apical thoracic vertebra and coronal imbalance and is not related to the magnitude of the main thoracic curve. On the contrary, the secondary lumbar curve plays role in the compensatory mechanism of the trunk.

Long-term donor-site morbidity after thumb reconstruction with twisted-toe technique.

BACKGROUND: Traumatic thumb loss is a serious injury affecting patient´s ability to work and participate in activities of daily life. The main goal for a plastic surgeon is to restore hand grip, often by microsurgical methods. However, patients should be informed of all effects associated with tissue harvesting. The aim of the study was to assess the impact on donor foot and gait cycle in patients who have undergone thumb reconstruction using twisted-toe technique modified by Kempný. MATERIAL AND METHODS: Twelve patients participated in the study: all suffered a thumb loss between the years 2003 and 2011 and the twisted-toe technique for thumb reconstruction was utilized. The changes in foot pressure distribution and lower extremity joint loading were evaluated. RESULTS: The differences in total maximal plantar pressure, pressure time integral, contact area, and maximum force between the affected and non-affected foot were statistically significant (P 0.1). No significant differences of temporal gait parameters between the affected and non-affected extremity were observed; however, statistically significant differences in kinetics parameters, frontal ankle and knee moments were detected. CONCLUSION: Donor limb functionality and anatomical disability were assessed using pedobarography systems and 3D-gait analysis. The recorded differences in plantar pressure distribution (increased pressure in I., IV. and V. metatarsal areas) and overload of the medial compartment of the knee joint were the most significant findings. Therefore, wearing individually adapted shoe insoles as prevention of osteoarthrosis might be beneficial for patients after thumb reconstruction by a twisted-toe technique.