The efficacy of Schroth exercises combined with the Chêneau brace for the treatment of adolescent idiopathic scoliosis: a retrospective controlled study.

PURPOSE: We aimed to determine the global effects of the Chêneau brace combined with Schroth exercises on adolescent idiopathic scoliosis (AIS). METHODS: We analyzed 192 patients with AIS who underwent the Chêneau brace treatment alone or combined with Schroth best practice (SBP) from June 2013 to October 2019. There were 138 patients in the Brace group and 54 patients in the Brace + SBP group. Radiographs were obtained at various treatment durations. Answers to the health-related quality of life (HRQoL) questionnaire were recorded before the intervention and at the time of treatment wean. RESULTS: The Cobb angle (-3.55°; p < 0.001) and C7-CSVL (-3.03 mm; p < 0.001) significantly decreased in the Brace + SBP group. Thoracic kyphosis (TK) decreased in both the Brace + SBP group (-1.85°; p = 0.0152) and the Brace group (-5.06; p < 0.001). Changes before and after treatment of TK were significantly different between groups (p < 0.001). The 22-item Scoliosis Research Society function score, self-image, mental health, and EuroQol 5-Dimension scores were significantly higher in the Brace + SBP group. The satisfaction score was higher in the Brace + SBP group (3.77 ± 0.63 vs. 3.13 ± 0.79; p < 0.001). CONCLUSIONS: Compared to bracing alone, the Schroth exercises plus bracing had a better effect on coronal balance. Schroth exercises improve flatback deformity caused by bracing and positively influence the HRQoL in AIS patients who received the Chêneau brace treatment.Implications for RehabilitationBracing and physiotherapy are common treatments for adolescent idiopathic scoliosis (AIS).The Chêneau brace treatment causes flatback deformity and muscle stiffness in AIS patients.The Schroth method helps patients increase muscle strength, halt curve progression, increase vital capacity, and maintain improved posture.The Schroth exercises could improve flatback deformity caused by bracing and positively influence the health-related quality of life in AIS patients who received the Chêneau brace treatment.

Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management.

PURPOSE: To establish a classification system for the different types of posterior tibial plateau fractures (PTPF), and to explore the fracture patterns and early results of treatment. METHODS: 39 PTPFs patients who received surgeries through posteromedial or (and) posterolateral knee approaches were analyzed retrospectively. RESULTS: There were 5 types of PTPFs identified in the new classification system: posteromedial split fracture (type I, 7 patients), posterolateral split fracture (type II, 5 patients), posterolateral depression fracture (type III, 11 patients), posterolateral split and depression fracture (type IV, 2 patients), and posteromedial split combined with posterolateral depression fracture (type V, 14 patients). All patients underwent surgeries safely without complications. The average follow up was 18.1 months (12-30 months). The average weight-bearing durations were 15.6 weeks (12-20 weeks). Based on Rasmussen functional scoring system, 20 cases were regarded as excellent, 14 were good, 5 were fair, and 0 was poor. There was significant change in the Rasmussen functional score before (8.38 ± 2.87) and after surgery (24.20 ± 3.44). According to Rasmussen radiology system, 28 cases were excellent, 8 cases were good, 3 were fair, and none was poor. There was also a significant difference detected between pre-operation (6.77 ± 2.27) and post-operation (16.41 ± 2.65). CONCLUSION: This study presents a new classification system for the different types of PTPFs based on the treatment. The classification is clinically relevant and can be used to guide the surgical management.

A biomechanical study on the interosseous membrane and radial head in cadaveric forearms.

OBJECTIVE: Our aim was to evaluate the biomechanical properties of the interosseous membrane (IOM) and radial head and investigate the pathomechanics of the Essex-Lopresti injury. METHODS: Twelve adult fresh frozen upper limbs of human cadavers were chosen for test. First, the 12 intact specimens were mounted onto a materials testing machine to carry out biomechanical tests in pronation, supination and neutral positions, respectively. An axial load of 100 N was applied along the longitudinal axis of the forearm for 30 seconds in each position. Then, the twelve specimens were randomly divided into two groups. The radial head was resected in 6 specimens. And the central band of IOM was severed in another 6 specimens. Each group was tested by the same method. Finally, both the radial head and the IOM were excised in all specimens and biomechanical tests were performed. RESULTS: The rotational position of the forearm or simple severance of the IOM had no effect on longitudinal displacement. The radial longitudinal displacement increased significantly after resection of the radial head. The severance of the IOM had no effect on compressive stiffness of the radius. However, compressive stiffness of the radius decreased significantly after resection of the radial head. CONCLUSION: The radial head fracture combined with the IOM injury was the most important cause of the Essex-Lopresti injury, and the radial head fracture was the major factor. The IOM was the major structure to maintain the longitudinal stability of the forearm after resection of the radial head.

[Comparison between pavlik harness and bryant traction for femoral shaft fractures in infants].

OBJECTIVE: To compare clinical effects between Pavlik harness and Bryant traction in treating femoral shaft fractures in infants,including the time of hospitalization, expense of treatment, complications,time of bone union. METHODS: From May 2005 to August 2010,the clinical data of 42 infants with femoral shaft fractures were retrospectively analyzed. Among the patients, 23 cases were treated with Pavlik harness(Pavlik harness group),there were 14 males and 9 females,ranging in age from 1 to 12 months with an average of (5.5+/-2.4) months,including upper 1/3 segment of 16 cases and middle segment of 7 cases; transverse fracture of 18 cases and oblique fracture of 5 cases. The other 19 patients were treated with Bryant traction (Bryant traction group),there were 15 males and 4 females,ranging in age from 2 to 12 months with an average of (6.7+/-2.8) months,including upper 1/3 segment of 13 cases and middle segment of 6 cases;transverse fracture of 12 cases and oblique fracture of 7 cases. The time of hospitalization,expense of treatment,complications,time of bone union were analyzed in the patients. RESULTS: All patients were followed up with an average of 25.3 months (ranging from 19 to 30) in Pavlik harness group and 23.7 months (ranging from 17 to 28) in Bryant traction group. Time of hospitalization, expense of treatment in Pavlik harness group were respectively (0.4+/-0.7) d, (2147.7+/-64.9) yuan; and in Bryant traction group were respectively(27.1+/-2.2) d, (2741.3+/-227.6) yuan;there was significant difference between two groups(P<0.05). No complication was found in Pavlik harness group and 8 cases complicated with skin hydroa in Bryant traction group, there was significant difference between two groups (P<0.05). Time of bone union,difference of both lower extremities in Pavlik harness group were respectively (4.1+/-0.3)weeks, (6.3+/-4.1) mm;and in Bryant traction group were respectively (3.9+/-0.3) weeks, (7.6 +/-4.3) mm; 20 cases got bone healing in Pavlik harness group and 18 cases got bone healing in Bryant traction group;there was no significant difference between two groups (P>0.05). CONCLUSION: Compared with Bryant traction method,Pavlik harness method has obvious advantages in time of hospitalization, expense of treatment, complications in treating femoral shaft fractures in infants.

Treatment of unstable posterior pelvic ring fracture with percutaneous reconstruction plate and percutaneous sacroiliac screws: a comparative study.

OBJECTIVE: The aim of this study is to compare the clinical effects of percutaneous reconstruction plate and percutaneous sacroiliac screws in treatment of unstable posterior pelvic ring fracture. METHODS: Fifty-eight patients with unstable posterior pelvic ring fracture treated with two methods from March 2002 to October 2007 were enrolled in the study and divided into two groups according to two kinds of internal fixation: percutaneous reconstruction plate (20 males and 9 females, at mean age 37.3 ± 11.3 years) and percutaneous sacroiliac screws (21 males and 8 females, at mean age 39.3 ± 10.4 years). Causes of injury included traffic accident in 38 patients, fall from height in 17, and crush in 3. The correlative data of operation duration, number of X-ray exposures, intraoperative bleeding volume, length of incision, Majeed postoperative functional evaluation, and postoperative complications were analyzed statistically. RESULTS: All 58 patients were followed up for 12-36 months (mean duration 21.3 months). There was statistical difference for operation duration, number of X-ray exposures, size of incision, and intraoperative bleeding volume between the two groups. Majeed postoperative functional evaluation indicated excellent and good rates of 86.1% for percutaneous reconstruction plate and 88.2% for percutaneous sacroiliac screws. CONCLUSIONS: The clinical effect of the two methods is similar in treatment of Tile C pattern posterior pelvic ring fracture. However, the percutaneous reconstruction plate has lower risk of damaging nerves and blood vessels than the percutaneous sacroiliac screws. Moreover, intraoperative fluoroscopy is rarely performed.

Anatomical and biomechanical study on the interosseous membrane of the cadaveric forearm.

OBJECTIVE: To study the anatomical and biomechanical features of the interosseous membrane (IOM) of the cadaveric forearm. METHODS: Ten radius-IOM-ulna structures were harvested from fresh-frozen cadavers to measure the length, width and thickness of the tendinous portion of IOM. Then, the tendinous portion was isolated along with the ulnar and radial ends to which the tendon attached after measurement. The proximal portion of the radius and the distal portion of the ulna were embedded and fixed in the dental base acrylic resin powder. The embedded specimen was clamped and fixed by the MTS 858 test machine using a 10 000 N load cell for the entire tensile test. IOM was stretched at a speed of 50 mm/min until it was ruptured. The load-displacement curve was depicted with a computer and the maximum load and stiffness were recorded at the same time. RESULTS: The IOM of the forearm was composed of three portions: central tendinous tissue, membranous tissue and dorsal affiliated oblique cord. IOM was stretched at a neutral position, and flexed at pronation and supination positions. The tendinous portion of IOM was lacerated in 6 specimens when the point of the maximum load reached to 1021.50 N+/-250.13 N, the stiffness to 138.24 N/m+/-24.29 N/m, and the length of stretch to 9.77 mm+/-1.77 mm. Fracture occurred at the fixed end of the ulna before laceration of the tendinous portion in 4 specimens when the maximum load was 744.40 N+/-109.85 N, the stiffness was 151.17 N/m+/-30.68 N/m, and the length of the stretch was 6.51 mm+/-0.51 mm. CONCLUSIONS: The IOM of the forearm is a structure having ligamentous characteristics between the radius and the ulna. It is very important for maintenance of the longitudinal stability of the forearm. The anatomical and biomechanical data can be used as an objective criterion for evaluating the reconstructive method of IOM of the forearm.