Build better bones with exercise (B3E pilot trial): results of a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in older women with vertebral fracture.

We pilot-tested a trial of home exercise on individuals with osteoporosis and spine fracture. Our target enrollment was met, though it took longer than expected. Participants stayed in the study and completed the exercise program with no safety concerns. Future trials should expand the inclusion criteria and consider other changes. PURPOSE: Osteoporotic fragility fractures create a substantial human and economic burden. There have been calls for a large randomized controlled trial examining the effect of exercise on fracture incidence. The B3E pilot trial was designed to evaluate the feasibility of a large trial examining the effects of home exercise on individuals at high risk of fracture. METHODS: Community-dwelling women ≥ 65 years with radiographically confirmed vertebral compression fractures were recruited at seven sites in Canada and Australia. We randomized participants in a 1:1 ratio to a 12-month home exercise program or equal attention control group, both delivered by a physiotherapist (PT). Participants received six PT home visits in addition to monthly phone calls from the PT and a blinded research assistant. The primary feasibility outcomes of the study were recruitment rate (20 per site in 1 year), retention rate (75% completion), and intervention adherence rate (60% of weeks meeting exercise goals). Secondary outcomes included falls, fractures and adverse events. RESULTS: One hundred forty-one participants were recruited; an average of 20 per site, though most sites took longer than anticipated. Retention and adherence met the criteria for success: 92% of participants completed the study; average adherence was 66%. The intervention group did not differ significantly in the number of falls (IRR 0.97, 95% CI 0.58 to 1.63) or fragility fractures (OR 1.11, 95% CI 0.60 to 2.05) compared to the control group. There were 18 serious adverse events in the intervention group and 12 in the control group. CONCLUSION: An RCT of home exercise in women with vertebral fractures is feasible but recruitment was a challenge. Suggestions are made for the conduct of future trials.

Investigation of the static and dynamic musculotendinous architecture of supraspinatus.

To date, the architecture of supraspinatus (SP) and its relation to joint position has not been investigated. The purpose of this study was to quantify the dynamic architecture of the distinct regions of SP using ultrasound (US). Seventeen subjects (8 M/9 F), mean age 36.4 +/- 12.7 years, without tendon pathology were recruited. The SP was scanned in relaxed and contracted states. For the contracted state, SP was scanned with the shoulder actively abducted to 60 degrees and the glenohumeral joint in neutral rotation; 80 degrees external rotation; 80 degrees internal rotation. Fiber bundle length (FBL) and pennation angle (PA) of distinct regions, and muscle thickness were computed. Measurements of the posterior region were limited because of acromion shadowing. Parameters between regions and changes between relaxed and contracted states were analyzed using paired t-tests and repeated measures ANOVA (P < 0.05). On contraction in the anterior region, mean percentage of FBL shortening ranged between 9% and 21%. However, in the posterior region, shortening of approximately 2% only occurred in two of the three positions; lengthening of approximately 2.5% occurred in internal rotation. For the anterior region, the mean PA increased the least in the externally rotated position, and the mean PA of the middle part was smaller than the deep part for all states. Findings suggest changes in the architecture are not uniform throughout the muscle and joint position may play an important role in force production. The US protocol may serve as an outcome measure of adaptive changes of muscle function following surgery, training, and rehabilitation.

Posterior dislocation of the long head of biceps tendon: case report and review of the literature.

Posterior or lateral dislocation of the long head of biceps is a rare complication of shoulder dislocation that can result in inability to relocate the humerus. The diagnosis should be suspected when certain radiographic features are present at the initial presentation. Other imaging modalities can aid diagnosis when clinical management is unsuccessful or protracted. We present a case of surgically proven posterior dislocation of the biceps tendon with conventional radiographic, computed tomography and magnetic resonance imaging assessment. The literature on this subject is reviewed, and imaging features associated with the diagnosis are described.

No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon.

AIM: To study the effects of early weight bearing following acute repair of ruptured Achilles tendon. METHODS: Using a comparative longitudinal study design, following repair of an Achilles tendon rupture, patients in Group 1 were immobilised with their ankle in gravity equinus, were encouraged to weight bear on the operated limb as soon as possible to full weight bearing, and received a single a cast change at 2 weeks, when the ankle was immobilised in a plantigrade position. Patients in Group 2 were immobilised with their ankle in full equinus, and received a cast change at 2 weeks, when the ankle was immobilised in mid equinus, and at 4 weeks, when the ankle was immobilised in a plantigrade position. They were advised to weight bear 4 weeks from the operation. RESULTS: Patients in Group 1 attended less outpatient visits, completely discarded their crutches at an average of 2.5 weeks from the operation (Group 2: average of 5.7 weeks from the operation), (p=0.013), and a greater proportion of them were satisfied with the results of surgery. At ultrasound scan, the average thickness of the repaired tendon was 12.1 mm (SD 2), with no difference in the thickness of the ruptured tendon regardless of the method of postoperative management. There was no significant difference in isometric strength between the two groups of patients. CONCLUSION: Early weight bearing with the ankle plantigrade is not detrimental to the outcome of repair following rupture of the Achilles tendon.

Ultrasound changes to intramuscular architecture of the quadriceps following intramedullary nailing.

BACKGROUND: Disuse atrophy is the basis for profound physiological changes of the muscles of immobilised limbs. The aim of this study was to use high resolution real-time ultrasonography (HRRTU) to assess the quadriceps musculature and to try and measure atrophy. METHODS: We monitored the effects of enforced reduction of mobility due to trauma on the intramuscular architecture of the quadriceps using HRRTU in 13 skeletally mature male patients (43.2 years, range 16 to 82 years), with an isolated unilateral diaphyseal fracture of the femur or of the tibia. All patients had undergone interlocked intramedullary nailing (IIN). Using HRRTU, the pennation angles and muscle fibre lengths of vastus lateralis, the cross sectional area (CSA) of the rectus femoris, and the quadriceps muscle layer thickness (MLT) were measured in the injured and the normal contralateral limb. RESULTS: Repeated measurements showed the technique of measurement of the variables used in this study to be highly reproducible. There was a significant difference in the angle of pennation of the vastus lateralis in the nailed (15.4 degree) and the unnailed limb (21.2 degree), documenting that muscle atrophy causes a change to muscle architecture that results in a significant decrease in pennation angle (p=0.0002). The muscle fibre length was significantly different (p=0.002) and there was a significant correlation between pennation angle and muscle fibre length (r=-0.51, p=0.001). There was also a significant difference in the quadriceps MLT (p=0.001) and CSA of the rectus femoris (p=0.0004) implying that the whole of the quadriceps muscle is affected. CONCLUSIONS: These simple, reproducible, non-invasive ultrasound measurements can easily demonstrate differences in the quadriceps morphology in the nailed and unnailed limb, which could allow individual exercise programme prescription.

Stromal tumour within a Meckel's diverticulum: CT and ultrasound findings.

The incidence of tumours within a Meckel's diverticulum is 0.5-3.2%. Their pre-operative diagnosis is rare. We report a case of an incidentally found gastrointestinal stromal tumour within a Meckel's diverticulum in a patient presenting with acute appendicitis. The tumour was demonstrated pre-operatively by ultrasound and CT.

A comparison of Fleet Phospho-soda with Picolax in the preparation of the colon for double contrast barium enema.

This study was performed to compare the patient acceptability and the efficacy of two different agents for bowel preparation prior to double contrast barium enema. One-hundred and ninety-four outpatients were randomized to have either two sachets of Picolax or two bottles of Fleet Phospho-soda and restricted to clear fluids on the day prior to their examination. Patients answered a short questionnaire before their enema. The decubitus films were assessed for faecal residue and bowel coating by three observers blinded to the type of preparation used. There was no significant difference in faecal residue nor in the bowel coating between the preparations. However patients found Picolax significantly easier to take, being better tasting and provoking less nausea and vomiting than Fleet Phospho-soda.