Validating the measurement of passive Musculo-articular wrist stiffness without intentional or reactive contraction using axillary plexus block.

BACKGROUND: Passive stiffness describes how easily a joint may move passively. To accurately measure wrist stiffness, an electro-oscillation device was developed. The objectives were to 1) ensuring that the measurement are free from intentional or reflex contraction, 2) analyzing how forearm anatomy affects the passive stiffness of the wrist and 3) determining the clinical practical relevance of the device. METHODS: In this prospective study, the device generated low amplitude sinusoidal motions in flexion and extension on the wrist to quantify elastic and viscous passive stiffness in voluntary orthopaedic patients. The first series of measurements was carried out in the state of voluntary relaxation, the second series of measurements was carried out after an axillary plexus anesthetic block. A matched group of healthy subjects were use for control. FINDINGS: The Electromechanical Oscillation methods effectively enable the measurement of passive joint stiffness since the stiffness values obtained show no statistically significant difference pre-post the anesthesia. The stiffness values are comparable to those of healthy subjects. The effect of forearm passive structure, estimated by the perimeter of the forearm, influences the passive stiffness of the wrist, mainly the viscous component. INTERPRETATION: The use of sinusoidal oscillation was well accepted by the participants, demonstrating its usefulness and applicability in a clinical setting. This work serves as a foundation for future investigations of orthopaedic and/or neurological pathological conditions characterized by abnormal passive joint stiffness of the wrist. It paves the way for its use as a diagnostic, prognostic, and monitoring tool in these pathologies.

Conservative treatment for iliotibial band syndrome: Are we facing a research gap? A scoping review of 98 studies with clinical perspectives.

OBJECTIVES: To identify which treatment modalities are described in the literature for the conservative management of ITBS (1) and to identify research gap (2). DATABASES: The following electronic databases were searched: MEDLINE/Pubmed, Embase, Scopus and Cochrane Library. ELIGIBILITY CRITERIA: The included studies had to report at least one conservative treatment on a human population suffering from ITBS. RESULTS: 98 studies reached the included criteria and seven categories of treatment were identified, i.e., stretching, adjuvants, physical modalities, injections, strengthening, manual techniques and education. Only 32 studies were designed as original clinical studies within which only 7 were randomized controlled trials, while 66 were review studies. Education, injections and medications as well as stretching were the most cited therapies. However, there was a clear discrepancy design. For example, stretching modalities were reported in 31% and 78% for clinical and review studies, respectively. CONCLUSIONS: There is an objective research gap in the literature concerning conservative ITBS management. The recommendations are mostly based on expert opinions and review article. More high-quality research studies should be performed for enhancing the ITBS conservative management understanding.

Validity and reliability of the assessment of hand flexors stiffness using a new electromechanical oscillatory device in people with stroke.

Hyper-resistance after a central nervous system injury has been largely referred to as spasticity, which is but one of its neural components. Assessment largely relies on clinical scales (Modified Ashworth scale - MAS and Modified Tardieu scale, MTS) which are unable to distinguish between the non-neural (tissue-related) and the neural (central nervous system-related) components. This study assessed criterion validity and reliability (reproducibility) of muscle stiffness measures, namely, maximum elastic stiffness (ELmax), viscous stiffness (VI), and path length (L-path) in the hand flexor muscles among people with stroke. Measurements were obtained with a wrist-electromechanical oscillatory device (w-EOD). Twenty-four people with arm impairment after stroke were evaluated with the w-EOD and clinical assessment (MAS and MTS), twice on the same day (short-term reliability) and once 10 days later (long-term reliability). For criterion validity, a Spearman coefficient ( r ) was calculated between stiffness values and the clinical scales. For reliability, intraclass correlation coefficients (ICCs), SEM, and MDC95 were calculated. Moderate correlations were observed between EL max and MAS ( r = 0.49) and MTS (V2, r = 0.43; V3, r = 0.49) of the wrist flexors, and finger flexors (MAS, r = 0.60; MTS V2, r = 0.56; MTS V3, r = 0.55). There was a poor correlation between the clinical scales and VI and L-path. Reliability was excellent for all stiffness measurements at short term (EL max : 0.95, VI: 0.94, L-path: 0.92) and good at long term (EL max : 0.87, VI: 0.76, L-path: 0.82). In conclusion, stiffness measurements are valid and reliable to evaluate hyper-resistance in people with stroke.

Locoregional lung ventilation distribution in girls with adolescent idiopathic scoliosis and healthy adolescents. The immediate effect of Schroth 'derotational breathing' exercise in a controlled-trial.

BACKGROUND: Scoliosis curves present transverse plane deviations due to vertebral rotation. The Schroth method supports thoracic derotation by training patients to exert "derotational" breathing based on assumed enhanced ventilation in areas called "humps" in scoliosis and a patient's ability to voluntarily direct ventilation in less ventilated areas called "flats." OBJECTIVE: To assess the asymmetric ventilation distribution and the ability of patients to direct their ventilation to perform derotational breathing. METHODS: Twelve girls with adolescent idiopathic scoliosis and 12 healthy girls performed 3 × 3 min of rest, maximal, and derotational breathing. Electrical impedance tomography was used to record locoregional lung ventilation distribution (LLVD) within 4 thoracic regions of interest: anterior right (ROI 1), anterior left (ROI 2), posterior right (ROI 3), and posterior left (ROI 4) quadrants. Humps and flats were the sums of ROI '2 + 3' and ROI '1 + 4,' respectively. RESULTS: Overall, no difference in LLVD was observed in the flats and humps between groups. At rest, the LLVD in the humps was more elevated than that in the flats (51.5 ± 8.1% versus 43.6 ± 7.9%; p = .021) when considering both groups. Maximal and derotational breathing led to a more homogeneous LLVD between the humps and flats. CONCLUSION: The postulated derotational breathing effect was not confirmed.

A preliminary study in classification of the severity of spine deformation in adolescents with lumbar/thoracolumbar idiopathic scoliosis using machine learning algorithms based on lumbosacral joint efforts during gait.

To assess the severity and progression of adolescents with idiopathic scoliosis (AIS), radiography with X-rays is usually used. The methods based on statistical observations have been developed from 3D reconstruction of the trunk or topography. Machine learning has shown great potential to classify the severity of scoliosis on imaging data, generally on X-ray measurements. It is also known that AIS leads to the development of gait disorder. To our knowledge, machine learning has never been tested on spine intervertebral efforts during gait as a radiation-free method to classify the severity of spinal deformity in AIS. Develop automated machine learning algorithms in lumbar/thoracolumbar scoliosis to classify the severity of spinal deformity of AIS based on the lumbosacral joint (L5-S1) efforts during gait. The lumbosacral joint efforts of 30 individuals with lumbar/thoracolumbar AIS were used as distinctive features fed to the machine learning algorithms. Several tests were run using various classification algorithms. The labeling consisted of three classes reflecting the severity of scoliosis i.e. mild, moderate and severe. The ensemble classifier algorithm including k-nearest neighbors, support vector machine, random forest and multilayer perceptron achieved the most promising results, with accuracy scores of 91.4%. This preliminary study shows lumbosacral joint efforts can be used to classify the severity of spinal deformity in lumbar/thoracolumbar AIS. This method showed the potential of being used as an assessment tool to follow-up the progression of AIS as a radiation-free method, alternative to radiography. Future studies should be performed to test the method on other categories of AIS.

Is simultaneous bilateral total hip arthroplasty deleterious in a biomechanical point of view? A comparative gait analysis study.

PURPOSE: Uni- or bilateral hip osteoarthritis is a common disease generating pain, stiffness, and functional disabilities. Changes in the normal walking with higher energy expenditures are observed. Facing a cruel lack of biomechanical data, we decided to analyse the impact on the walking of single and simultaneous bilateral total hip arthroplasties (THA). METHOD: We conducted a prospective monocentric study, comparing two matched groups of 15 patients able to walk with symptomatic isolated uni- (group 1) or bilateral HO (group 2) and treated respectively by unilateral THA (UTHA) or simultaneous bilateral THA (SBTHA). Surgery was performed by a single surgeon with a direct anterior approach and approved by local ethical committee. Walking was assessed by a « 3D Gait analysis motion¼ pre and at 6 months post operatively. RESULT: In the UTHA group, recovery, i.e., efficiency of locomotor mechanism (p < 0.001) and pelvis sagittal balance (p = 0.031) improved, while external and total work (p = 0.010) decreased post operatively. In the SBTHA group, speed (p = 0.035), step length (p = 0.046), range of motion of knee sagittal stance (p = 0.009) and hip frontal (p = 0.031), and internal work are significatively higher (p < 0.001) post operatively. CONCLUSIONS: This original study attests that THA has a positive impact on walking and energetics outcome in UTHA and SBTHA.

Quantitative gait analysis in children with osteogenesis imperfecta: relationship between gait deviations and clinical features.

Osteogenesis imperfecta is a rare congenital disease of connective tissue characterized by recurrent fractures and progressive skeletal deformities which may impact on gait. The aims of this prospective study were to identify gait deviations in children with osteogenesis imperfecta compared to age-matched controls and establish relationships with clinical features. We evaluated 22 patients with different types of osteogenesis imperfecta using three-dimensional gait analysis. The incidence and location of frac- tures, fracture at birth, age at first fracture, use of intramedullary rodding and number of surgical in- terventions in the lower extremities, bone mineral density, hypermobility and number of injections of bisphosphonates were recorded for each patient. Step length was lower in the osteogenesis imperfecta group compared with the control group. Kinematics showed that sagittal pelvic and transversal hip range of motion were higher in the osteogenesis imperfecta group, whereas sagittal knee range of motion during swing phase was reduced. Regarding kinetics, hip flexion moment and hip negative power peak were significantly decreased in the osteogenesis imperfecta group. Mechanical and energetic parameters were considered as normal. The principal component analysis revealed that the bone mineral density was increased in children who had received more in- jections of bisphosphonates and these had also less deficit in kinematic parameters. Main modifications in gait parameters were observed in spatiotemporal, kinematic and kinetic data. More studies are necessary to allow stratification of severity of the osteogenesis imperfecta disease, help improve its challenging multidisciplinary treatment and ob- jectively assess treatment outcomes.

Are running stitches needed in DT4 Single Anteromedial Bundle Biological Augmentation transplant preparation?

Partial running whipstitches are commonly used in DT4 SAMBBA (Single Anteromedial Bundle Biological Augmentation) transplant preparation. We wanted to determine whether or not running whipstitches all over the graft affected the risk of iterative rupture and the overall outcome of the procedure. Two groups of 32 patients comparable in terms of sex, age, sport level and type of sport practiced were recruited in this prospective cohort study. DT4 SAMBBA was performed for all patients by a single surgeon. One cohort was treated with a full length running whipstitches during SAMBBA DT4 transplant preparation (F), the other had a classical SAMBBA DT4 graft preparation (NO F). The ACL RSI, subjective IKDC and KOOS scores were established preoperatively and with a 4 years follow-up. Complication rates (iterative rupture, cyclops syndrome) as well as pre and postoperative score variations were calculated. No statistically significant difference in terms of frequency of iterative rupture or complications could be demonstrated (NO F 9.3% vs F 3.1%, p = 0.61). There was no difference either on score variations compared pre and post operatively. Full running whipstitches of the DT4 SAMBBA transplant does not seem to influence the ligamentoplasty outcomes with a 4 years follow-up.

Relationship Between Leisure Time Physical Activity, Weight, and the Onset and Persistence of Nonspecific Neck Pain: A Systematic Review.

OBJECTIVE: To study the relationships between weight, leisure time physical activity (PA), and the onset and persistence of neck pain in adults with nonspecific neck pain (NSNP). DESIGN: Etiology and prognosis systematic review. LITERATURE SEARCH: Five databases (PubMed, Scopus, Embase, Cochrane Library, PsycINFO) were searched from January 2010 to November 2021. STUDY SELECTION CRITERIA: Case-control or cohort studies assessing the relationship between the onset and the persistence of NSNP, weight, and leisure time PA in healthy adults or adults with NSNP at baseline. DATA SYNTHESIS: Use of the "vote counting based on direction of effects" and qualitative synthesis. RESULTS: Nine articles were included (20 350 participants, range 86-11 391), four on the onset and five on the persistence of NSNP. Methodological quality varied from poor to good according to the Newcastle-Ottawa Scale. For the onset and the persistence of NSNP, there was very low certainty evidence for modest associations suggesting a decreased risk with higher levels of leisure time PA and an increased risk in people with overweight and obesity. CONCLUSION: The risk for onset and persistence of NSNP may be lower in more active people and higher in people with overweight and obesity. Results should be interpreted cautiously and should not be generalized to populations other than workers. J Orthop Sports Phys Ther 2022;52(12):777-791. Epub: 12 August 2022. doi:10.2519/jospt.2022.11137.

New technologies promoting active upper limb rehabilitation after stroke: an overview and network meta-analysis.

INTRODUCTION: The primary aim of this work was to summarize and compare the effects of active rehabilitation assisted by new technologies (virtual reality [VR], robot-assisted therapy [RAT] and telerehabilitation [TR)) on upper limb motor function and everyday living activity during the subacute and chronic phases of stroke. The secondary aims were to compare the effects of these technologies according to the intervention design (in addition to or in substitution of conventional therapy), the duration of active rehabilitation and the severity of patients' motor impairments. EVIDENCE ACQUISITION: Several databases, namely PubMed, Scopus, Embase and Cochrane Library, were searched. Studies were included if they were meta-analyses with a moderate to high level of confidence (assessed with AMSTAR-2) that compared the effects of a new technology promoting active rehabilitation to that of a conventional therapy program among patients with stroke. Network meta-analyses were conducted to compare the effects of the new technologies. EVIDENCE SYNTHESIS: Eighteen different meta-analyses were selected and fifteen included in the quantitative analysis. In total these 15 meta-analyses were based on 189 different randomized controlled trials. VR (SMD≥0.25; P<0.05), RAT (SMD≥0.29; P≤0.29) and TR (SMD≥-0.08; P≤0.64) were found to be at least as effective as conventional therapy. During the subacute phase, RAT's greatest effect was observed for patients with severe-moderate impairments whereas VR and TR's greatest effects were observed for patients with mild impairments. During the chronic phase, the highest effects were observed for patients with mild impairments, for all studies technologies. Network meta-analyses showed that VR and RAT were both significantly superior to TR in improving motor function during the chronic phase but revealed no significant difference between VR, RAT and TR effectiveness on both motor function (during the subacute phase) and activity (during both chronic and subacute phase). CONCLUSIONS: This overview provides low-to-moderate evidence that rehabilitation assisted with technologies are at least as effective as conventional therapy for patients with stroke. While VR and RAT seem to be more efficient during the subacute phase, all technologies seem to be as efficient as one another in the chronic phase.

MyotonPro Is a Valid Device for Assessing Wrist Biomechanical Stiffness in Healthy Young Adults.

Background: The MyotonPro is a portable device for measuring biomechanical and viscoelastic properties in superficial soft tissues. The aims of this study are firstly to validate the MyotonPro compared to a reliable gold-standard frame and secondly to observe the influence of MyotonPro measurement on the total wrist viscoelasticity. Methods: Three silicone polymers with different elastic properties were assessed with the MyotonPro and with a reference rheometer (Universal Tribometer Mod). Then, a free oscillations method was used to measure the passive elastic and viscous stiffness of the wrist and compared to MyotonPro forearm measurements. Results: A one-way ANOVA demonstrated the validity of the MyotonPro's stiffness (p = 0.001), decrement (p < 0.001), and relaxation (p = 0.008) parameters for measuring the elastic stiffness (k) of the three polymers. The MyotonPro parameters demonstrated excellent reliability on the forearm. Proximal and distal anterior myofascial measurements of the MyotonPro were moderately correlated to the elastic stiffness (p = 0.0027-0.0275, absolute r = from 0.270 to 0.375) of the wrist while the postero-distal myofascial tissues of the forearm demonstrated a moderate correlation with the viscous stiffness of the wrist (p = 0.0096-0.0433, absolute r = from 0.257 to 0.326). Discussion: The MyotonPro is a valid device for measuring elastic stiffness as well as a portable, affordable, and easy-to-use tool for quantifying the biomechanical properties and viscoelasticity of myofascial tissue in healthy subjects.

Locally developed external fixators as definitive treatment of open tibia diaphyseal fractures: a clinical prospective study conducted in Ivory Coast.

BACKGROUND: This study sought to evaluate the effectiveness of locally developed external fixators (LDEF) as definitive treatment for open tibia diaphyseal fractures (OTDF) in Ivory Coast. METHODS: Gustilo I, II, and IIIA OTDFs of patients admitted within 24 hours of injury were prospectively included and treated with LDEF. The rates of union, mal-union, septic complications, as well as the functional results were assessed, in addition to the LDEF construct's integrity. Predictive factors of failure or poor results were assessed. RESULTS: Overall, 40 OTDF patients were admitted within 24 hours of injury. Gustilo I, II, and IIIA fractures were observed in three, 13, and 24 patients, respectively. Uneventful fracture healing was obtained in 29 cases, with an average union time of 8.47 months. Mal-union and non-union were registered in three and four cases, respectively. Pin-track infection (PTI) was observed in 13 cases and deep infection in seven. Infection resolved in all patients except four, who developed chronic osteomyelitis. None of the non-unions were associated with an infection. The overall functional result was satisfactory in 32 patients. PTI was the only predictive factor for chronic infection. Biplanar frames, when compared to monoplanar constructs, were associated with a significantly improved functional outcome. CONCLUSION: LDEF improved significantly the OTDF management, as it provided better stability and superior fracture healing rates than what is observed with the standard of care in the same environment. PTI remains an essential problem but with, hopefully, limited negative consequences.

Survey regarding prevention of surgical site infection after orthopaedic surgery in Belgium: are we on the right track?

Prevention strategies are essential to reduce the rate of surgical site infection (SSI) in orthopaedic surgery. Members of the Royal Belgian Society for Orthopaedic Surgery and Traumatology (SORBCOT) and the Belgische Vereniging voor Orthopedie en Traumatologie (BVOT) were asked to answer a 28-question questionnaire on the internet about the application of surgical antimicrobial prophylaxis measures and to compare them with current inter- national recommendations. 228 practicing orthopedic surgeons responded to the survey from different regions (Flanders, Wallonia and Brussels), different hospitals (university, public and private), different levels of experience (< 5 years, 5 to 10 years and > 10 years) and different subspecialties (lower limb, upper limb and spine). Regarding the questionnaire: 7% systematically perform a dental check-up. 47.8% of the participants never carry out a urinalysis, 41.7% when the patient presents symptoms and 10.5% carry it out systematically. 2.6% systematically propose a pre-operative nutritional assessment. 5.3% of respondents suggest stopping biotherapies (Remicade®, Humira®, rituximab®, etc.) before an operation and 43.9% do not feel comfortable with this type of treatment. 47.1% suggest smoking cessation before the operation and 22% of them advise smoking cessation for a period of 4 weeks. 54.8% never carry out MRSA screening. 68.3% systematically per- formed hair removal, 18.5% when the patient had hirsutism. Among them, 17.7% use shaving with razors. Alcoholic Isobetadine is the most used product with 69.3% when disinfecting the surgical site. 42.1% of the surgeons chose a delay between the injection of antibiotic prophylaxis and the incision of less than 30 minutes, 55.7% between 30 and 60 minutes and 2.2% between 60 and 120 minutes. However, 44.7% did not wait for the injection time to be respected before incising. An incise drape is used in 79.8% of cases. The response rate was not influenced by the surgeon's experience. Most international recommendations in terms of prevention of surgical site infection are correctly applied. However, some bad habits are maintained. These include the use of shaving for depilation and the use of non-impregnated adhesive drapes. Practices that could be improved include management of treatment in patients with rheumatic diseases, a 4-week smoking cessation period, and treating positive urine tests only when symptomatic.

Sensorimotor performance in acute-subacute non-specific neck pain: a non-randomized prospective clinical trial with intervention.

BACKGROUND: The assessment of cervical spine kinematic axial rotation performance is of great importance in the context of the study of neck sensorimotor control. However, studies addressing the influence of the level of provocation of spinal pain and the potential benefit of passive manual therapy mobilizations in patients with acute-subacute non-specific neck pain are lacking. METHODS: A non-randomized prospective clinical trial with an intervention design was conducted. We investigated: (1) the test-retest reliability of kinematic variables during a fast axial head rotation task standardized with the DidRen laser test device in 42 Healthy pain-free Control Participants (HCP) (24.3 years ±6.8); (2) the differences in kinematic variables between HCP and 38 patients with Acute-subacute Non-Specific neck Pain (ANSP) assigned to two different groups according to whether their pain was localized in the upper or lower spine (46.2 years ±16.3); and (3) the effect of passive manual therapy mobilizations on kinematic variables of the neck during fast axial head rotation. RESULTS: (1) Intra-class correlation coefficients ranged from moderate (0.57 (0.06-0.80)) to excellent (0.96 (0.91-0.98)). (2) Kinematic performance during fast axial rotations of the head was significantly altered in ANSP compared to HCP (age-adjusted) for one variable: the time between peaks of acceleration and deceleration (p<0.019). No significant difference was observed between ANSP with upper vs lower spinal pain localization. (3) After the intervention, there was a significant effect on several kinematic variables, e.g., ANSP improved peak speed (p<0.007) and performance of the DidRen laser test (p<0.001), with effect sizes ranging from small to medium. CONCLUSION: (1) The DidRen laser test is reliable. (2) A significant reduction in time between acceleration and deceleration peaks was observed in ANSP compared to HCP, but with no significant effect of spinal pain location on kinematic variables was found. (3) We found that neck pain decreased after passive manual therapy mobilizations with improvements of several kinematic variables. TRIAL REGISTRATION: Registration Number: NCT04407637.

Variations in Patterns of Muscle Activity Observed in Participants Walking in Everyday Environments: Effect of Different Surfaces.

Purpose: The purpose of this study was to examine variations in lower limb surface electromyography (EMG) activity when individuals walked on different outdoor surfaces and to characterize the different potential motor strategies. Method: Forty healthy adult participants walked at a self-selected speed over asphalt, grass, and pavement. They then walked on an indoor treadmill at the same gait speed as observed for each outdoor condition. The EMG activity of the vastus lateralis (VL), tibialis anterior (TA), biceps femoris (BF), and gastrocnemius lateralis (GL) muscles was recorded, and the duration and intensity (root mean square) of EMG burst activity was calculated. Results: Walking on grass resulted in a longer TA burst duration than walking on other outdoor surfaces. Walking on pavement was associated with increased intensity of TA and VL activation compared with the indoor treadmill condition. The variability of EMG intensity for all muscle groups tested (TA, GL, BF, VL) was greatest on grass and lowest on asphalt. Conclusions: The muscle activity patterns of healthy adult participants vary in response to the different qualities of outdoor walking surfaces. Ongoing development of ambulatory EMG methods will be required to support gait retraining programmes that are tailored to the environment.

Objectif : examiner les variations de l'activité électromyographique (EMG) de surface des membres inférieurs lorsqu'une personne marche sur différentes surfaces extérieures et caractériser les diverses stratégies motrices potentielles. Méthodologie : au total, 40 participants adultes en bonne santé ont marché à vitesse spontanée sur de l'asphalte, du gazon et des pavés. Ils ont ensuite dû marcher sur un tapis roulant à la même vitesse que sur chaque surface extérieure. Les chercheurs ont enregistré l'activité EMG des muscles vaste latéral (VL), tibial antérieur (TA), biceps fémoral (BF) et gastrocnémien latéral (GL) durant la marche. Ils ont ensuite calculé la durée et l'intensité (moyenne quadratique) de la bouffée d'activité EMG. Résultats : la marche sur le gazon provoque principalement une bouffée d'activité du muscle TA plus longue que la marche sur les autres surfaces extérieures. La marche sur les pavés est liée à une augmentation de l'intensité d'activation des muscles TA et VL par rapport à celle sur le tapis roulant. La variabilité de l'intensité EMG de tous les muscles testés (TA, GL, BF, VL) était plus élevée sur le gazon et plus faible sur l'asphalte. Conclusion : les tracés d'activité musculaire des participants varient selon la nature des surfaces de marche extérieure. Les méthodes d'enregistrement de l'EMG devront être améliorées de façon à valider les programmes de rééducation de la marche adaptés à l'environnement.

Touch® double mobility arthroplasty for trapeziometacarpal osteoarthritis: outcomes for 92 prostheses.

Trapeziometacarpal prostheses have been used in the treatment of first carpometacarpal joint osteoarthritis for many years. No studies have demonstrated statistical superiority over gold-standard trapeziectomy, but they have been proved to enable shorter convalescence, better pain relief and faster functional recovery. The aims of the present study were to report functional results in a large cohort treated with the Touch® new-generation dual mobility trapeziometacarpal prosthesis, with comparison to results in the literature. A retrospective study included 92 Touch® prostheses. Assessment comprised pre- and post-operative pain, QuickDASH score and satisfaction rate. Mean follow-up was 1.33 ± 0.4 years. Pain significantly improved after surgery. Functional QuickDASH scores did not significantly differ from those reported in the age-matched general population. Return to work was fast, at 2.6 months. Satisfaction scores were high. There were no major complications such as dislocation, fracture or loosening, but the rate of De Quervain's tenosynovitis was higher than in other studies. The Touch® prosthesis appeared to be a safe and stable implant, providing good satisfaction and very good functional scores and fast return to work and leisure activity. Considering the high rate of postoperative De Quervain's tenosynovitis, we suggest opening the first sheath of the extensors tendons while positioning the prosthesis.

Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review.

Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting. A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS). Eight papers met the inclusion criteria and had an average CMS of 70 (range 54-73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation. Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost.

Effects of prolonged-release fampridine on multiple sclerosis-related gait impairments. A crossover, double-blinded, placebo-controlled study.

BACKGROUND: People with multiple sclerosis have reduced walking speed and impaired gait pattern. Prolonged release-fampridine is a potassium channel blocker that improves nerve conduction in patients with multiple sclerosis, leading to walking benefits. Whether fampridine alters gait pattern is unknown. METHODS: In this crossover, randomized controlled trial, patients with multiple sclerosis were tested for responder status during a 4-week run-in period. Patients were considered responders if they improved their 25-ft walk test by 10% and improved their perceived walking capacity. Responders were randomized to prolonged release-fampridine (10 mg b.i.d.) or placebo for a 6-week period. After a 2-week wash-out period, they were allocated to the other treatment for 6 weeks. Participants were assessed before and after both conditions. Three-dimensional gait analysis assessed kinematic, kinetic, mechanic and energetic variables while walking on a treadmill at comfortable speed. Six-minute walk test and 25-ft walk test were used to assess walking speed on middle and short-distances, respectively. Patient-reported outcome measures were also used. Repeated measures ANCOVAs were applied to assess the treatment effects. FINDINGS: Out of 39 included patients, 24 responders (12 women; Expanded Disability Status Scale:4.25[4-5]; age:46 ± 10 years; maximal speed:0.93 ± 0.38 m·s-1) were identified. Among them, prolonged release-fampridine reduced the external mechanical work (-0.039 J·kg-1·m-1;p = 0.02), and improved knee flexion during swing phase (+5.3°; p = 0.02). No differences were found in other walking tests and patient-reported outcomes, at group-level. INTERPRETATION: Prolonged release-fampridine increases knee flexion during swing phase and lowers mechanical external work. Whether these changes are related to clinically meaningful improvements in walking capacity and other functional variables should be further investigated.

A Comparison of Genicular Nerve Blockade With Corticosteroids Using Either Classical Anatomical Targets vs Revised Targets for Pain and Function in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial.

OBJECTIVE: Compare the effectiveness of genicular nerve blockade (GNB) using classical anatomical targets (CT) versus revised targets (RT) in patients suffering from chronic knee osteoarthritis pain. DESIGN: Double-blinded randomized controlled trial. SETTING: Pain medicine center of a teaching hospital. METHODS: We randomly assigned 55 patients with chronic knee osteoarthritis pain to receive a GNB (using a fluid mixture of 2 mL: lidocaine 1% + 20 mg triamcinolone) with either classical targets (CT-group, n = 28) or revised targets (RT-group, n = 27). Numeric rating pain scale (NRS), Oxford knee score (OKS), Western Ontario and McMaster Universities osteoarthritis index score (WOMAC), Quantitative analgesic questionnaire (QAQ) and global perceived effects were assessed at baseline, and at 1-hour, 24-hours, 1, 4, and 12 weeks post-intervention. RESULTS: The RT-group showed greater reduction in NRS mean score at 1-hour post-intervention (2.4 ± 2.1 vs 0.4 ± 0.9, 95% confidence interval (CI) [.0-.8] vs [1.6-3.2], P < .001). The proportion of patients achieving more than 50% knee pain reduction was higher in the RT-group at each follow up interval, yet these differences were statistically significant only at 1-hour post intervention (82.1% [95% CI = 63.1-93.9] vs 100% [95% CI = 97.2-100] P = .02). Both protocols resulted in significant pain reduction and joint function improvement up to 12 weeks post-intervention. CONCLUSIONS: The revised technique allowed more pain relief as well as greater proportion of successful responders at 1-hour post intervention. The large volume injected during therapeutic GNB could have compensated the lack of precision of the classical anatomical targets, mitigating differences in outcomes between both techniques.