Role of the peroneal tendons in the production of the deformed foot with posterior tibial tendon deficiency.

Ten patients were identified with traumatic, complete common peroneal nerve palsy, with no previous foot or ankle surgery or trauma distal to the knee, who had undergone anterior transfer of the posterior tibial tendon to the midfoot. Six of these patients had a transfer to the midfoot and four had a Bridle procedure with tenodesis of half of the posterior tibial tendon to the peroneus longus tendon. Average follow-up was 74.9 months (range, 18-351 months). All patients' feet were compared assessing residual muscle strength, the longitudinal arch, and motion at the ankle, subtalar, and Chopart's joint. Weightbearing lateral X-rays and Harris mat studies were done on both feet. In no case was any valgus hindfoot deformity associated with posterior tibial tendon rupture found. It seems that the pathologic condition associated with a posterior tibial tendon deficient foot will not manifest itself if peroneus brevis function is absent.

Electromyographic analysis of grand-plié in ballet and modern dancers.

PURPOSE: The purpose of this report is to describe lower extremity muscle activity in grand-plié, as determined by EMG analysis; to compare and contrast muscle function in grand-plié and demi-plié to support the hypothesis that grand-plié is not simply a deeper demi-plié, but rather a fundamentally different movement in terms of muscle use; and to present further evidence in support of the hypothesis that ballet dancers use muscles differently than modern dancers in dance movement. METHODS: Surface electromyography was used to analyze lower extremity muscle activity during grand-plié in first position with lower extremities turned out in five ballet and seven modern female professional dancers. RESULTS: Electromyographic (EMG) activity of tibialis anterior included continuous activity from heel-off during the lowering phase, through midcycle, and ending at heel-on during the rising phase in all grand-pliés; the majority of tibialis anterior EMG tracings in ballet dancers had additional activity at the end of the rising phase. All EMG tracings for vastus lateralis and medialis included a peak of activity during the lowering phase, a decrease (valley) at midcycle, followed by another peak during the rising phase; increased activity at the end of the rising phase was observed in most grand-plié in ballet, and not modern, dancers. Adductor EMG activity was also observed in all tracings with a peak during the lowering phase from heel-off to midcycle, a valley at midcycle, followed by a peak of activity in early rising phase; the midcycle valley was of lower, and the rising phase peak of higher, activity in ballet compared with modern dancers. Variation of EMG patterns was observed for lateral and medial gastrocnemius, gluteus maximus, and hamstrings. CONCLUSIONS: The data support the concept that lower extremity muscle activity in dance movement is comprised of three major types: (a) unique, characteristic activity required for the execution of the movement; (b) varied activity which is characteristic of dancers of different dance idioms; and (c) varied activity which may depend on factors such as balance, personal habit, and individual training background. Furthermore, EMG activity of vastus lateralis and medialis at the midcycle valley in grand-plié was significantly less in ballet dancers than in modern dancers despite similar degree of knee flexion, suggesting that ballet dancers may have lower patellofemoral joint reaction force at midcycle than modern dancers.

Treatment of supracondylar femoral fractures with a retrograde intramedullary nail.

From August 1992 to January 1995, 24 patients with 26 supracondylar femoral fractures were treated with a retrograde intramedullary nail. There were 22 patients with 24 nails available for review. Eight fractures were open and 13 were intraarticular fractures. There were a significant number of associated injuries. The average followup interval was 18 months (range, 4-36 months). All fractures healed by 4 months, (average, 3 months). Only 1 patient required bone grafting. There were no implant failures or superficial or deep infections. One malunion occurred. Average knee range of motion was 104 degrees. A previously described rating scale was used to evaluate function. There were 4 excellent, 16 good, 2 fair, and 2 poor results. The supracondylar nail provides rigid internal fixation for rapid healing and comparable functional outcomes to lateral fixation devices with significantly less soft tissue dissection.

Electromyographic analysis of standing posture and demi-plié in ballet and modern dancers.

Surface electromyography was used to analyze lower extremity muscle activity during standing posture and demi-plié in first position with lower extremities turned out, in five ballet and seven modern female professional dancers. In standing posture, increased electromyographic (EMG) activity above baseline was detected most frequently at the medial gastrocnemius (54% standing repetitions) and tibialis anterior (29%) electrodes (all dancers); in ballet dancers, increased EMG activity during standing was significantly less frequent at the medial gastrocnemius, but more frequent at the tibialis anterior, than in modern dancers. In demi-plié, the tibialis anterior had a discrete peak of EMG activity at midcycle in all dancers (97% demi-pliés). All dancers also had midcycle EMG activity in both vastus lateralis and medialis (100% demi-pliés). At the end of rising phase of demi-plié, ballet dancers had greater EMG activity than at midcycle in vastus lateralis (100% demi-pliés) and medialis (92%); in modern dancers, end-rising phase voltage was lower than at midcycle for vastus lateralis (71% demi-pliés) and medialis (83%). Genu recurvatum > or = 10 degrees was observed at the beginning and end of demi-plié in all ballet dancers, but not in modern dancers. There was marked variation of EMG activity during demi-plié in the lateral gastrocnemius, medial gastrocnemius, gluteus maximus, hamstrings, and adductors. The results support the hypothesis that ballet and modern dancers have different patterns of muscle use in standing posture and demi-plié, which in part may be a result of differences in genu recurvatum and turnout between the two groups.