Partial monopolar transfer of pectoralis major for elbow active flexion restoration in children with arthrogryposis

BACKGROUND: One of the main problems that limited or made the self-ability of patients with arthrogryposis impossible is the lack of active elbow flexion due to hypoplasia (or aplasia) of the forearm flexors and, especially the m. biceps brachii. AIM: To evaluate the possibility of active forearm flexion restoration in children with arthrogryposis by partial monopolar transposition of the pectoralis major muscle. MATERIALS AND METHODS: Elbow active flexion restoration by partial monopolar transposition of the pectoralis major muscle to biceps brachii was conducted in 34 children with arthrogryposis (39 upper limbs) from 2011 to 2020. The muscle autograft included a fragment of the fascia of the m. rectus abdominis. Clinical examinations of patients were performed before and after the operation. Statistical data processing was performed using the software packages Statistica 10 and SAS JMP 11. RESULTS: The follow-up results were estimated from 6 to 99 months (44.53 31.72) postoperative. The mean age of patients was 6.24 4.24 years. The active postoperative elbow motion was 0120 (71.94 33.40). The passive postoperative elbow motion did not change and was 90130 (104.12 12.40). Muscles strength after the operation was grade 25. Elbow extension was limited in 30 cases (76.9%) from 0 to 40 (21.70 12.27) without problem in the activities of daily living. Good results were determined in 15 cases (38.5%), satisfactory in 8 (20.5%), and poor in 16 (41%). CONCLUSIONS: This study revealed that our partial monopolar transfer of pectoralis major to biceps brachii technic restored sufficient forearm flexion and improved self-ability without forming severe elbow flexor contractures of more than half of the patients with arthrogryposis.

Effects of platelet-rich plasma injection on pain, range of motion, and disability in adhesive capsulitis: A prospective, randomized-controlled study

Objectives: In this study, we aimed to investigate the effectiveness of intra-articular platelet-rich plasma (PRP) injection in adhesive capsulitis. Patients and methods: Between January 2019 and December 2019, a total of 40 patients (21 males, 19 females; mean age: 57.1±6.5 years; range, 44 to 72 years) with idiopathic adhesive capsulitis were included. The patients were randomly assigned into two equal groups as the PRP and the control group. The PRP group received two doses of PRP via intra-articular route biweekly under ultrasound guidance. No injection was performed to the control group. In both groups, stretching and Codman exercises were applied as a home- based program. The Visual Analog Scale (VAS), range of motion (ROM), and Shoulder Pain and Disability Index (SPADI) scores were evaluated before the treatment and at 2, 6 and 12 weeks after the treatment. Results: There were significant differences in all VAS, SPADI, and ROM scores at all time points after treatment compared to baseline in both groups. At the end of the study, there were significant differences in the active flexion, passive flexion, active abduction, passive abduction, and active external rotation scores at 12 weeks between the groups (p=0.012, p=0.015, p=0.008, p=0.019, and p=0.040, respectively). No significant difference was observed between the groups in terms of VAS and SPADI scores and the other parameters (active and passive extension, active and passive internal rotation, passive external rotation) at 2, 6, and 12 weeks (p>0.05). Conclusion: The addition of PRP to exercise treatment can improve patients' joint mobility, but not pain and disability in patients with adhesive capsulitis.

Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of –6° and –9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and –5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating. Level of evidence: IV

The efficacy of intermittent pneumatic compression and negative pressure therapy on muscle function, soreness and serum indices of muscle damage: a randomized controlled trial

Background The study aimed to assess whether intermittent pneumatic compression (IPC) and intermittent negative pressure (INP) would attenuate the muscle damaging effects of eccentric exercise. Methods Forty-five healthy males were recruited. Immediately post, 24 and 48 h post eccentric exercise consisting of 100 drop jumps, volunteers randomly received 30-min sessions of intermittent pneumatic compression (IPC, n = 15) or intermittent negative pressure (INP, n = 15), or sham microcurrent (PT, n = 15). Creatine kinase (CK), lactate dehydrogenase (LDH), isokinetic muscle strength, soreness and active flexion of the knee joint were measured after every therapy session. Results No significant intergroup differences were observed in biochemical or functional measurements. However, there was an increase in muscle soreness (P < 0.05), CK and LDH activity (P < 0.05), and a reduction in muscle strength (P < 0.05) and range of active knee flexion (P < 0.05). Conclusions The prescription of IPC and INP did not attenuate the reduction of markers to muscle function or pain perception up to 48 h after muscle damaging exercise. Future research should focus on the potential impact of treatment frequency and duration on muscle recovery. Trial registration The study was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR); The trial registration number: ACTRN12621001294842; date of registration: 24/09/2021.

Functional Outcome of Closed Metacarpal Fractures Treated with Mini Fragment Plates and Screws

Aim: To assess the functional outcome after metacarpal fracture fixation with mini fragment plates. Study design: Prospective cohort study Place and duration of study: Department of Orthopaedic Surgery, GTTH, Lahore from 01-01-2015 to 31-07-2020. Methodology: Sixteen patients who were operated with mini fragment plates for metacarpal fractures. Functional outcome was evaluated with help of American Society for Surgery of the Hand (ASSH) Total Active Flexion (TAF) score and the disabilities of the arm, shoulder. Results: Union was achieved in all patients. The functional outcome was excellent in 13 and good in 2 and poor in 1. Three cases of infection (all superficial) were noted, which settled with dressings and antibiotics. Conclusion: Mini fragment plates for metacarpals fractures are a good option, providing early mobilization and excellent functional outcome. Keywords: Functional outcome, Metacarpal fracture, Mini fragment plat, Open reduction internal fixation (ORIF)

Design and Implementation of a Robotic Hip Exoskeleton for Gait Rehabilitation

In this paper, a four degrees-of-freedom robotic hip exoskeleton was proposed for gait rehabilitation. The robotic hip exoskeleton was designed with active flexion/extension and passive abduction/adduction at each hip joint to comply with the movement of the thigh. Due to each user’s different lower limbs characteristics and unknown torques at hip joints, model-free linear extended state observer (LESO)-based controllers were proposed for rehabilitation gait control. The prototypes of the robotic hip exoskeleton and controller designs were validated and compared through walking and ascending rehabilitation experiments. Additionally, a motion captured system and EMG signals were used to investigate the walking assistance of the robotic hip exoskeleton.

Rehabilitation after flexor tendon repair and others: a safe and efficient protocol

In this review I detail the protocol that I use after flexor tendon repair and outline my experience regarding how its framework might be used for other disorders. The early passive–active flexion protocol has a sufficient number of cycles of active flexion in each exercise session, which is at least 40, and ideally 60 to 80. The frequency of exercise sessions may range from 4 to 6 a day, distributed in the morning, afternoon and evening. Increasing the number of daily sessions without a sufficient number of runs in each session is ineffective. In the first 2–3 weeks after surgery, active digital flexion should go through only a partial range. In weeks 4–6, the patient gradually moves through the full range. With modifications, I suggest generalization of the partial-range finger motion to therapy after treating other hand injuries. I consider partial-range active flexion a generalizable working principle for different hand disorders.

Correction of rheumatoid swan-neck deformity of the finger using the modified Thompson–Littler method

ABSTRACT Objectives To investigate the outcomes of the modified Thompson–Littler (m-TL) method, a corrective surgical method utilising a dynamic tenodesis, in patients with rheumatoid swan-neck deformity. Methods Twenty-seven fingers in 10 patients with rheumatoid arthritis (RA) underwent surgical correction. The mean age at the time of surgery was 60.3 (45–77) years, the mean duration of RA was 19.3 (4–34) years, and the mean postoperative follow-up period was 2.4 (0.5–6) years. Results The deformity was corrected and the proximal interphalangeal (PIP) joint pain disappeared in all operated fingers. The mean pinch power between the thumb and the operated finger increased. The active extension decreased, the active flexion increased, and the total arc of motion decreased. Comparing the range of motion by Nalebuff’s type classification, the postoperative arc of motion decreased as the type advanced. Conclusions The m-TL method provided a favourable outcome in cases of Type ≤III rheumatoid swan-neck deformity without severe joint deterioration at the PIP joint. Aesthetic and functional improvements were observed and the patients were satisfied with the operation.

Reliability and concurrent validity of Iphone®level application for measuring lower limb active flexion and extension range of motions in physical education students

Background and Study Aim. The aim of this study was to analyse reliability and validity of accelerometer-based Iphone® Level application for measuring lower extremity active flexion and extension joint range of motion. Material and Methods. Thirty physically healthy students enrolled in sport sciences (11 males, 19 females, 21.2±1.5 years, Body mass 64.4±10.0 kg, Height 1.68±0.8 m, Fat percentage 21.2±7.8 %, 22.5±2.6 kg/m2) participated in the measurements of hip, knee, and ankle joint range of motion twice through Universal goniometer and Iphone® Level applications. The same experienced measurer carried out blind study of plantarflexion, dorsiflexion and knee flexion/extension, hip flexion/extension joint range of motion three times for each measurement methods and the other researcher recorded the results. For simultaneous validity analysis Pearson coefficient of correlation was used to decide the level of adaptation between the two intraclass correlation coefficient and Cronbach’s alpha values. Bland-Altman graphics were utilized for level of agreement between these two different methods. Results. The results of Pearson coefficient of correlation analysis revealed a positive correlation between the measurement values of joint range of motion performed through Universal goniometer and Level App (r2 = 0.44-0.94, p <0.05). Bland-Altman graphics showed a good agreement among Cronbach Alpha values and intraclass correlation coefficient in the confidence range of %95, and universal goniometers and Level App application. Conclusions. The results of this study revealed that goniometric measurements using Iphone® Level App is a good reliable method for measuring lower extremity active range of motion compared to universal goniometer.

Up to five-week delay in primary repair of Zone 2 flexor tendon injuries: outcomes and complications

We report the outcomes of delayed primary repair of flexor tendons in Zone 2 in 31 fingers and thumb (28 patients) averaging 15 days (range 4–37) after injury in 2020. The delay was longer than usual due to the COVID-19 pandemic. The tendons were repaired with a 6-strand core suture (M-Tang method) or a double Tsuge suture and a peripheral suture. This was followed by an early, partial-range, active flexion exercise programme. Adhesions in four digits required tenolysis. These patients were not with longest delay. Outcomes of two improved after tenolysis. The other two patients declined further surgery. One finger flexor tendon ruptured in early active motion. This was re-repaired, and final outcome was good. Overall excellent and good results using the Tang criteria were in 27 out of 31 fingers and thumbs (87%). The time elapsed between the injury and surgery is not an important risk factor for a good outcome, rather it depends on proper surgical methods, the surgeon's experience and early mobilization, properly applied. Adhesions may occur, but they can be managed with tenolysis. Level of evidence: IV