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Orthopaedics & Traumatology, Surgery &... Feb 2023Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be... (Review)
Review
Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be overlooked, due to young age and the cartilaginous nature of the joint. There is little bone remodeling in the elbow and displacement fracture, and especially supracondylar or lateral condyle fracture, has to be corrected rigorously, notably in older children. In case of lateral tilt in fracture of the neck of the radial head, on the other hand, remodeling is effective. Deformity in cubitus varus and cubitus valgus leads to neurological lesions and instability. Treatment should be early, with adapted surgery in expert hands. Post-traumatic stiffness is rare. Early intensive physiotherapy is unsuited to children and could worsen the stiffness due to inflammation. Lateral condyle non-union is a classic complication of fracture. Simple percutaneous screwing is a useful option. The equivalent in the medial epicondyle is well-tolerated, and simple monitoring now suffices. Late posterolateral rotational instability is a poorly known complication. It should be considered in case of cubitus varus that becomes painful after a long asymptomatic course. Radiocapitellar subluxation is seen on X-ray. Residual radial head dislocation after primary treatment (Monteggia lesion) responds well to the Bouyala technique of ulnar flexion osteotomy associated to annular ligament repair, without requiring ligament reconstruction.
Topics: Child; Humans; Elbow Fractures; Fractures, Bone; Elbow Joint; Ulna; Joint Dislocations
PubMed: 36302449
DOI: 10.1016/j.otsr.2022.103454 -
Journal of Applied Biomechanics Apr 2021This study determined changes in lower limb joint stiffness when running with body-borne load, and whether they differ with stride or sex. Twenty males and 16 females...
This study determined changes in lower limb joint stiffness when running with body-borne load, and whether they differ with stride or sex. Twenty males and 16 females had joint stiffness quantified when running (4.0 m/s) with body-borne load (20, 25, 30, and 35 kg) and 3 stride lengths (preferred or 15% longer and shorter). Lower limb joint stiffness, flexion range of motion (RoM), and peak flexion moment were submitted to a mixed-model analysis of variance. Knee and ankle stiffness increased 19% and 6% with load (P < .001, P = .049), but decreased 8% and 6% as stride lengthened (P = .004, P < .001). Decreased knee RoM (P < .001, 0.9°-2.7°) and increased knee (P = .007, up to 0.12 N.m/kg.m) and ankle (P = .013, up to 0.03 N.m/kg.m) flexion moment may stiffen joints with load. Greater knee (P < .001, 4.7°-5.4°) and ankle (P < .001, 2.6°-7.2°) flexion RoM may increase joint compliance with longer strides. Females exhibited 15% stiffer knee (P = .025) from larger reductions in knee RoM (4.3°-5.4°) with load than males (P < .004). Stiffer lower limb joints may elevate injury risk while running with load, especially for females.
Topics: Ankle Joint; Biomechanical Phenomena; Female; Gait; Hip Joint; Humans; Knee Joint; Male; Range of Motion, Articular; Running; Sex Factors; Weight-Bearing; Young Adult
PubMed: 33361491
DOI: 10.1123/jab.2020-0135 -
Journal of Applied Biomechanics Apr 2021The purpose of the present study was to examine the effect of chronic ankle instability (CAI) on lower-extremity joint coordination and stiffness during landing. A total...
The purpose of the present study was to examine the effect of chronic ankle instability (CAI) on lower-extremity joint coordination and stiffness during landing. A total of 21 female participants with CAI and 21 pair-matched healthy controls participated in the study. Lower-extremity joint kinematics were collected using a 7-camera motion capture system, and ground reaction forces were collected using 2 force plates during drop landings. Coupling angles were computed based on the vector coding method to assess joint coordination. Coupling angles were compared between the CAI and control groups using circular Watson-Williams tests. Joint stiffness was compared between the groups using independent t tests. Participants with CAI exhibited strategies involving altered joint coordination including a knee flexion dominant pattern during 30% and 70% of their landing phase and a more in-phase motion pattern between the knee and hip joints during 30% and 40% and 90% and 100% of the landing phase. In addition, increased ankle inversion and knee flexion stiffness were observed in the CAI group. These altered joint coordination and stiffness could be considered as a protective strategy utilized to effectively absorb energy, stabilize the body and ankle, and prevent excessive ankle inversion. However, this strategy could result in greater mechanical demands on the knee joint.
Topics: Ankle; Ankle Joint; Biomechanical Phenomena; Female; Humans; Joint Instability; Knee Joint; Range of Motion, Articular
PubMed: 33450730
DOI: 10.1123/jab.2020-0272 -
Der Unfallchirurg Mar 2021Posttraumatic stiffness of the shoulder joint is a frequent and socioeconomically relevant result of injury; however, prior to making the diagnosis as the only cause of...
Posttraumatic stiffness of the shoulder joint is a frequent and socioeconomically relevant result of injury; however, prior to making the diagnosis as the only cause of a persisting impairment of motion, it is necessary to rule out other sequelae of trauma. Even intensive conservative treatment is mostly accompanied by the stagnation of the impairments of movement. In many cases the treatment of choice is early arthroscopic arthrolysis with a standardized approach and intensive follow-up treatment. In the surgical treatment of proximal humeral fractures with humeral head preservation, arthroscopic arthrolysis with simultaneous implant removal is a form of planned second intervention for improvement of shoulder function in cases of persisting motion deficits after bony consolidation. Despite sometimes substantial limitations of movement, a clinically relevant and lasting improvement of shoulder function can be achieved with arthroscopic arthrolysis in posttraumatic shoulder stiffness.
Topics: Device Removal; Humans; Joint Diseases; Range of Motion, Articular; Shoulder; Shoulder Fractures; Shoulder Joint; Treatment Outcome
PubMed: 33590264
DOI: 10.1007/s00113-021-00956-1 -
Journal of Biomechanics Aug 2023Older runners (OR) are increasing their participation in races. Aging may impact the adopted running pattern. Hence, the analysis of stiffness and the inter-joint lower...
Older runners (OR) are increasing their participation in races. Aging may impact the adopted running pattern. Hence, the analysis of stiffness and the inter-joint lower limb coordination in the sagittal plane could contribute to investigating this impact. This study aimed to compare the vertical stiffness (K) and the inter-joint lower limb coordination in the sagittal plane between younger runners (YR) and OR. This cross-sectional study recruited 15 YR males and 15 OR males. The pelvis and lower limb motions were assessed while running on a treadmill at self-selected (range OR: 1.94-3.75 m.s, YR: 2.08-4.17 m.s) and fixed speeds (3.33 m.s). Hip-ankle, knee-ankle, and hip-knee coupling angle (CA) and its variability (CAV) were extracted using the vector coding method. Mann-Whitney U tests compared K between groups at each running speed. Watson's U tests compared the mean CA between groups in three intervals of the contact phase at each running speed. Statistical Parametric Mapping independent t-test compared the CAV curve between groups at each running speed. OR showed greater K than YR at both speeds. Hip-ankle CA pattern differed between groups during the early stance at both speed conditions. OR showed in-phase, distal dominancy in hip-ankle CA, whereas YR showed anti-phase, proximal dominancy. Knee-ankle CA was distinct only at self-selected speed, in which OR showed in-phase, proximal dominancy, while YR exhibited anti-phase, proximal dominancy. CAV did not differ between groups. The findings showed that OR adopted a stiffer pattern characterized by distinct inter-joint lower limb CA, at early stance, during self-selected and fixed speeds.
Topics: Male; Humans; Aged; Cross-Sectional Studies; Biomechanical Phenomena; Lower Extremity; Knee Joint; Knee; Ankle Joint
PubMed: 37421910
DOI: 10.1016/j.jbiomech.2023.111705 -
Journal of Biomechanics Sep 2021Hiking boots provide an interface for walking in challenging environments, typically equipped with a shaft to provide ankle joint stability in rough terrains. Currently...
Hiking boots provide an interface for walking in challenging environments, typically equipped with a shaft to provide ankle joint stability in rough terrains. Currently it is unclear if the ankle joint is stabilized to an extent that protects against ankle injuries, and if so, to what degree this added ankle stability sacrifices ankle mobility and hence decreases efficient gait propulsion. The aim of the present study was to compare the effect of shaft construction and stiffness on lower extremity kinematics and kinetics during level and step-down walking to simulate hiking conditions. Thirteen healthy males walked in one low-cut and three shafted commercially available hiking shoes with varying shaft stiffness. Lower extremity kinematics and ground reaction forces were recorded simultaneously. During level walking, ankle plantar-dorsiflexion range of motion was significantly reduced for the stiffest shaft hiking shoe compared to the low-cut shoe. A reduction in the muscle contribution to ankle joint work was found for all shafted shoes compared to the low-cut shoe. The reduced ankle joint work for the shafted shoes conversely increased eccentric knee joint work. Kinematic and kinetic differences between shoes diminished during box step-down walking. The present study shows that shaft height and stiffness can influence ankle joint range of motion, and ankle and knee joint work, with the high-shaft shoes redistributing load from the ankle to the knee joint. This may have implications for gait efficiency and increase the risk of knee joint loading or injuries.
Topics: Ankle Joint; Biomechanical Phenomena; Gait; Humans; Kinetics; Knee Joint; Male; Shoes; Walking
PubMed: 34358901
DOI: 10.1016/j.jbiomech.2021.110643 -
Orthopaedics & Traumatology, Surgery &... Feb 2024Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal... (Review)
Review
Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal joint arthritis causes pain, loss of strength during pinch grips, and eventually stiffness and progressive deformity of the thumb column. Conservative treatment must be implemented first. It aims to spare the joint by using standardized methods. It must be initiated as soon as pain starts, not once the deformity has settled in. There is broad agreement that surgery is indicated when pain relief is not achieved after at least 6months of conservative treatment. The available surgical techniques can be classified as joint-sparing (extra-articular) and joint-sacrificing (intra-articular). The former consists of trapeziometacarpal stabilizing ligament reconstruction, subtraction osteotomy of the first metacarpal and thumb carpometacarpal denervation. The latter consists of trapeziometacarpal fusion, trapeziectomy (and its variants) and implant arthroplasty. Except in very specific cases, trapeziectomy and trapeziometacarpal implant arthroplasty with a total joint prosthesis or an interposition implant are the two main surgical techniques for treating basal joint arthritis. After reviewing the pathophysiology and the diagnosis of thumb basal joint arthritis, we will provide an overview of the available treatment options, with emphasis on the accepted surgical strategies in 2023. LEVEL OF EVIDENCE: III.
Topics: Humans; Female; Thumb; Trapezium Bone; Osteoarthritis; Arthroplasty, Replacement; Pain; Carpometacarpal Joints; Arthroplasty
PubMed: 38000508
DOI: 10.1016/j.otsr.2023.103772 -
Journal of Sports Sciences Mar 2022Forefoot and toes are prominent regions for locomotion and individual metatarsophalangeal joint (MTPJ) stiffness may be linked to jump take-off mechanics and...
Forefoot and toes are prominent regions for locomotion and individual metatarsophalangeal joint (MTPJ) stiffness may be linked to jump take-off mechanics and performances. However, little is known about the relationships between MTPJ stiffness and take-off related variables. This study examined the relationship between individual MTPJ stiffness and biomechanical variables under various vertical countermovement jumps (CMJ) conditions. We measured MTPJ stiffness on 21 male university basketball players and then asked them to perform jumps under single, consecutive and running CMJ conditions. Pearson's correlation coefficient was employed to examine the relationships between MTP passive stiffness and each jumping performance, ground reaction force (GRF) and joint kinematic and kinetic variables. The results indicated that MTPJ stiffness significantly correlated with maximum jump height ( = 0.49, ), peak take-off velocity ( = 0.47, ), peak take-off ankle plantarflexion moment ( = 0.68, ), peak dorsiflexion moment ( = 0.60, ) and peak take-off ankle power ( = 0.44, ) in consecutive CMJ. Only a moderate correlation between MTPJ stiffness and peak MTPJ extension take-off velocity ( = -0.46, ) was determined in a single CMJ. There were no significant correlations found in running CMJ conditions. These findings imply that higher MTPJ stiffness of participants was related to improved jump performances in consecutive jumps.
Topics: Ankle Joint; Basketball; Biomechanical Phenomena; Humans; Lower Extremity; Male; Metatarsophalangeal Joint
PubMed: 35083953
DOI: 10.1080/02640414.2021.2010412 -
Arthroscopy : the Journal of... May 2020More than 100 surgical techniques have been described for the reconstruction of the coracoclavicular ligament complex. None of the techniques appears superior, but...
More than 100 surgical techniques have been described for the reconstruction of the coracoclavicular ligament complex. None of the techniques appears superior, but double-button fixation for acute high-grade acromioclavicular dislocations has become an attractive option. The clinical outcomes are good to excellent, and the return to physical activity and sport is above 90%. However, complications such as loss of reduction and tunnel widening have been described and can reach up to 80%. The load to failure of the native coracoclavicular complex is more than 600 N, and any surgical technique must surpass this figure. Single-button and loop techniques do not always sufficiently stabilize the acromioclavicular joint. Even double- and triple-button techniques may not restore vertical and horizontal stability of the acromioclavicular joint to its native normal state. Double-button technique restores both scapula and clavicular rotation closest to the native state, but still has lower stiffness and results in higher superior-inferior translation, which could cause ongoing vertical instability.
Topics: Acromioclavicular Joint; Clavicle; Humans; Ligaments, Articular; Scapula; Shoulder Dislocation
PubMed: 32370889
DOI: 10.1016/j.arthro.2020.03.015 -
Operative Orthopadie Und Traumatologie Oct 2020The placement of an external elbow fixator can be statically carried out as temporary stabilization or as a hinged movement fixator. As a hinged movement fixator a... (Review)
Review
AIM OF SURGERY
The placement of an external elbow fixator can be statically carried out as temporary stabilization or as a hinged movement fixator. As a hinged movement fixator a functional follow-up treatment is possible due to control of the joint guidance and reduction of the compromising forces on the osteoligamentous structures.
INDICATIONS
As a temporary stabilization of the elbow, the external fixator is used as a damage control method. As a movement fixator it is used as an additional protection and movement control after complex osteoligamentous interventions and persisting tendency to dislocation of the joint and also as a standalone procedure. In some cases, the procedure is also used in distraction arthrolysis of stiff elbows and as a salvage procedure in patients with relevant comorbidities as part of fracture treatment.
CONTRAINDICATIONS
Inexperience in relation to the procedure as well as a local acute infection at the level of the intended pin locations should specifically be mentioned as contraindications. In addition, compliance and patient understanding of the procedure are essential for the success of treatment.
SURGICAL TECHNIQUE
Soft tissue preparation for pin placement should be preferred over percutaneous incisions to enable a safe bone exposure. Knowledge of the course of neurovascular structures (particularly the radial nerve) is essential. When placing a hinge, knowledge of the position and detection of the idealized center of rotation is of fundamental importance.
POSTOPERATIVE MANAGEMENT
The type of postoperative management required essentially depends on the underlying injury. When placing a hinged fixator, the aim is to enable movement as early as possible. Nevertheless, blocking of the hinged fixator may be useful for a short period of time. Adequate pin care over the duration of the treatment is essential in order to prevent complications.
RESULTS
Good functional results have been reported for the treatment of unstable elbows after primary and secondary placement of a hinged external fixator. Good functional scores and improvement in the range of motion were also recorded in the context of an arthrolysis (additive for open arthrolysis or distraction arthrolysis); however, in contrast a significant number of complications associated with this surgery are likely to emerge. As a definitive salvage procedure, satisfactory results were obtained in a small case series of a selected older patient group with relevant comorbidities.
Topics: Elbow; Elbow Joint; External Fixators; Humans; Range of Motion, Articular; Treatment Outcome
PubMed: 32959082
DOI: 10.1007/s00064-020-00676-6