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Cureus Apr 2021Recurvatum is defined as hyperextension of the knee in the stance phase of gait. Recurvatum knee is a naturally occurring common gait deviation in those with cerebral... (Review)
Review
Recurvatum is defined as hyperextension of the knee in the stance phase of gait. Recurvatum knee is a naturally occurring common gait deviation in those with cerebral palsy, along with crouch knee, jump knee, and stiff knee gaits. Early and late recurvatum occur in the first and second halves of stance. Early recurvatum is associated with dynamic calf contraction that raises the heel and pushes the knee into hyperextension as the forefoot contacts the floor. Late recurvatum occurs after the foot is already flat on the floor. As the body weight comes forward over the foot, the tibia stops its forward motion too early as the ankle comes to its range-of-motion limit. The advancing body then moves forward over a hyperextending knee. Surgical hamstring lengthening can have recurvatum as a side effect. There are several strategies to decrease this risk. Medial hamstring lengthening may be safer than combined medial and lateral lengthening. The concept here is that less lengthening or less aggressive lengthening means less recurvatum risk. However, combined medial and lateral lengthening can be reasonably safe from the risk of causing recurvatum if the knee is showing enough preoperative flexion in stance to warrant the increased surgery. More flexion in stance relates to less risk, while less flexion in stance relates to more risk. Knee flexion in stance can be measured. This is done by measuring knee flexion at initial contact and knee flexion in stance in a gait lab or with stop-action video. If there is minimal knee flexion in stance, hamstring lengthening might not be advisable, even if the hamstrings are tight on popliteal angle testing. There are other factors that contribute to recurvatum risk, such as knee hyperextension on static exam, equinus contracture, and jump knee gait. For treatment of recurvatum, the mainstay is the use of ankle foot orthoses set in dorsiflexion. Surgical equinus correction in those with early stance recurvatum can be effective but it is not likely to be effective in those with late stance recurvatum.
PubMed: 33859920
DOI: 10.7759/cureus.14408 -
Clinics in Orthopedic Surgery Dec 2021Anteromedial osteoarthritis is a recognized indication for unicompartmental knee arthroplasty (UKA). Favorable postoperative outcomes largely depend on proper patient...
BACKGROUD
Anteromedial osteoarthritis is a recognized indication for unicompartmental knee arthroplasty (UKA). Favorable postoperative outcomes largely depend on proper patient selection, correct implant positioning, and limb alignment. Computer navigation has a proven value over conventional systems in reducing mechanical errors in total knee arthroplasty (TKA). However, the lack of strong evidence impedes the universal use of computer navigation technology in UKA. Therefore, this study was proposed to investigate the accuracy of component positioning and limb alignment in computer navigated UKA and to observe the role of navigation in proper patient selection.
METHODS
A total of 50 knees (38 patients) underwent computer navigated UKA between 2016 and 2018. All operations were performed by the senior surgeon using the same navigation system and implant type. The navigation system was used as a tool to aid patient selection: knees with preoperative residual varus > 5° on valgus stress and hyperextension > 10° were switched to navigated TKA. We measured the accuracy of component placement in sagittal and coronal planes on postoperative radiographs. Functional outcomes were also evaluated at the final follow-up (a minimum of 16 months).
RESULTS
Nine patients had tibia vara and 14 patients had preoperative hyperextension deformity. We observed coronal outliers for the tibial component in 12% knees and for the femoral component in 10% knees. We also observed sagittal outliers for the tibial component in 14% knees and for the femoral component in 6% knees. There was a significant improvement in the functional score at the final follow-up. On multiple linear regression, no difference was found in functional scores of knees with or without tibia vara ( = 0.16) and with or without hyperextension ( = 0.25).
CONCLUSIONS
Our study further validates the role of computer navigation in desirable implant positioning and limb alignment. We encourage use of computer-assisted navigation as a tool for patient selection, as it allows intraoperative dynamic goniometry and provides real-time kinematic behavior of the knee to obviate pitfalls such as significant residual varus angulation and hyperextension that predispose early failure of UKA.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Retrospective Studies; Surgery, Computer-Assisted; Tibia
PubMed: 34868498
DOI: 10.4055/cios20166 -
Journal of Pain Research 2020This study aimed to compare the demographic features (including total cost), surgical effects, radiographic parameters, and complications of kyphoplasty (KP) and...
PURPOSE
This study aimed to compare the demographic features (including total cost), surgical effects, radiographic parameters, and complications of kyphoplasty (KP) and vertebroplasty (VP) in the hyperextension (HP) and neutral positions (NP) and to assess their efficacy and cost-effectiveness for treating single-level osteoporotic vertebral compression fractures (OVCF).
PATIENTS AND METHODS
This was a retrospective analysis of 245 consecutive patients who underwent KP or VP from February 2018 to February 2019 with observation on postoperative day 2 and at the one-year follow-up. The first 122 patients (86 KP and 36 VP cases) were treated in the neutral position, and the remaining 123 in the hyperextension position (90 VP and 33 KP cases). Back pain and impact on daily life were evaluated. Cobb's angle and the ratio of the anterior (AR) and middle vertebral (MR) bodies were the main radiographic parameters. The chi-square test, one-way analysis of variance (ANOVA), repeated measurement ANOVA, and post hoc tests (Bonferroni adjustments) were used for statistical analysis.
RESULTS
There were no significant differences in the demographic features, operation time, or rate of re-fracture at the one-year follow-up among the groups. The rate of cement leakage was significantly lower in the HPVP group than in the NPKP group. The total cost was significantly lower in the VP groups than in the KP groups. At the one-year follow-up, back pain was significantly lower in the HPVP group than in the NPKP group. The Oswestry Disability Index, Cobb's angle, AR, and MR in the HPVP group were similar to those in the NPKP and HPKP groups, but better than those in the NPVP group.
CONCLUSION
HPVP can achieve better pain relief, and similar disability scores, Cobb's angle, AR and MR recovery, with a lower total cost, compared with NPKP. HPVP is the most economically efficacious treatment for OVCF.
PubMed: 33116792
DOI: 10.2147/JPR.S268610 -
Taiwanese Journal of Obstetrics &... Sep 2007Iniencephaly is characterized by a variable deficit of the occipital bones, resulting in an enlarged foramen magnum; partial or total absence of cervical and thoracic... (Review)
Review
Iniencephaly is characterized by a variable deficit of the occipital bones, resulting in an enlarged foramen magnum; partial or total absence of cervical and thoracic vertebrae with an irregular fusion of those present, accompanied by incomplete closure of the vertebral arches and/or bodies; significant shortening of the spinal column due to marked lordosis and hyperextension of the malformed cervicothoracic spine; and an upward-turned face and mandibular skin directly continuous with that of the chest due to the lack of neck. This article provides a comprehensive review of the reported cases of prenatally detected iniencephaly, including prenatal diagnosis, associated malformations, associated chromosomal abnormalities, and differential diagnosis. Prenatal diagnosis of a neural tube defect involving a body defect in the occiput and rachischisis of the cervical and thoracic spine with retroflexion of the head should raise the suspicion of iniencephaly. Iniencephaly may be associated with craniorachischisis and other structural anomalies. Prenatal diagnosis of non-isolated iniencephaly and craniorachischisis should alert one to the possibility of chromosomal abnormalities and prompt a cytogenetic investigation.
Topics: Diagnosis, Differential; Female; Fetal Diseases; Humans; Neural Tube Defects; Pregnancy; Prenatal Diagnosis
PubMed: 17962097
DOI: 10.1016/S1028-4559(08)60021-2 -
Acta Bio-medica : Atenei Parmensis Mar 2022Rhizarthrosis represents 10% of all arthritic manifestations and its prevalence increases with age and in women. The hyperextension of the metacarpophalangeal joint...
BACKGROUND AND AIM
Rhizarthrosis represents 10% of all arthritic manifestations and its prevalence increases with age and in women. The hyperextension of the metacarpophalangeal joint (MCPj) is consequent to a progressive dorsoradial subluxation of the trapeziometacarpal joint (TMj) in advanced osteoarthritis. The aim of this retrospective study is to evaluate the clinical and functional results of 32 patients affected by advanced rhizarthrosis who underwent to modified Burton-Pellegrini's trapeziectomy in absence of surgical correction of MCPj hyperextension in order to understand when this last step is really necessary.
METHODS
Patients were assessed trough DASH and PRWHE questionnaires; the functionality of the hand was assessed by carrying out specific test (grip strength, key-pinch, kapandji test, reduction of wrist flexion strength) and the degree of MCP joint hyperextension was recorded.
RESULTS
Clinical evaluation and individual satisfactory were positive in most cases (mean DASH 19 and mean PRWHE 21.8, with a reduction of 77% of VAS pain score). Kapandji test was excellent in 26 patients and grip strength and key pinch were stackable in operated and non-operated hands. Twenty-five out 32 patients presented a MCP joint hyperextension between 0° and 5°, 5 of 10° and other 2 of 15°.
CONCLUSION
Modified Burton-Pellegrini's trapeziectomy is a valid option to treat patient with TMj osteoarthritis. The absence of surgical correction of the MCPj does not affect clinical and functional results in deformities <15°.
Topics: Female; Humans; Metacarpophalangeal Joint; Osteoarthritis; Retrospective Studies; Thumb; Trapezium Bone
PubMed: 35604247
DOI: 10.23750/abm.v92iS3.12625 -
BMJ Case Reports Oct 2017We present a case of a 19-year-old woman with a forced hyperextension trauma of the knee causing a posteromedial fracture, a medial meniscus root tear and rupture of the...
We present a case of a 19-year-old woman with a forced hyperextension trauma of the knee causing a posteromedial fracture, a medial meniscus root tear and rupture of the posterior cruciate ligament. The posteromedial fracture of the tibial plateau was treated operatively with open reduction and internal fixation. Anatomical reconstruction was achieved. Postoperative treatment included unlimited flexion and minimal weight bearing. After 3 months, the patient had minimal pain after weight bearing and returned to preoperative range of motion.
Topics: Female; Fracture Fixation, Internal; Humans; Knee Joint; Menisci, Tibial; Open Fracture Reduction; Posterior Cruciate Ligament; Range of Motion, Articular; Recovery of Function; Rupture; Tibia; Tibial Fractures; Tibial Meniscus Injuries; Treatment Outcome; Young Adult
PubMed: 29018143
DOI: 10.1136/bcr-2016-217714 -
Orthopaedics & Traumatology, Surgery &... Oct 2016Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most...
Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most common and best-known manifestation of carpal dislocation, typically occurring after hyperextension trauma. Other forms are very rare and have different causative mechanisms. Carpometacarpal (CMC) dislocations are also uncommon and may affect isolated or multiple CMC joints. These lesions are prone to wrist instability if not treated promptly. The aim of this article is to provide a systematic radiologic approach to the evaluation of wrist injury and to present two acute cases of rare CMC dislocations.
Topics: Accidents, Traffic; Adult; Bone Nails; Carpometacarpal Joints; Female; Humans; Joint Dislocations; Male; Metacarpophalangeal Joint; Middle Aged
PubMed: 27210506
DOI: 10.1016/j.otsr.2016.04.003 -
Chinese Journal of Traumatology =... Jan 2023Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related... (Review)
Review
Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.
Topics: Child; Humans; Spinal Cord Injuries; Spinal Cord
PubMed: 36137934
DOI: 10.1016/j.cjtee.2022.07.005 -
Journal of Orthopaedic Surgery and... Jun 2019To report the diagnosis, injury mechanisms, and imaging characteristics of hyperextension bicondylar tibial plateau fractures and examine the indications and feasibility...
PURPOSE
To report the diagnosis, injury mechanisms, and imaging characteristics of hyperextension bicondylar tibial plateau fractures and examine the indications and feasibility of the modified anterior midline incision as a treatment strategy.
METHODS
We performed a retrospective analysis of 11 cases of hyperextension bicondylar tibial plateau fractures who were treated with open reduction and internal fixation, predominantly via an anterolateral and posteromedialdouble incision or a modified anterior midline incision. Radiological and functional evaluations were performed.
RESULTS
Eleven patients were followed-up for a mean period of 11.5 months (range 3-24 months). The mean time to radiographic bony union was 12.5 weeks (range 10-26 weeks). At final follow-up, the average Rasmussen functional score was 26.8 (range 24 - 29); five patients had an excellent rating, and six a good rating. The average range of motion of the affected knees was 3.4-130° postoperatively. Fixation failure was not observed in any of the treated fractures.
CONCLUSION
Hyperextension bicondylar tibial plateau fractures show a special Tiankeng-like collapse characteristic, while the changes in posterior tibial slope angle are easy to overlook. The modified anterior midline incision is a safe and effective approach for treatment of hyperextension bicondylar tibial plateau fractures with less rear displacement. Open reduction and double plating for the treatment of hyperextension bicondylar tibial plateau fractures provides excellent results.
Topics: Adult; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Open Fracture Reduction; Radiography; Retrospective Studies; Tibia; Tibial Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 31238968
DOI: 10.1186/s13018-019-1220-z -
Orthopaedic Surgery Feb 2014Injury of the ulnar collateral ligament (UCL) of thumb can be incapacitating if untreated or not treated properly. This injury is notorious for frequently being missed... (Review)
Review
Injury of the ulnar collateral ligament (UCL) of thumb can be incapacitating if untreated or not treated properly. This injury is notorious for frequently being missed by inexperienced health care personnel in emergency departments. It has frequently been described in skiers, but also occurs in other sports such as rugby, soccer, handball, basketball, volleyball and even after a handshake. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Many treatment options exist, surgical treatment being offered depending on various factors, including timing of presentation (acute or chronic), grade (severity of injury), displacement (Stener lesion), location of tear (mid-substance or peripheral), associated or concomitant surrounding tissue injury (bone, volar plate, etc.), and patient-related factors (occupational demands, etc.). This review aims to identify the optimal diagnostic techniques and management options for UCL injury available thus far.
Topics: Collateral Ligaments; Diagnostic Imaging; Humans; Metacarpophalangeal Joint; Physical Examination; Rupture; Thumb
PubMed: 24590986
DOI: 10.1111/os.12084