[TREATMENT FOR OSTEOARTHRITIS OF THE KNEE].

INTRODUCTION: Osteoarthritis is the most common joint disorder in the world and its incidence is rising. In Western populations it is one of the most frequent causes of pain, loss of function and disability in adults. The estimated lifetime risk for knee osteoarthritis is approximately 40% in men and 47% in women. The diagnosis of osteoarthritis is complex due to a lack of specific physical and/or laboratorial findings. The American College of Rheumatology (ACR) has recommended using the following criteria for the diagnosis of knee osteoarthritis: chronic knee pain (lasting for more than 6 weeks) and at least three of the following: • Age over 50 years old. • Morning knee stiffness lasting up to 30 minutes. • Crepitus with active motion • Tenderness on bony palpation • Thickening or growth of the bones • No local heat on palpation Treatment of osteoarthritis involves alleviating pain, attempting to rectify mechanical misalignment, and identifying and addressing manifestations of joint instability. The American Academy of Orthopedic Surgeons (AAOS) has conducted a systematic review of the current scientific and clinical research and has issued clinical practice guidelines containing fifteen recommendations for the treatment of osteoarthritis of the knee, and include only less invasive alternatives to total or partial knee arthroplasty. This review presents the background, diagnosis, treatment and a summary of the AAOS guidelines regarding "Treatment of Osteoarthritis of the Knee".

[HAND INJURIES IN ROCK CLIMBERS].

INTRODUCTION: Rock climbing, whether practiced in nature on cliffs and boulders or indoors on walls made of resin and wood, has gained tremendous popularity in recent decades. More people are exposed to injuries associated with the unique biomechanical forces of rock climbing. A series of repetitive high torque movements of the upper limbs are needed to ascend a wall or rockface. These movements subject the hand and wrist to large forces, potentially resulting in ligament and tendon sprains or rupture and even bone fracture. This review describes the anatomy, biomechanics and the common hand injuries in rock climbers.

User Assessment of a Novel Suspension for a Wheelchair-A Prospective, Randomized, Double Blind Trial.

BACKGROUND: Many Wheelchair users experience adverse effects specific to their situation, some of which might be avoided if suspension systems are integrated into the wheelchair. OBJECTIVES: Our study aimed to compare the user experience using a novel wheelchair suspension system with normal wheels. We tried to quantify the user feelings and impressions while using the different wheels. STUDY DESIGN: Double blinded comparative randomized study. METHODS: The patients were randomized into 2 groups. One used shock absorbing wheels, and the other group had a set of standard wheels with the same exact wheelchairs. The patients were taken to a daily trip by the caregivers and given questionnaires in the second and fourth days. On the morning of the third day the wheels were interchanged, creating a cross over between the groups. We collected general and medical information from the participants. The main outcome measures were the questionnaires filled by the patients and the caregivers aiming to quantify the user experience with the suspension equipped wheels. RESULTS: Statistical significance was reached in 2 questions referred to the patients: "In general-During the ride I didn't feel the bumps" and "I feel very confident when riding the chair" and in one question referred to the caregiver-"It was easy to push the chair in suboptimal ground." CONCLUSIONS: We conclude that the shock absorbing system provided a better user experience in the immediate term than standard wheels. Further study is needed to assess the long-term implications.

Trunk kinematic, kinetic, and neuro-muscular response to foot center of pressure translation along the medio-lateral foot axis during gait.

Footwear devices that shift foot center of pressure (COP), thereby impacting lower-limb biomechanics to produce clinical benefit, have been studied regarding degenerative diseases of knee and hip joints, exhibiting evidence of clinical success. Ability to purposefully affect trunk biomechanics has not been investigated for this type of footwear. Fifteen healthy young male subjects underwent gait and electromyography analysis using a biomechanical device that shifts COP via moveable convex elements attached to the shoe sole. Analyses were performed in three COP configurations for pairwise comparison: (1) neutral (control) (2) laterally deviated, and (3) medially deviated. Sagittal and frontal-plane pelvis and spine kinematics, external oblique activity, and frontal and transverse-plane lumbar moments were affected by medio-lateral COP shift. Transverse-plane trunk kinematics, activity of the lumbar longissimus, latissimus dorsi, rectus abdominus, and quadratus lumborum, and sagittal-plane lumbar moment, were not significantly impacted. Two linear mixed effects models assessed predictive impact of (I) COP location, and (II) trunk kinematics and neuromuscular activity, on the significant lumbar moment parameters. The COP was a significant predictor of all modeled frontal and transverse-plane lumbar moment parameters, while pelvic and spine rotation, and lumbar longissimus activity were significant predictors of one frontal-plane lumbar moment parameter. Model results suggest that, although trunk biomechanics and muscle activity were altered by COP shift, COP offset influences lumbar kinetics directly, or via lower-limb changes not assessed in this study, but not by means of alteration of trunk kinematics or muscle activity. Further study may reveal implications in treatment of low back pain.

Congenital pseudoarthrosis of the clavicle: Should we reconsider timing and fixation method?

BACKGROUND: Congenital pseudoarthrosis of the clavicle (CPC) is rare and may require treatment, usually because of an unacceptable appearance or occasionally because of pain in an adolescent patient. Spontaneous union is unknown, and consequently any desired union requires open reduction and bone grafting. Many authors recommend performing the operation at the age of 3-5 years and using different fixation methods. We present our experience with three cases and literature review in an attempt to further elucidate the appropriate timing of the procedure and the fixation method. METHODS: This was a retrospective review of three cases presenting with pseudoarthrosis of the clavicle. All cases were treated by curettage of the pseudoarthrosis, with the void filled using full-thickness ileac crest autologous bone graft and bridging plate-one compression and two anatomical, at different ages. We performed a literature review with emphasis on timing of the procedure, fixation method and complications. RESULTS: All patients healed with good callus formation. One patient (5-year-old female treated using a compression plate) experienced overlying skin irritation and underwent removal of the plate. There were no restriction of movement, pain or any other complaint on the final follow-up. We did not find any difference in the operating complexity at different ages, but when a compression plate was used, it had to be removed later due to bulging of the plate. DISCUSSION: No clinical difference was observed between earlier and late operation. Therefore, we suggest performing a curettage of the pseudoarthrosis, gapping the void using autologous bone graft, and using an anatomical bridging plate.

Can orthopedic surgeons help create a better head start for osteoporosis treatment after hip fracture?

BACKGROUND: Treatment for osteoporosis in the community in patients who were operated for hip fracture appears to be suboptimal at best. Evidence regarding treatment beyond the 1st year after surgery is scarce. We examined the association between discharge recommendations for treatment of osteoporosis in patients suffering from hip fractures and treatment beyond the 1st year. METHODS AND MATERIALS: We performed a retrospective observational cohort study in patients age 50 to 90 years operated for osteoporotic hip fractures between the years 2008 and 2014. We investigated the correlation between discharge recommendations and rates of osteoporosis treatment postdischarge 1 to 7 years, and the influence of osteoporosis diagnosis upon treatment. Exclusion criteria besides age included high-energy trauma, pathologic or periprosthetic fractures, and patients deceased within 1-year postsurgery. RESULTS: A total of 602 patient files were examined. Univariate analysis showed that, of 283 patients who were prescribed dietary supplementation of vitamin D and calcium, a significantly higher percentage of patients received treatment if they had a recommendation (50.3% vs 36.1%, P = 0.0005), were diagnosed (43.8% vs 14.4%, P < 0.0001), or were of female gender (84.1% vs 57.3%, P < 0.0001). Multivariate analysis showed that the odds ratio (OR) for receiving treatment compared with the control group (patients without a recommendation and a diagnosis) was higher among patients who had both a recommendation and a treatment (OR = 5.4, P < 0.0001) than the group with a diagnosis only (OR = 4.75, P < 0.0001) or a recommendation only (OR = 2.06, P = 0.0006). CONCLUSIONS: A formal recommendation for osteoporosis treatment in the discharge letters of patients who suffered hip fragility fractures increases treatment rate of osteoporosis in the community compared with patients without a recommendation. Patients who receive such a recommendation but also have a formal coded diagnosis of osteoporosis in their medical files have an even higher chance of receiving treatment in the community. Our observations may assist in amplifying the overall treatment rates, which are still undoubtedly low.

Intrauterine fetal death of one twin of diamnionic twins is associated with adverse perinatal outcome of the co-twin.

OBJECTIVE: To determine whether intrauterine fetal death (IUFD) of one twin of diamnionic twins after 22 weeks of gestation is associated with adverse perinatal outcome to the co-twin. METHOD: A retrospective case-control study (n = 4070), including all twin births delivered between the years 1988 and 2010, was conducted. Perinatal outcome of the co-twin in diamnionic pregnancies complicated by IUFD were compared with the first twin from a pair of live-born diamnionic twins. A multiple logistic regression model was constructed to determine the association between IUFD of one twin and postpartum death (PPD) of the co-twin while controlling for confounders such as gestational age. RESULTS: Pregnancies complicated with IUFD of a co-twin (n = 116) had higher rates of adverse perinatal outcomes such as PPD (9.5% vs. 2.3%, p < 0.001), low Apgar scores (<7) at 1 and 5 min (30.2% vs. 10.6%, p < 0.001 and 6.9% vs. 1.8%, p < 0.001, respectively), lower birth weight (1953 ± 746 g vs. 2299 ± 559 g), and higher rates of preterm birth before 34 weeks of gestation (38.8% vs. 16.4%, p < 0.001). Using a multivariate analysis with PPD as the outcome variable, mortality was attributed to gestational age (adjusted OR = 0.58; 95% CI 0.5-0.6, p < 0.001) and not to the IUFD per se (adjusted OR = 1.3, 95% CI 0.5-3.3, p = 0.552). CONCLUSION: Intrauterine fetal death of one twin (of diamnionic twins) is associated with adverse perinatal outcome of the co-twin mainly due to prematurity.