The effect of Pilates-based exercise applied with hybrid telerehabilitation method in children with adolescent idiopathic scoliosis: A randomized clinical trial.

This study aimed to investigate the effect of Pilates-based exercise training applied with hybrid telerehabilitation on Cobb angle, respiratory function, respiratory muscle strength, and functional capacity in patients with adolescent idiopathic scoliosis (AIS). This is an evaluator-blinded, randomized, controlled trial. For the study, 32 patients were randomly allocated into two groups: a hybrid telerehabilitation group (training group), provided with modified Pilates-based exercises with synchronous sessions; and a home-based group (control group), doing the same exercises in their home. The Pilates-based exercise program consists of stretching and strengthening exercises combined with postural corrections and breathing exercises modified according to the curve type and localization of the patients, done every day of the week for 12 weeks. Analyses were made based on the comparison between the angle of trunk rotation, Cobb angle, spirometry, maximal inspiratory (MIP) and expiratory pressures (MEP), and incremental shuttle walk tests done at the beginning and end of the study. The training group showed statistically significant improvements in Cobb angle, PEF%, MIP, and MEP values compared with the control group (p < 0.05). CONCLUSION:  Pilates-based exercises applied with the hybrid telerehabilitation method can improve Cobb angle and respiratory muscle strength in patients with AIS. The hybrid telerehabilitation method can be used as an alternative to home-based programs, especially in locations and times where there may be limited access to supervised training. Also, the nature of the disease that requires long-term follow-up is another factor where hybrid telerehabilitation may be an advantage. TRIAL REGISTRATION:  ClinicalTrials.gov ID: NCT05761236. WHAT IS KNOWN: • Exercise training is one of the main approaches to treating scoliosis. WHAT IS NEW: • Application of exercises via telerehabilitation method may contribute more to the improvement of scoliosis-related parameters than home-based programs. • Telerehabilitation may be a preferable alternative exercise method in scoliosis, considering the advantages of accessibility and long-term follow-up.

Local Prophylactic Teicoplanin Effect on Spinal Fusion Surgery: A Comparative Retrospective Study.

BACKGROUND: Surgical site infection (SSI) is one of the severe complications of spinal fusion surgery that leads to increased morbidity and mortality rates. Prophylactic antibiotic usage is one of the methods that reduce the SSI possibility in this procedure. To determine the effect of local subfascial teicoplanin and compare it to vancomycin on surgical outcomes in patients who underwent decompression with posterior instrumentation (DPI) for lumbar spinal stenosis (LSS). PATIENTS AND METHODS: Medical charts of patients with LSS who received DPI and met the study criteria were divided into three groups: the teicoplanin group included patients who underwent DPI with local teicoplanin before closure, the vancomycin group, included patients who underwent DPI with local vancomycin, and the control group included patients who underwent DPI without any local prophylactic antibiotics. RESULTS: A total of 101 patients were included in the study. No significant differences were found among groups regarding demographics, follow-up, and clinical and functional outcomes. No significant differences were observed among groups regarding postoperative improvements in SF-36-MCS, SF-36-PCS, Oswestry disability index, and VAS (p>0.05). In the teicoplanin and vancomycin groups, the SSI rate was lower without statistical significance (2/35, 1/34, and 5/32, respectively, p=0.136); however, the postoperative fusion volume was significantly higher in the teicoplanin group when compared to other groups (3.35±1.08 cm3, 2.68±1.17 cm3, and 2.65±1.28 cm3, respectively, p=0.007). CONCLUSIONS: Although its cost is relatively higher, teicoplanin was a good alternative for vancomycin in preventing SSIs with a higher fusion rate, but no superiority was observed regarding other outcomes.

Effects of inspiratory muscle training on respiratory muscle strength, respiratory function and functional capacity in adolescents with idiopathic scoliosis : A randomized, controlled trial.

BACKGROUND: Adolescent Idiopathic Scoliosis (AIS) may impair respiratory dynamics and affect the performance of inspiratory and expiratory muscles. The benefit of inspiratory muscle training (IMT) is not well investigated in AIS. We aimed to investigate the effects of IMT on respiratory muscle strength, respiratory function and functional capacity in adolescents with mild to moderate AIS. METHODS: Thirty-six adolescents were randomized into control or IMT groups. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) were measured by spirometry; respiratory muscle strength by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); and functional capacity by 6-min walk test (6MWT) before and after the 8-week-long home-based exercise program. Both groups received conventional exercise program including diaphragmatic breathing exercises, resistive local expansion exercise on the collapsed areas in concave sides of scoliosis, spinal stabilization, strengthening of interscapular muscles and stretching exercises. IMT group also trained with Threshold IMT device for 15 minutes, twice a day for 8 weeks at the intensity of 30% of initial MIP value in addition to conventional exercise program. RESULTS: FEV1, PEF, MIP, MEP and 6MWT distance significantly improved in both groups. IMT group also showed significant improvement in FVC. The increases in FVC, MIP, MEP and 6MWT distance of IMT group were significantly higher compared to control group. CONCLUSION: IMT is found to be beneficial for patients with AIS for achieving further improvements in respiratory function, respiratory muscle strength and functional capacity compared to conventional exercise program alone.

Effects of Core Stabilization Exercises on Pulmonary Function, Respiratory Muscle Strength, Peripheral Muscle Strength, Functional Capacity, and Perceived Appearance in Children With Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to investigate the effects of core stabilization exercises on pulmonary function, respiratory muscle strength, peripheral muscle strength, walking capacity, and perceived appearance in children with adolescent idiopathic scoliosis. DESIGN: This is an evaluator-blinded, randomized controlled trial. A total of 30 patients were randomly allocated to either a training group (n = 15, age = 13.8 ± 2.8 yrs, Cobb angle = 19.3 ± 6 degrees, Risser sign: n(1) = 1; n(2-4) = 14) or a control group (n = 15, age = 15.8 ± 3.4 yrs, Cobb angle = 20.8 ± 7.9 degrees, Risser sign: n(1) = 1; n(2-4) = 14). The training group received core stabilization exercises in addition to the traditional scoliosis exercises for 8 wks. The control group only received the traditional scoliosis exercises for 8 wks. Spirometry, maximal inspiratory and expiratory pressures, 6-min walking test, peripheral muscle strength, and the Walter Reed Visual Assessment Scale were assessed at the beginning and end of the study. RESULTS: The training group showed statistically significant improvements in maximal inspiratory pressure, maximum expiratory pressure, and Walter Reed Visual Assessment Scale score (respectively, mean changes = 17.4 ± 5.2 cmH2O; 10.6 ± 4.3 cmH2O; 2.4 ± 1.6), which were significantly larger compared with the control group (P < 0.05). CONCLUSIONS: Core stabilization exercises given in addition to the traditional scoliosis exercise can improve respiratory muscle strength and perceived appearance in patients with adolescent idiopathic scoliosis. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Determine the evaluation methods required for scoliosis patients; (2) Evaluate respiratory parameters in scoliosis patients; and (3) Plan and implement an exercise program for scoliosis patients. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Double-Layer Reconstruction of the Achilles' Tendon Using a Modified Lindholm's Technique and Vascularized Fascia Lata.

Loss of the Achilles' tendon with overlying soft tissue and skin defects remains a complex reconstructive challenge. Herein we present our experience using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata and a modified Lindholm's technique to repair the Achilles' tendon. A 37-year-old man suffered from tertiary Achilles' tendon rupture. For reconstruction, the free composite ALT flap with vascularized fascia lata was used to wrap Achilles' tendon. A modified Lindholm's technique was used to cover overlying soft tissue defects. The patient was followed up for 12 months. No wound healing problems were reported, and the patient was able to walk and return to his daily ambulating activities without any support after 5 months postoperatively. This technique may be useful to achieve satisfactory outcomes in patients with ruptured Achilles' tendons following tertiary repair.

Comparison of two types of proximal femoral hails in the treatment of intertrochanteric femur fractures.

BACKGROUND: Hip nailing is frequently used to treat unstable intertrochanteric femoral fractures (ITF) in elderly patients. In this retrospective study, we compared the functional and radiological results, and the complications, of patients treated using proximal femoral nails (PFN) with an integrated, interlocking, compression lag screw, or two separate lag screws, which allow linear compression at the fracture site. METHODS: A total of one hundred and eighteen patients were operated on for AO/OTA 31-A2 ITF between May 2010 and April 2012, and eighty-two of these patients, for whom sufficient follow-up data and documentation were available, were included into the study. PFNs with interlocking, integrated lag screws (Group I) were used in forty-four patients, and PFNs with two separate lag screws (Group II) in thirty-eight. Outcome parameters were the extent of varus collapse and leg length discrepancy on radiographs, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris hip scores (HHS) as functional results. RESULTS: Mean follow-up duration was 20 months (range, 12-36 months); fractures healed in all patients. Mean varus collapse values were 2.03±5.68° and 5.21±5.27° (p=0.01), Harris hip scores 73.2±11.65 and 74.72±11.15 (p=0.54), and WOMAC scores 70.78±11.41 and 71.78±11.19 (p=0.69) in Groups I and II, respectively. No difference was detected between the groups in terms of outcome parameters or complication rate. CONCLUSION: In the treatment of ITF, PFNs with an integrated, interlocking, compression lag screw, or two separate lag screws did not differ in terms of functional and radiological results or complication rate.

Patients with black hip and black knee due to ochronotic arthropathy: case report and review of literature.

Ochronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis.

Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus.

The purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus.

Muscle Abscess due to Salmonella Enterica.

Non typhoidal Salmonellae spp. causes clinical symptoms especially in neonates, infants, aged and immunocompromised patients. Hematogenous dissemination may occur in complicated cases whereas the formation of abscess is rare. A 61-year old woman presented to our hospital with pain and a mass in her left arm, without fever and leukocytosis. She was using methotrexate, corticosteroids and quinine for rheumatoid arthritis. She had a history of cervix cancer and was given radiotherapy and chemotherapy 3 years ago. Upon physical examination and magnetic resonance imaging, the mass was considered as an abscess and was surgically drained. Salmonella enterica spp. enterica was yielded in the culture of the drainage material. Ceftriaxon 2g/day was started intramuscularly and continued for 4 weeks. Salmonellosis is usually a self-limited disease, generally restricted to gastrointestinal tract and acquired following food poisoning. Management of Salmonella abscess requires a combination of antibiotherapy, surgical drainage and eradication of primary foci.

Does obesity negatively affect the functional results of arthroscopic partial meniscectomy? A retrospective cohort study.

PURPOSE: The purpose of this study was to evaluate the impact of body mass index (BMI) on early functional results of patients who undergo isolated partial meniscectomy. METHODS: The functional results for 1,090 patients who underwent partial meniscectomy, in 2 different orthopaedic clinics, were evaluated retrospectively. The study includes cases with arthroscopic partial meniscectomy for isolated meniscal tears; patients with concomitant knee pathology were excluded. Three hundred forty-one (31%) patients with isolated lateral meniscal tears, 628 (58%) patients with isolated medial meniscal tears, and 121 (11%) patients with both medial and lateral meniscal tears underwent arthroscopic partial meniscectomy. We divided these patients into 3 subgroups on the basis of their BMI; <26, between 26 and 30, ≥30. Preoperative functional results were compared with 1-year postoperative follow-up results using the International Knee Documentation Committee (IKDC),(26) Lysholm Knee Scale,(27) and Oxford Scoring System(28) scores. RESULTS: According to all 3 knee scales, age, side of lesion, and tear type had no effect on functional outcome. When compared with the group with BMI <26, the patients with BMI between 26 and 30 and the patients with BMI ≥30 had significantly worse outcomes as measured by the IKDC, Oxford Scoring System, and Lysholm Knee Scale scores. Patients with BMI between 26 and 30 and ≥30 did not have significantly different functional outcomes. CONCLUSIONS: Short-term outcomes after arthroscopic partial menisectomy reflect significant improvement in subjective outcome. However, patients with moderate or significant obesity (BMI >26) have inferior short-term outcomes compared with nonobese patients. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Metatarsal head resurfacing hemiarthroplasty in the treatment of advanced stage hallux rigidus: outcomes in the short-term.

OBJECTIVE: The aim of this study was to evaluate the short-term outcomes of metatarsal head metal resurfacing hemiarthroplasty in patients with advanced stage hallux rigidus. METHODS: The study included 14 feet (4 left, 10 right) of 12 patients (10 female, 2 male; mean age: 63 ± 5; range: 55 to 71 years) who underwent metatarsal head metal resurfacing hemiarthroplasty (HemiCAP(®)) between 2007 and 2010. Additionally, capsular release and periarticular osteophyte debridement were performed. Staging was made according to Coughlin and Shurnas' clinical and radiological grading system. Hallux valgus and intermetatarsal angles were measured using pre and postoperative standing AP and lateral foot views. Clinical assessment was made with first metatarsophalangeal joint range of motion, the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale and satisfaction level. RESULTS: Mean follow up was 19.5 (range: 14 to 26) months. Two patients had bilateral involvement. According to Coughlin and Shurnas' clinical and radiological grading system, nine feet were Stage 3 and five feet were Stage 4. According to the AOFAS scale, results of eight feet (57.1%) were excellent, four feet (28.6%) were good and two feet (14.3%) were moderate. Mean total AOFAS score increased by 26.2 points postoperatively (p<0.05). Mean range of motion of the first metatarsophalangeal joint improved significantly from a preoperative 22.2 ± 5.6 (range: 10 to 28) degrees to a postoperative 56.3 ± 9.6 degrees (p<0.05). Mean hallux valgus angle decreased from a preoperative 14.3 (range: 9 to 17) degrees to a postoperative 11.1 (range: 4 to 13) degrees and the mean intermetatarsal angle increased from a preoperative 10.5 (range: 8 to 14) degrees to a postoperative 10.8 (range: 8 to 15) degrees. Patient satisfaction levels were very good in 10 feet (71.4%), good in 3 (21.4%), and moderate in one (7.2%). Complications included metatarsalgia aggravated by long walks in one patient and hypoesthesia of the great toe in three patients. Push-off power of the great toes was measured as 4/5 in three cases, and 5/5 in others. CONCLUSION: Metatarsal head metal resurfacing hemiarthroplasty provides high patient satisfaction level and good functional outcome in the short-term, in the surgical treatment of advanced stage hallux rigidus refractory to conservative treatment options.