Design and Testing of a Dynamic Orthosis to Reduce Glenohumeral Subluxation With Omnidirectional Shoulder Motion.

OBJECTIVE: This paper aimed to develop an orthosis to apply a compensating force to improve the stability of the glenohumeral joint without resisting arm movement. METHODS: The proposed orthosis was based on a parallelogram structure to provide a pair of compensating forces to the glenohumeral joint center. Theoretical analysis was used to evaluate the additional moments caused by glenohumeral joint center shifting. Then, an experimental evaluation platform, composed of a torque sensor, a force sensor, and a 3D printed arm, was set up to assess the additional moments and compensating force. Finally, the proposed orthosis was compared with the traditional orthosis to compare the subluxation reduction and the movement restriction when worn by stroke patients. RESULTS: There was only a maximum additional moment of 0.87 Nm for the glenohumeral center shifting. During 3D printed arm movement, the moment correlation coefficient between with and without the proposed orthosis was greater than 0.98, and the compensating force was larger than 90% of the arm weight. The proposed orthosis reduced subluxation by 12.5±3.5 mm, and the traditional orthosis reduced subluxation by 7.7±2.2 mm, indicating that the subluxation reduction of the proposed orthosis was more effective ( ). Meanwhile, the proposed orthosis's motion restriction joint was significantly smaller than traditional orthosis ( ). CONCLUSION: The proposed orthosis provided sufficient gravity compensation without resisting arm movement. SIGNIFICANCE: The proposed orthosis can improve the shoulder's stability during shoulder movement, potentially improving the rehabilitation effect of patients with shoulder subluxation.

Outcomes following conservative treatment of extension fractures in the setting of diffuse idiopathic skeletal hyperostosis: is external orthosis alone a reasonable option?

OBJECTIVE: Extension fractures in the setting of diffuse idiopathic skeletal hyperostosis (DISH) represent highly unstable injuries. As a result, these fractures are most frequently treated with immediate surgical fixation to limit any potential risk of associated neurological injury. Although this represents the standard of care, patients with significant comorbidities, advanced age, or medical instability may not be surgical candidates. In this paper, the authors evaluated a series of patients with extension DISH fractures who were treated with orthosis alone and evaluated their outcomes. METHODS: A retrospective review from 2015 to 2022 was conducted at a large level 1 trauma center. Patients with extension-type DISH fractures without neurological deficits were identified. All patients were treated conservatively with orthosis alone. Baseline patient characteristics and adverse outcomes are reported. RESULTS: Twenty-seven patients were identified as presenting with extension fractures associated with DISH without neurological deficit. Of these, 22 patients had complete follow-up on final chart review. Of these 22 patients, 21 (95.5%) were treated successfully with external orthosis. One patient (4.5%) who was noncompliant with the brace had an acute spinal cord injury 1 month after presentation, requiring immediate surgical fixation and decompression. No other complications, including skin breakdown or pressure ulcers related to bracing, were reported. CONCLUSIONS: Treatment of extension-type DISH fractures may be a reasonable option for patients who are not candidates for safe surgical intervention; however, a risk of neurological injury secondary to delayed instability remains, particularly if patients are noncompliant with the bracing regimen. This risk should be balanced against the high complication rate and potential mortality associated with surgical intervention in this patient population.

The first case report of multiple thoracic vertebrae fractures caused by a low-voltage electric shock.

BACKGROUND: This paper describes a unique case-the first case of multiple fractures of the thoracic vertebrae caused by a low-voltage electric shock. CASE PRESENTATION: A 22-year-old male patient was diagnosed with compression fractures of Th2-Th6 caused by a muscle spasm resulting from an electric shock. The patient was treated conservatively using a cervico-thoracic support corset. After rehabilitation, the patient has regained his physiological movement of the spine without any back pain. CONCLUSIONS: Albeit vertebral fractures caused by electric shock injury are extremely rare, clinicians should always keep in mind this diagnosis, especially when clinical symptoms such as pain and limitation of movement are present.

Effect of lower limb orthoses on cartilage in patients with knee osteoarthritis: A narrative review.

The objective of this review was to infer how the use of an orthosis affects cartilage in patients with knee osteoarthritis. A search was performed in four different databases (Web of Science, Scopus, EMBASE, and PubMed) up to the 21st of November of 2020 to evaluate how the patient's condition was monitored. The parameters chosen for this review were medial tibial cartilage volume, x-ray evaluation, Lequesne Index, pain visual analog scale score, Western Ontario and McMaster Universities Arthritis Index pain score, and Knee Injury and Osteoarthritis Outcome Score pain subscale score. The initial search yielded a total of 12,622 documents. After thoroughly screening them, 38 were selected for analysis. Of the resulting data, only two objectively evaluated the cartilage (medial tibial cartilage volume, n = 1; x-ray evaluation, n = 1), with the remainder evaluating subjective symptoms (Lequesne Index, n = 8; pain visual analog scale score, n = 18; Western Ontario and McMaster Universities Arthritis Index pain score, n = 10; Knee Injury and Osteoarthritis Outcome Score pain subscale score, n = 10). The data did not converge toward any general outcome. The articles read demonstrated a great tendency to evaluate qualitative parameters pertinent to the symptoms of this condition or quantitative parameters related to the biomechanics of the knee. However, these parameters are not ideal because they are ambiguous. As such, a shift toward more objective quantitative parameters that directly assess the cartilage volume of the knee should be considered in future clinical trials.

Side Effects of Cranial Remolding Orthoses: A Multi-Site Review.

ABSTRACT: Infants with deformational head shapes may be treated with a Cranial Remolding Orthosis (CRO). Risks of CROs include skin irritations and other minor side effects. It is important to examine the incidence of complications with CRO treatment to determine if the potential benefits outweigh the risks.This study retrospectively examined surveys provided by both practitioners and caregivers regarding orthotic treatment side effects and wear time at four clinics in Canada. Statistical analysis including the Chi-square test and Fisher's exact tests were performed to examine how the side effects varied by treatment site and by reported orthotic wear time.In total, 5,025 surveys about the CRO treatment of 453 patients were reviewed. The most common side effects were pressure spots, redness lasting for more than 1 hour, excessive sweat , and foul odor; however, the vast majority reported no significant issues (87.08%). Only 2.81% of surveys reported multiple side effects, which was about three times more like to happen when the CRO was reported to have fit problems. Wear time is correlated with the report of side effects; infants who wore the CRO 18 to 23.5 hours had statistically fewer side effects than those who wore the CRO for less time. The reported incidence of side effects may be artificially inflated because infants experiencing side effects are more likely to have more frequent follow-up.Overall, the side effects of CRO treatment reported in this cohort were relatively rare and minimal, indicating CRO treatment is a safe way to treat deformational head shapes.

Effectiveness of Quickcast Versus Custom-Fabricated Thermoplastic Orthosis Immobilization for the Treatment of Mallet Fingers: A Randomized Clinical Trial.

BACKGROUND: Mallet finger is a common injury involving a detachment of the terminal extensor tendon from the distal phalanx. This injury is usually treated with immobilization in a cast or splint. The purpose of this study is to compare outcomes of mallet fingers treated with either a cast (Quickcast) or a traditional thermoplastic custom-fabricated orthosis. METHODS: Our study was a prospective, assessor-blinded, single-center randomized clinical trial of 58 consecutive patients with the diagnosis of bony or soft tissue mallet finger treated with immobilization. Patients were randomized to either an orfilight thermoplastic custom-fabricated orthosis or a Quickcast orthosis. Patients were evaluated at 3, 6, and 10 weeks for bony and 4, 8, and 12 weeks for soft tissue mallets. Skin complications, pain with orthosis, compliance, need for surgical intervention, and extensor lag were compared between the 2 groups. RESULTS: Both bony and soft tissue mallet finger patients experienced significantly less skin complications (33% vs 64%) and pain (11.2 vs 21.6) when using Quickcast versus an orfilight thermoplastic custom-fabricated orthosis. The soft tissue mallet group revealed a greater difference in pain, favoring Quickcast (6.2 vs 22). No significant difference in final extensor droop or need for secondary surgery was found between the 2 groups. CONCLUSIONS: Quickcast immobilization for the treatment of mallet finger demonstrated fewer skin complications and less pain compared with orfilight custom-fabricated splints.

Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation.

BACKGROUND: Dysphagia is one of the most serious complications in patients treated with a halo-vest brace. However, the cause of dysphagia development by halo-vest fixation is not yet clear. We therefore investigated the incidence of dysphagia and cervical alignment as well as clinical data from medical charts in patients treated with a halo-vest brace. METHODS: We retrospectively reviewed clinical data from the medical charts of 49 patients who had undergone halo-vest fixation. Occipito (O)-C2 angle, C2-C6 angle, and pharyngeal inlet angle were assessed by lateral plain X-rays of the cervical spine. The impacts of these parameters on incidence and severity of dysphagia were analyzed. RESULTS: Thirteen patients (32%) suffered from dysphagia during halo-vest fixation, and age and length of intensive care unit (ICU) stay were greater in the dysphagia group (p = 0.044 and 0.013, respectively) than in those who did not develop dysphagia. O-C2 angle was smaller in the dysphagia group (p = 0.016). After multivariate logistic analysis, body mass index, ICU stay, and O-C2 angle remained as independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative correlation between ICU stay and Food Intake Level Scale (FILS) (p = 0.026), and a positive correlation between O-C2 angle and FILS (p = 0.008). CONCLUSION: This study suggested that O-C2 angle is related to both incidence and severity of dysphagia due to halo-vest fixation.

Análise do equilíbrio postural estático e da intensidade das dores musculoesqueléticas após o uso de palmilhas proprioceptivas por militares do serviço ostensivo / Análisis del equilibrio postural estático y de la intensidad de los dolores musculoesqueléticas después del uso de plantillas propioceptivas por militares del servicio ostensivo / Analysis of static postural balance and of intensity of musculoskeletal pains after the use of proprioceptive insoles by ostensive service militaries

RESUMO Para a manutenção do equilíbrio, o organismo utiliza os sistemas visuais, vestibulares e proprioceptivos, que enviam informações para o sistema nervoso central acerca das condições do corpo com o objetivo de estabilizá-lo. Este estudo avaliou o efeito das palmilhas proprioceptivas sobre o equilíbrio postural estático e as dores musculoesqueléticas após dois meses de uso, por meio de uma pesquisa analítica longitudinal com 15 militares saudáveis do sexo masculino com média de idade de 34±7,5 anos. Eles foram submetidos à avaliação do equilíbrio por meio da plataforma Medicapteurs® e pelo protocolo CNT. Não houve diferença estatística para os desvios do corpo e velocidade do centro de pressão. A pressão plantar teve mudança estatisticamente significante para o pé esquerdo e o pé direito correspondendo a p=0,0001 e p=0,0007, respectivamente. Houve redução das médias de dores nos joelhos, pés e calcanhares e diminuição significativa da dor lombar, com p=0,0180. O equilíbrio estático não foi alterado significativamente com o uso das palmilhas proprioceptivas pelos militares, contudo elas proporcionaram melhor redistribuição das pressões plantares e parecem atenuar as dores musculoesqueléticas das extremidades inferiores. Por isso as palmilhas podem ser consideradas para esse grupo uma terapêutica de prevenção contra lesões relacionadas à sua atividade laboral.

RESUMEN Para mantener el equilibrio el cuerpo utiliza los sistemas visuales, vestibulares y propioceptivos, que envían información al sistema nervioso central sobre las condiciones del cuerpo para estabilizarlo. Este estudio evaluó el efecto de las plantillas propioceptivas sobre el equilibrio postural estático y los dolores musculoesqueléticas después de dos meses de uso, a través de una investigación analítica longitudinal con 15 soldados sanos con una edad media de 34±7.5 años. Ellos fueron sometidos a evaluación de equilibrio a través de la plataforma Medicapteurs® y por el protocolo CNT. No hubo diferencia estadística para las desviaciones del cuerpo y para la velocidad del centro de presión. La presión plantar tuvo un cambio estadísticamente significativo para el pie izquierdo y el pie derecho correspondiente a p=0.0001 y p=0.0007, respectivamente. Hubo una reducción en las promedio de los dolores en las rodillas, pies y talones y una disminución significativa en el dolor lumbar, con p=0.0180. El equilibrio estático no se modificó significativamente con el uso de plantillas propioceptivas por los militares, sin embargo, proporcionaron una mejor redistribución de las presiones plantares y parecen ablandar los dolores musculoesqueléticas en las extremidades inferiores. Por lo tanto las plantillas pueden considerarse para ese grupo como una terapia de prevención contra lesiones relacionadas con su actividad laboral.

ABSTRACT To maintain the balance, the body uses visual, vestibular and proprioceptive systems, which send information to the central nervous system about the body's conditions in order to stabilize it. This study evaluated the effect of proprioceptive insoles on static postural balance and musculoskeletal pains after two months of use, through a longitudinal analytical study with 15 healthy male soldiers with a mean age of 34±7.5 years. They were subjected to balance evaluation through the Medicapteurs® platform and by CNT protocol. There was no statistical difference for the deviations of the body and speed of the center of pressure. Plantar pressure had a statistically significant change for the left and the right feet, corresponding to p=0.0001 and p=0.0007, respectively. There was a reduction in the mean values of the pains in the knees, feet and heels and a significant decrease in lumbar spine pain, with p=0.0180. The static balance was not significantly altered with the use of proprioceptive insoles by the militaries; however, these insoles provided a better redistribution of plantar pressures and seem to attenuate the musculoskeletal pains of the lower extremities. Therefore, insoles can be considered as a prevention therapy against injuries for this group related to their work activity.

Scoliosis Progression After the Nuss Procedure for Pectus Excavatum: A Case Report.

INTRODUCTION: Pectus excavatum and scoliosis are associated conditions with a high rate of coincidence. However, there are no reports to guide surgeons on the management of adolescents with moderate scoliosis and pectus excavatum, because there are conflicting conclusions in the literature regarding how the Nuss procedure with substernal bar affects scoliosis. CASES: In 2017, we encountered two patients with moderate scoliosis treated with a spinal orthosis. After undergoing the Nuss procedure for pectus excavatum, their scoliosis acutely progressed into surgical magnitude requiring posterior instrumented spinal fusion. The first patient progressed 26° despite the pre-Nuss radiographs showing him to be Risser 4/5, while the second patient also progressed 26° from the Nuss procedure. Both patients acknowledged noncompliance with brace wear because of discomfort after the Nuss procedure. However, their progression rate still doubles the rate of reported rapid accelerators, indicating that a significant component of curve progression is directly attributed to forces on the spine from the corrective maneuver with substernal bar. CONCLUSION: The purpose of this case report is to describe the features of these two patients to help with clinical decision-making in patients with moderate scoliosis (curves >25°) who are contemplating the Nuss procedure for correction of pectus excavatum. We caution patients and providers that spinal deformity could worsen with surgical intervention of the pectus excavatum via the Nuss procedure and necessitate scoliosis surgery.

Posttraumatic C5 Palsy After Application of Hard Collar in Ankylosing Spondylitis.

BACKGROUND: Ankylosing spondylitis (AS) is a systemic enthesopathy. In its presence, spinal fractures are often unstable. Acknowledging the preinjury level of kyphosis is key in the management of cervical fractures, and placement into a hard collar has been shown to result in life-threatening spinal cord complications. CASE DESCRIPTION: This report presents the unique case of a patient with AS who developed a unilateral C5 palsy after the application of a hard collar for a C5/6 fracture, to our knowledge the first such case presented to date. The patient subsequently went on to an anterior fixation and partially recovered from the C5 palsy/injury. After the case report is an examination of the currently available literature and evidence exploring the factors that may contribute to C5 palsy after the application of a collar for acute fracture in AS. CONCLUSIONS: We described the first case in the literature of a posttraumatic C5 palsy after application of a hard collar in AS. This report and literature review should act to underscore the importance of respecting a preexisting rigid kyphotic deformity in cervical fractures but also to stimulate further thoughts and investigations into what may contribute to a posttraumatic C5 palsy.

[Correction of the lumbosacral orthosis in the patients presenting with patellofemoral pain syndrome with the use of physical exercise therapy]. / Korrektsiia myshechnogo korseta poiasnichno-kresttsovogo otdela pozvonochnika u patsientov s patellofemoral'nym bolevym sindromom metodom lechebnoi fizkul'tury.

THE RATIONALE: The differential approach taking into consideration the pathogenetic aspects of the pathological condition of interest with the identification of the principal cause of disorders in the musculo-skeletal system is a topical issue in the development of the measures for the rehabilitative treatment of the affected patients. Despite a great variety of methods and guidelines currently available for the conservative treatment of the musculoskeletal system diseases, further investigations and the development of the approaches and recommendations are needed for the correction and prevention of pathobiomechanical disorders and securing the optimal motor stereotype. AIM: The objective of the present study was to improve the existing methods for the correction of the lumbosacral orthosis in the patients presenting with patellofemoral pain syndrome with the use of physical exercise therapy for the improvement of their locomotor activity. MATERIAL AND METHODS: We have undertaken a randomized controlled clinical study involving 60 outpatients. They were divided into two groups designated as the main and control ones. The inclusion criteria were the age between 18 and 35 years, the feeling of discomfort or pain in the lumbosacral region, and the combined patellofemoral syndrome. All the patients underwent the comprehensive examination of the musculoskeletal system, and evaluation of pain intensity based on the relevant visual-analogue scales, stabilometry before and after the treatment of the patients comprising the main group with the use of the combined correction and of the control patients with the application of the conventional correction methods. RESULTS: The treatment with the use of the proposed original physical exercise therapy of the patients presenting with the pain syndrome in the lumbosacral region resulted in a reduction of its intensity by 27% on the average (p<0.05) and a significant 40% decrease in the frequency of dysfunction of the thoracoabdominal diaphragm. Simultaneously, the frequency of dysfunction of the muscles stabilizing the lumbosacral spine and the lower extremity on the side of the patellofemoral complex decreased by 53.4% and 17.8% on the average, respectively. Parameters of stabilometry evaluated from the results of the 'Mishen' (Target) test and the Romberg test with eyes closed improved by 1.9 times (p<0.05) and 2.5 times (p<0.05) on the average, respectively. CONCLUSION: The study has demonstrated that dysfunction of the sacral bone and muscles in the lumbosacral spine region responsible for the formation of the pain syndrome in the lower part of the back develops in 67% of the patients presenting with the patellofemoral pain syndrome. Physiotherapy including endurance-type exercises and activation of the muscles stabilizing the lumbosacral spine and lower extremities can improve results of rehabilitation.

Semirigid cervical spine collar and risk of missing significant soft tissue injuries.

We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery would be needed subsequently.This case demonstrates that while cervical collars remain a fundamental aspect of initial prehospital care in trauma, they have potential drawbacks to their use, which need to be carefully noted. Some of these drawbacks have been reported extensively in the literature. This case outlines the necessity of a thorough secondary survey in the trauma patient as the cervical collar can obscure the assessment of significant head and neck soft tissue injuries.

Clinical Outcomes with the Intrepid Dynamic Exoskeletal Orthosis: A Retrospective Analysis.

INTRODUCTION: Severe lower limb injuries have a negative impact on many aspects of an individual's life. One rehabilitative option for patients who have undergone limb salvage is the Intrepid Dynamic Exoskeletal Orthosis (IDEO). The IDEO is a custom-made dynamic response device which is used to restore function for patients with a wide variety of injuries. Clinical outcomes were routinely collected on patients fit with IDEOs at the Center for the Intrepid, Brooke Army Medical Center. The purpose of this retrospective study was to analyze the clinical outcomes collection process and the patient outcomes collected as part of routine clinical care. METHODS: The Brooke Army Medical Center IRB approved this study and granted waivers of informed consent and HIPAA authorization. Electronic medical records were reviewed over an 18-month period from July 2014 to January 2016. Records were examined to obtain the date of IDEO delivery, date of outcomes form completion, responses on the forms, and to verify diagnosis or injury. Data gathered included wear time, IDEO comfort, pain with and without the IDEO, Lower Extremity Functional Scale scores with and without the IDEO, and global rating of change questions for everyday activities and high impact activities. Wilcoxon signed-ranked tests were used to compare pain and function with vs. without the IDEO. RESULTS: During the 18-month period, new IDEOs were delivered to 156 unique patients. Outcomes forms were collected as part of routine clinical care from 90 of these 156 patients (58%). An additional nine forms were collected from patients who received their IDEOs prior to July 2014. In all, 99 outcomes forms were collected. Mean follow-up time from IDEO delivery to outcomes form completion was 35 ± 31 days for the original 90 patients. The most common patient diagnoses were fracture, nerve injury, arthritis, and fusion. Responses on the forms indicated that patients were generally comfortable wearing their IDEOs (8.3 ± 1.3 on a 0-10 scale) and wore them most of the day (10.7 ± 3.4 hours per day). Improvement in pain (from 5.2 ± 2.9 to 1.7 ± 1.6 points on a 0-10 scale) and Lower Extremity Functional Scale scores (from 29.7 ± 16.6 to 59.5 ± 13.6 points) with the IDEO were both more than the minimal clinically important difference and were statistically significant (p < 0.001). CONCLUSION: This descriptive retrospective study demonstrated that it was feasible to collect clinical outcomes data which were relevant for characterizing the effects of IDEO use and enabled quantification of improvements in self-reported function and walking pain with the IDEO. Due to the retrospective nature of this study, limitations include missing data and the lack of any performance measures to complement the self-reported data. Clinical outcomes collection continues as a routine part of clinical care and there remains an ongoing aim to collect information on all patients to obtain an accurate assessment of devices and services and ultimately better serve our patients.

In Vitro Biomechanical Study of Epidural Pressure during the Z-shape Elevating-Pulling Reduction Technique for Cervical Unilateral Locked Facets.

Objective: To analyze the mechanism of the halo vest-assisted Z-shape elevating-pulling reduction technique for cervical unilateral locked facets, and confirm the safety of the spinal cord under the epidural pressure that occurs during the reduction process. Methods: Eleven osteoligamentous whole coronal and cervical spine specimens were established as skull-neck-thorax models of cervical unilateral locked facets at the C5/6 level. The halo vest-assisted Z-shape elevating-pulling reduction technique was then applied to reduce the locked facets. The changes in the epidural pressure in five cervical positions (cervical physiological curvature, cervical lateral bending, cervical unilateral locked facets, cervical unilateral perched facets, and reduction) were measured by a pressure sensor during the reduction procedure. The models simultaneously underwent multi-angle radiographic examination and CT scanning. Results: Successful closed reduction was achieved via the halo vest-assisted Z-shape elevating-pulling reduction technique in all 11 models. The epidural pressure in the cervical unilateral locked facets position was significantly higher than that in the other four cervical positions (P < 0.005). There was no significant difference in the epidural pressures measured during cervical lateral bending, cervical unilateral perched facets, and reduction. Conclusions: Maximum epidural pressures were measured in the position of cervical unilateral locked facets. The halo vest-assisted Z-shape elevating-pulling reduction technique achieved spinal decompression without causing secondary spinal cord injury. The halo vest-assisted Z-shape elevating-pulling reduction technique is safe and effective, and has a high success rate of reduction.

Vacuum bell treatment of pectus excavatum: An early North American experience.

PURPOSE: Conservative treatment of pectus excavatum with a vacuum bell device may be an attractive alternative to surgical repair. We describe an early North American experience with this device. METHODS: Prospectively maintained chest wall clinic registries from two institutions were reviewed to identify pectus excavatum patients ≤21 years treated with the vacuum bell from 2013 to 2017. Multivariate linear regression was used to compare mean improvements in deformity-depth and Haller Index between groups of patients based on age and usage metrics (hours/day and days/week). RESULTS: Thirty-one patients with a median age of 14 years received treatment with the device. Mean follow-up duration was 18 months. Median depth and Haller Index at treatment onset were 2.3 cm and 3.9, respectively. Improvements in deformity-depth were superior with device usage >2 h/day (p < 0.01) and daily use (p < 0.01). After adjusting for compliance, younger age of treatment onset was associated with greater improvement in Haller Index but not deformity depth. CONCLUSION: Our prospective early North American experience found the vacuum bell to be a potential alternative to surgical treatment for pectus excavatum. Longer usage periods in a daily frequency are associated with best results. TYPE OF STUDY: Treatment study; case series with no comparison group. LEVEL OF EVIDENCE: Level IV.

Comparación del tratamiento conservador y quirúrgico en la rotura aguda del tendón de Aquiles / Comparison of conservative and surgical treatment in acute Achilles tendon rupture

El objetivo de esta revisión fue comparar el tratamiento quirúrgico y el tratamiento conservador para ver cuál era más eficaz ante la nueva rotura. Hubo resultados contradictorios. La pieza clave parece ser el protocolo de rehabilitación posterior a la intervención.Se realizó una búsqueda en bases de datos (Pubmed, Cochrane y PEDro) para encontrar artículos que comparasen ambos tratamientos. Se hizo criba de los mismos según los criterios de inclusión y exclusión.Encontramos que los estudios que no usan un protocolo de rehabilitación con carga temprana tuvieron un resultado a favor del tratamiento quirúrgico para evitar la recidiva (P=0,002). En cambio, los estudios que sí usaron este protocolo no encontraron tanta diferencia de nueva rotura entre el tratamiento conservador y el quirúrgico (P=0,05). Se vio que el tratamiento quirúrgico sí está relacionado con el aumento de las complicaciones (P=0,004).En conclusión, el tratamiento quirúrgico está relacionado con una menor tasa de nueva rotura, a no ser que haya un protocolo de rehabilitación con carga temprana. En este caso, la tasa de recidiva sería similar para ambos tratamientos, siempre teniendo en cuenta que la cirugía abierta está relacionada con más complicaciones

The objective of this review was to compare the surgical treatment and the conservative treatment to see which was the most effective in a new rupture. There were contradictory results. The key seems to be the rehabilitation protocol after the intervention. A search was made in databases (Pubmed, Cochrane and PEDro) to find articles comparing both treatments. They were screened according to the inclusion and exclusion criteria. We found out that studies that do not use a rehabilitation protocol with loading had a result in favor of surgical treatment to avoid recurrence (P = 0.002). However, the studies that used this protocol didn’t find as much difference of new rupture between conservative and surgical treatment (P = 0.05). It was found that the surgical treatment was related to the increase in complications (P = 0.004). In conclusion, the surgical treatment is related to a lower rate of new rupture, unless there were a rehabilitation protocol of early weighting. In this case, the recurrence rate is similar for both treatments, always bearing in mind that open surgery is related to more complications

Influence of age and level of activity on the applicability of a walker orthosis - a prospective study in different cohorts of healthy volunteers.

BACKGROUND: Walker orthosis are frequently prescribed as they are removable to allow wound control, body care and physiotherapy and are adaptable to the soft tissue conditions. The prerequisite for successful treatment with any walker orthosis is a correct use by the patient. Therefore, the aim of this study was to investigate patients' handling of a commonly used walker. METHODS: Prospective observational study analyzing the applicability of a walker orthosis in different cohorts with varying age and level of activity. Volunteers were recruited from a mountain-biking-team (Sport), a cardiovascular-health-sports-group (Cardio) and a retirement home (Senior). The correct application was assessed following initial training (t0) and one week later (t1). Outcome parameters were an Application Score, strap tightness, vertical heel lift-off and subjective judgement of correct application. RESULTS: Thirty-three volunteers, 11 Sports group (31 ± 7a), 12 Cardio group (59 ± 11a), 10 Senior group, (82 ± 5a) were enrolled. No differences for any parameter could be observed between t0 and t1. Age showed a moderate correlation for all outcome parameters and the cohort influenced all variables. The Senior group presented significant inferior results to the Sport- and Cardio group for the Application Score (p = 0.002-p < 0.001) and strap tightness (p < 0.001). Heel lift-off was significantly inferior in the Cardio- and Senior- compared to the Sport group (p = 0.003-p < 0.001). 14% in the Sport-, 4% in the Cardio- and 83% in the Senior group achieved less than 9 points in the Application Score - which was considered insufficient. However, out of these 90% believed the application to be correct. CONCLUSIONS: The elderly cohort living in a retirement home demonstrated an impaired handling of the walker orthosis. Further, participants were incapable to self-assess the correct handling. These aspects should be respected when initiating treatment with a walker orthosis. TRIAL REGISTRATION: Retrospectively registered on the 16th of February 2018: # DRKS00013728 on DRKS.

Hand-foot-skin reaction related to use of the multikinase inhibitor sorafenib and hard orthotics.

Hand-foot-skin reaction is a distinct clinical condition arising in association with the use of multikinase inhibitors, including sorafenib. Because multikinase inhibitors are increasingly being used in children with cancer, recognition of this previously unfamiliar condition is of importance to pediatric dermatologists. We describe the diagnosis and successful treatment of a case of hand-foot-skin reaction in a child taking sorafenib for an unresectable desmoid tumor.

Systematic review of the complications associated with magnetically controlled growing rods for the treatment of early onset scoliosis.

PURPOSE: To analyse the complication profile of magnetically controlled growing rods (MCGRs) in early onset scoliosis (EOS). METHODS: This is a systematic review using PUBMED, Medline, Embase, Google Scholar and the Cochrane Library (keywords: MAGEC, Magnetically controlled growing rods and EOS) of all studies written in English with a minimum of five patients and a 1-year follow-up. We evaluated coronal correction, growth progression (T1-S1, T1-T12) and complications. RESULTS: Fifteen studies (336 patients) were included (42.5% male, mean age 7.9 years, average follow-up 29.7 months). Coronal improvement was achieved in all studies (pre-operative 64.8°, latest follow-up 34.9° p = 0.000), as was growth progression (p = 0.001). Mean complication rate was 44.5%, excluding the 50.8% medical complication rate. The unplanned revision rate was 33%. The most common complications were anchor pull-out (11.8%), implant failure (11.7%) and rod breakage (10.6%). There was no significant difference between primary (39.8%) and conversion (33.3%) procedures (p = 0.462). There was a non-statistically significant increased complication rate with single rods (40 vs. 27% p = 0.588). CONCLUSIONS: MCGRs improve coronal deformity and maintain spinal growth, but carry a 44.5% complication and 33% unplanned revision rate. Conversion procedures do not increase this risk. Single rods should be avoided. These slides can be retrieved under Electronic Supplementary material.