Functional Outcomes Following Anterior Transfer of the Tibialis Posterior Tendon for Foot Drop Secondary to Peroneal Nerve Palsy.

BACKGROUND: This retrospective comparative study reports the practical function in daily and sports activities after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. METHODS: Seventeen patients were followed for a minimum of 3 years after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Matched controls were used to evaluate the level of functional restoration. Functional evaluations included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) scores, and isokinetic muscle strength test. Radiographic evaluation for the changes of postoperative foot alignment included Meary angle, calcaneal pitch angle, hindfoot alignment angle, and navicular height. RESULTS: Mean AOFAS, FAOS, and FAAM scores significantly improved from 65.1 to 86.2, 55.6 to 87.8, and 45.7 to 84.4 points at final follow-up, respectively. However, all functional evaluation scores were significantly lower as compared to the control group ( P < .001). Mean peak torque (60 degrees/sec) of ankle dorsiflexors, plantarflexors, invertors, and evertors at final follow-up were 7.1 (deficit ratio of 65.4%), 39.2, 9.8, and 7.3 Nm, respectively. These muscle strengths were significantly lower compared to the control group ( P < .001). No significant differences in radiographic measurements were found, and no patients presented with a postoperative flat foot deformity. One patient (5.9%) needed an ankle-foot orthosis for occupational activity. CONCLUSIONS: Anterior transfer of the tibialis posterior tendon appears to be an effective surgical option for paralytic foot drop secondary to peroneal nerve palsy. Although restoration of dorsiflexion strength postoperatively was about 33% of the normal ankle, function in daily activities and gait ability were satisfactorily improved. In addition, tibialis posterior tendon transfer demonstrated no definitive radiographic or clinical progression to postoperative flat foot deformity at intermediate-term follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Ischial Tuberosity Avulsion Stress Fracture after Short Period of Repetitive Training.

Fatigue fracture of the pelvis is the form of fracture due to repetitive micro-stress accumulation, can be affected by a number of factors such as patient's nutritional status, biomechanics, social status and so on. Still there is no study about precise standard degree of external force that lead to stress fracture, but it may caused by compression force, traction force or complex force and others. Avulsion stress to ischial tuberosity or anterior superior iliac spine by attached muscle is known as the main factor for the avulsion fracture. This report will deal with 19 years old conscripted policeman who occurred ischial tuberosity avulsion fracture after training of 6-hour running for 5 days accompanying hip hyper-flexion motion. This reports aims to provide case study of stress fracture occurred after 5 days of exercise which is relatively short period who had no specific trauma history or pain.

Characterizing the Progression of Varying Types of Calcific Tendinitis around Hip.

PURPOSE: To assess the progression of clinical symptoms and disease course of calcific tendinitis in the hip region according to types of calcification. MATERIALS AND METHODS: Among patients with the hip pain, 28 patients (21 males and 7 females; mean age 51 years, range 32-74 years) showing calcified lesions in simple radiography without other possible sources of pain were analyzed retrospectively. Twelve patients displayed a symptom duration of less than three weeks (acute; average=1±0.9 week) and 16 displayed greater than three weeks (chronic; average=21.0±19.5 weeks). Lesions were classified as nodular (11, 39.3%), nodular-fragmented (13, 46.4%), or amorphous (4, 14.3%). Initial symptoms, progression of clinical features, radiological findings and prognosis were investigated and analyzed according to calcification type. RESULTS: In 15 patients (53.6%), lesions were located superior to the great trochanter. On average, the acute group was younger (44.58 vs. 55.44 years, P=0.006), suffered more (mean pain Numeric Rating Scale [NRS], 6.3 vs. 3.8; P<0.001), and recovered more (difference between initial and follow-up NRS, 5.1 vs. 2.63; <<0.001) than the chronic group. The mean length of initial lesions was longer in the acute group than the chronic group (15.8 vs. 9.1 mm, P=0.008). When compared to patients with distinctive margins (15, 53.6%), those with nondistinctive margins showed better improvement (difference between initial and follow-up NRS, 4.7 vs. 2.8; P=0.01) and more significant decrease in lesion size (difference between initial and follow-up length, 10.8 vs. 2.6 mm; P=0.003). CONCLUSION: Calcific tendinitis occurring in the hip area displayed a variety of characteristics. Although complaining of more severe pain in the initial phase, patients with acute pain or calcific lesions with nondistinctive margins showed better symptom improvement when compared to their counterparts.

Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report.

As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.

Antiplatelet activity of beta-carboline alkaloids from Perganum harmala: a possible mechanism through inhibiting PLCgamma2 phosphorylation.

Beta-carboline alkaloids including harmalol, harmaline, norharmane, harmol, harmine and harmane are important constituents of the medicinal plant, Perganum harmala L. (Zygophylaceae), which has been used in traditional medicine. In the present study, the antiplatelet activities of six beta-carboline alkaloid compounds were investigated in vitro. At a concentration of 200 microM, these compounds have no effect on arachidonic acid (AA)-, thrombin- and U46619 (a thromboxane A2 mimic)-stimulated platelet aggregation. On the contrary, it was revealed that collagen-induced platelet aggregation could be inhibited by these compounds with different potencies (harmane and harmine were most potent, harmol had medium potency, and harmol, norharmane, harmalol and harmaline had a weak, non significant effect), indicating a selective inhibition on collagen-mediated platelet activation. Consistently, further study revealed that collagen-mediated phospholipase (PL) Cgamma2 and protein tyrosine phosphorylation, cytosolic calcium mobilization and arachidonic acid liberation were completely inhibited by harmane and harmine in a concentration-dependent manner, while the other compounds were only partially or not effective at all. Taken together, these results indicate that three of these six beta-carboline alkaloids can selectively affect collagen-induced platelet aggregation with different potencies; in particular, harmane and harmine were most potent, and their antiplatelet activities may be mediated by inhibiting PLCgamma2 and protein tyrosine phosphorylation with sequential suppression of cytosolic calcium mobilization and arachidonic acid liberation, indicating that harmane and harmine have a potential to be developed as a novel agent for atherothrombotic diseases.

Dynamics of wrinkle growth and coarsening in stressed thin films.

A stressed thin film on a soft substrate can develop complex wrinkle patterns. The onset of wrinkling and initial growth is well described by a linear perturbation analysis, and the equilibrium wrinkles can be analyzed using an energy approach. In between, the wrinkle pattern undergoes a coarsening process with a peculiar dynamics. By using a proper scaling and two-dimensional numerical simulations, this paper develops a quantitative understanding of the wrinkling dynamics from initial growth through coarsening till equilibrium. It is found that, during the initial growth, a stress-dependent wavelength is selected and the wrinkle amplitude grows exponentially over time. During coarsening, both the wrinkle wavelength and amplitude increases, following a power-law scaling under uniaxial compression. More complicated dynamics is predicted under equibiaxial stresses, which starts with a faster coarsening rate before asymptotically approaching the same scaling under uniaxial stresses. At equilibrium, a parallel stripe pattern is obtained under uniaxial stresses and a chaotic labyrinth pattern under equibiaxial stresses. Under stresses of the same magnitude, the two patterns have the same average wavelength, but different amplitudes. It is noted that the dynamics of wrinkling, while analogous to other phase ordering phenomena, is distinct and rich under the effects of stress and substrate elasticity.