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1.
World Neurosurg ; 133: e342-e347, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31562968

RESUMEN

OBJECTIVE: This study was carried out to analyze the surgical effect of cervical spine sagittal alignment for patients with Hirayama disease (HD). METHODS: Forty-four subjects were retrospectively analyzed for the parameters of cervical spine sagittal alignment. The case group consisted of 23 patients with HD, whereas the control group consisted of 21 healthy adolescent subjects. Pre- and postoperative cervical spine sagittal parameters of the patients with HD were collected; the cervical sagittal parameters of the healthy adolescent subjects were also collected. Sagittal alignment parameters were compared between the patients with HD and the healthy adolescent subjects, and between the pre- and postoperative parameters for the patients with HD. RESULTS: Forty-four subjects completed the follow-up, with the average follow-up period being 18.0 months. No significant differences were detected between the HD and control groups for clinical parameters (P > 0.05). The preoperative HD group had smaller values compared with the control group in the sagittal parameters of C2-7 cervical lordosis (CL) angle, T1 slope, thoracic inlet angle (TIA), and cervical tilt angle (P < 0.05). For the patients with HD, the preoperative values were smaller compared with the postoperative HD values for the parameters of C2-7 CL angle, T1 slope, and cervical tilt angle (P < 0.05). We found no significant differences between the postoperative patients with HD and the healthy subjects, including C2-7 CL angle, C2-7 sagittal vertical axis, T1 slope, TIA, neck tilt angle, cervical tilt angle, and cranial tilt angle (P > 0.05). CONCLUSIONS: Patients with HD have sagittal imbalance of the cervical spine compared with age-matched healthy adolescent subjects, and surgical treatment could correct the sagittal imbalance.


Asunto(s)
Vértebras Cervicales/patología , Discectomía , Fusión Vertebral , Atrofias Musculares Espinales de la Infancia/cirugía , Adolescente , Adulto , Antropometría , Placas Óseas , Tornillos Óseos , Femenino , Estudios de Seguimiento , Humanos , Cifosis/diagnóstico por imagen , Cifosis/etiología , Cifosis/patología , Lordosis/diagnóstico por imagen , Lordosis/etiología , Lordosis/patología , Masculino , Aparatos Ortopédicos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Estudios Retrospectivos , Atrofias Musculares Espinales de la Infancia/complicaciones , Adulto Joven
2.
Clin Podiatr Med Surg ; 37(1): 125-150, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735264

RESUMEN

The article discusses the nuances required to effectively perform the biomechanical examination in children and assess the findings. The author covers several factors in children that make the examination different in certain respects than in that of adults, including growth, osseous maturation, gait development, and interpretation of symptoms as conveyed by the child. Further delineation is made for prewalkers, foot-flat to foot-flat walkers, and heel-to-toe walkers. Segmental review of the lower extremity is covered by age bracket, with clinical pearls inserted where relevant to assist the clinician. A brief discussion of shoe wear and orthoses is made as well.


Asunto(s)
Deformidades del Pie/terapia , Adolescente , Factores de Edad , Fenómenos Biomecánicos , Niño , Preescolar , Deformidades del Pie/diagnóstico , Deformidades del Pie/fisiopatología , Marcha , Humanos , Lactante , Aparatos Ortopédicos , Selección de Paciente , Examen Físico , Zapatos
3.
Clin Podiatr Med Surg ; 37(1): 71-89, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735271

RESUMEN

The adult acquired flatfoot deformity resulting from posterior tibial tendon dysfunction is the result of rupture of the posterior tibial tendon as well as key ligaments of the ankle and hindfoot. Kinematic studies have verified certain levels of deformity causing hindfoot eversion, lowering of the medial longitudinal arch and forefoot abduction. The condition is progressive and left untreated will cause significant disability. Bracing with ankle-foot orthoses has shown promising results in arresting progression of deformity and avoiding debilitating surgery. Various types of ankle-foot orthoses have been studied in terms of effects on gait as well as efficacy in treatment.


Asunto(s)
Pie Plano/terapia , Disfunción del Tendón Tibial Posterior/complicaciones , Adulto , Anciano , Pie Plano/etiología , Pie Plano/fisiopatología , Humanos , Persona de Mediana Edad , Aparatos Ortopédicos , Disfunción del Tendón Tibial Posterior/fisiopatología
4.
Oral Maxillofac Surg Clin North Am ; 32(1): 105-116, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31685348

RESUMEN

Idiopathic condylar resorption (ICR), alternatively called progressive condylar resorption, is an uncommon aggressive form of degenerative disease of the temporomandibular joint seen mostly in adolescent and young women. ICR occurring before the completion of growth results in a shorter mandibular condyloid process, ramus and body, compensatory growth at the gonial angle and coronoid process, as well as an increase in anterior facial vertical dimension. Management options discussed include oral appliances, orthodontics, medical management, orthognathic surgery with and without disc repositioning, and alloplastic temporomandibular joint replacement.


Asunto(s)
Resorción Ósea , Cóndilo Mandibular/cirugía , Ortodoncia Correctiva , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Adolescente , Resorción Ósea/etiología , Femenino , Humanos , Cóndilo Mandibular/patología , Aparatos Ortopédicos , Articulación Temporomandibular
5.
Muscle Nerve ; 61(1): 52-57, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31588574

RESUMEN

INTRODUCTION: Loss of ambulation in Duchenne muscular dystrophy presages scoliosis, respiratory failure, and death. Strategies to maintain ankle range of motion are employed, but little evidence exists to support these approaches and limited information is available concerning current practice. METHODS: In this study we assessed baseline bracing data from 187 boys participating in a multicenter, international clinical trial. RESULTS: Ankle-foot orthoses (AFOs) were recommended for 54% of the boys, with nighttime static AFOs and nighttime dynamic AFOs utilized in 94% and 6% of these boys, respectively. Daytime static AFOs were recommended for 3 boys. Compliance with bracing recommendations was 54% for nighttime static braces and 67% for nighttime dynamic braces. DISCUSSION: The basis for the variation in recommended AFO use is unknown and requires further study. Long-term follow-up of boys may permit assessment of the effects of AFO use.


Asunto(s)
Tobillo , Tirantes , Distrofia Muscular de Duchenne/rehabilitación , Distrofia Muscular de Duchenne/terapia , Articulación del Tobillo , Niño , Preescolar , Método Doble Ciego , Pie , Humanos , Masculino , Aparatos Ortopédicos , Cooperación del Paciente , Modalidades de Fisioterapia , Rango del Movimiento Articular , Resultado del Tratamiento , Caminata
6.
Spine (Phila Pa 1976) ; 44 Suppl 24: S1-S12, 2019 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-31790063

RESUMEN

STUDY DESIGN: A modified Delphi method was used to establish consensus. Subject matter experts were invited to participate as the expert panel. Best practice statements were distributed to the panel. Panel members were asked to mark "agree" or "disagree" after a series of statements during several rounds until either consensus could be obtained or the practice method was deemed unable to achieve consensus. OBJECTIVE: Lumbar total disc replacement (TDR) is acknowledged as an alternative to spinal fusion in appropriately selected patients. There is a lack of unanimity on the appropriate postoperative patient protocols and rehabilitation expectations for the procedure. The long-term viability of Lumbar TDR, further adoption in the community setting and specific patient outcomes are contingent on the existence of appropriate postoperative recovery programs. SUMMARY OF BACKGROUND DATA: Currently there are no established methods for postoperative care following lumbar TDR. Establishing a postoperative clinical pathway algorithm may improve patient outcomes with respect to lumbar TDR. METHOD: A lumbar TDR expert panel of 22 spine surgeons employed a modified Delphi method to drive consensus on postoperative care following single-level Lumbar TDR. The panel first reviewed literature and guidelines relevant to postoperative care following lumbar TDR. Panel members considered 21 survey questions intended to determine "standard-practice" postoperative care recommendations for patients who have undergone lumbar TDR for the initial recovery phase (0-4 wk) and rehabilitation (4-20 wk). Each panel member participated in a round of anonymous voting followed by a group discussion. Consensus was defined as 80% agreement or higher among the respondents. RESULTS: Consensus was achieved in 11 of the 21 survey questions. There was a high degree of consensus around the key goals for both the initial recovery and rehabilitation phases, ceased use of narcotics for pain management by 4 weeks postoperative, unrestricted walking immediately following surgery, timelines for physical therapy (within 2-4 wk) and return to work based on level of activity (as early as 1 wk postoperative). Lack of agreement included the use of back bracing and timing of postoperative visits. Generally, panel members felt that patient expectations regarding return to function were different following lumbar TDR versus fusion and warrant further study. CONCLUSION: Surgeon and patient alignment around postoperative expectations may significantly affect the long-term results of lumbar TDR. This surgeon consensus study found agreement for immediate postoperative ambulation, rapid reduction in opioids within the first month, and early return to work. When expectations are appropriately set with patients preoperatively, both provider and patient have shared goals in the return-to-function process. LEVEL OF EVIDENCE: 5.


Asunto(s)
Vértebras Lumbares/cirugía , Planificación de Atención al Paciente , Cuidados Posoperatorios , Reeemplazo Total de Disco/rehabilitación , Algoritmos , Analgésicos Opioides/uso terapéutico , Consenso , Vías Clínicas , Técnica Delfos , Humanos , Aparatos Ortopédicos , Modalidades de Fisioterapia , Reinserción al Trabajo , Caminata
7.
NeuroRehabilitation ; 45(4): 519-524, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31868690

RESUMEN

BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments. OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI. METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge. RESULTS: There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group. CONCLUSIONS: Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI.


Asunto(s)
Lesiones Traumáticas del Encéfalo/rehabilitación , Vida Independiente/normas , Rehabilitación Neurológica/métodos , Aparatos Ortopédicos , Adulto , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Movimiento , Rehabilitación Neurológica/instrumentación , Alta del Paciente/estadística & datos numéricos , Recuperación de la Función
9.
Zhonghua Shao Shang Za Zhi ; 35(11): 821-823, 2019 Nov 20.
Artículo en Chino | MEDLINE | ID: mdl-31775473

RESUMEN

Scar contracture after burn on the back of hand can easily lead to the limitation of flexion function of fingers, which seriously affects daily life activities. Generally, comprehensive rehabilitation treatment is adopted for scar contracture on the back of hand, among which wearing braces is an effective treatment method. However, some braces will limit the normal finger joints or must wait until all the affected fingers heal before they can be worn, and the wearing operation is quite complicated. In order to solve these problems, the author designed and made a finger flexion band, which was used to stretch the patients with limited flexion of finger caused by scar contracture after burn on the back of hand, and achieved good therapeutic effect. According to the measured hand size, the finger flexion band is cut and spliced from the fabric commonly used in daily life. The finger flexion band is designed with finger sleeve, which will not limit the normal finger joints, can interfere with the healed finger in advance, fix the corresponding fingers better, and improve the treatment comfort, especially for children who do not cooperate with the braces wearing. This finger flexion band is simple to make, cheap, convenient to use, and suitable for clinical promotion.


Asunto(s)
Quemaduras/rehabilitación , Cicatriz/rehabilitación , Contractura/rehabilitación , Traumatismos de la Mano/rehabilitación , Aparatos Ortopédicos , Dedos , Humanos
10.
Orthopade ; 48(10): 879-896, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31511916

RESUMEN

Atraumatic fractures of the spine are a common orthopedic disease condition that can be asymptomatic or associated with complaints of varying intensity and quality. The risk factors for such fracture forms are often metabolic and genetic diseases, which have a direct or indirect effect on bone metabolism and therefore secondarily affect the stability of the spinal vertebrae. Furthermore, benign and malignant tumors as well as infectious diseases can also be causative for atraumatic spinal fractures; however, those factors that are attributable to lifestyle habits should also not be underestimated. The treatment of affected patients is complex and nearly always interdisciplinary. In addition to purely symptom-oriented treatment concepts, orthoses in particular and when indicated surgical treatment procedures can be implemented. This article summarizes the important clinical, diagnostic and therapeutic aspects of atraumatic spinal fractures.


Asunto(s)
Aparatos Ortopédicos , Fracturas de la Columna Vertebral/diagnóstico , Columna Vertebral , Discitis/complicaciones , Humanos , Vértebras Lumbares , Factores de Riesgo , Fracturas de la Columna Vertebral/etiología
11.
BMC Musculoskelet Disord ; 20(1): 437, 2019 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-31554516

RESUMEN

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.


Asunto(s)
Absceso/terapia , Vértebras Cervicales/cirugía , Discectomía/efectos adversos , Infecciones Relacionadas con Prótesis/terapia , Fusión Vertebral/efectos adversos , Absceso/etiología , Antibacterianos/uso terapéutico , Vértebras Cervicales/microbiología , Desbridamiento , Remoción de Dispositivos/efectos adversos , Drenaje , Quimioterapia Combinada/métodos , Humanos , Masculino , Persona de Mediana Edad , Disección del Cuello , Aparatos Ortopédicos , Prótesis e Implantes/efectos adversos , Infecciones Relacionadas con Prótesis/etiología , Fusión Vertebral/instrumentación , Staphylococcus aureus/aislamiento & purificación , Factores de Tiempo , Titanio/efectos adversos , Resultado del Tratamiento
12.
Turk J Pediatr ; 61(1): 79-84, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31559725

RESUMEN

Seyhan K, Kerem-Günel M. Does stable sitting influence upper limb function in children with cerebral palsy? Turk J Pediatr 2019; 61: 79-84. Bilateral spastic cerebral palsy (BSCP) patients frequently need to use various sitting devices for body control and function. The aim of this study was to investigate whether the use of a belt to position the pelvis in an adjustable chair would affect upper limb function in preschool children with BSCP. Fortyone children with BSCP [mean age 44 ±11, range 18-60 months] classified according to the Gross Motor Function Classification System (GMFCS), as level III (n=21) and level IV (n=20) were fitted with a hip-positioning belt. Upper limb functions were assessed by Quality of Upper Extremity Skills Test (QUEST). The median scores of the following upper extremity functions increased significantly by wearing the hip positioning belt: dissociated movements, grasping, weight bearing and protective extension. The total QUEST score increased from 56.7 (±46.3) to 66.1 (±39.2) (p < 0.001). The portable and adaptable hip-positioning belt may be used in daily life to improve upper limb activity in preschool children with moderate to severe BSCP.


Asunto(s)
Parálisis Cerebral/fisiopatología , Parálisis Cerebral/rehabilitación , Aparatos Ortopédicos , Sedestación , Extremidad Superior/fisiopatología , Preescolar , Femenino , Humanos , Lactante , Masculino
13.
World Neurosurg ; 132: 63-66, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31479787

RESUMEN

BACKGROUND: Symptomatic calcification of the ligamentum flavum (CLF) is common in the cervical spine but rare in the thoracic spine. Rapidly progressing CLF in the thoracic spine has not been reported in the literature. CASE DESCRIPTION: A 76-year-old Asian male experienced back pain after a fall and was diagnosed with osteoporotic vertebral fractures at T11 and L1. He was treated conservatively because of the lack of neurologic deficits. Nine months after the initial visit, he complained of progressive incomplete paraplegia. Magnetic resonance imaging and computed tomography of the thoracic spine showed CLF at T11-T12 severely compressing the spinal cord. This finding had not been seen on imaging studies at the initial visit. The patient underwent surgical resection of CLF and posterior instrumented spine fusion. Symptoms of muscle weakness recovered postoperatively. CONCLUSIONS: In this case, sequential imaging studies with a 9-month interval showed evidence of rapidly progressing thoracic CLF. The preceding osteoporotic vertebral fracture may have triggered the development of CLF.


Asunto(s)
Calcinosis/cirugía , Ligamento Amarillo/cirugía , Vértebras Lumbares/cirugía , Fracturas Osteoporóticas/terapia , Fracturas de la Columna Vertebral/terapia , Vértebras Torácicas/cirugía , Anciano , Calcinosis/complicaciones , Calcinosis/diagnóstico por imagen , Tratamiento Conservador , Progresión de la Enfermedad , Humanos , Ligamento Amarillo/diagnóstico por imagen , Masculino , Aparatos Ortopédicos , Fracturas Osteoporóticas/complicaciones , Paraplejía/etiología , Fracturas de la Columna Vertebral/complicaciones , Fusión Vertebral , Vértebras Torácicas/lesiones , Vertebroplastia
14.
BMC Musculoskelet Disord ; 20(1): 401, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31481055

RESUMEN

BACKGROUND: Stress fracture of the lateral tubercle of the posterior talar process in runners is extremely rare. Here, we describe a case of a female long-distance runner who sustained a stress fracture of the lateral tubercle of the posterior talar process. Osteosynthesis with screw fixation via two-portal hindfoot endoscopy achieved a good surgical outcome with a less invasive procedure. CASE PRESENTATION: An 18-year-old female long-distance runner who belonged to her university's road running club presented to our institution with a half-year history of persistent left hindfoot pain when running. Radiographs revealed a stress fracture of the lateral tubercle of the posterior talar process. Because the fracture showed no signs of healing 3 months after starting conservative therapy, osteosynthesis with screw fixation was performed via two-portal hindfoot endoscopy. Non-contrast computed tomography at 10 weeks postoperatively revealed consolidation of the stress fracture. At 15 weeks postoperatively, the patient was permitted to jog and return to athletic activity while wearing an orthosis. As of this writing 2 years postoperatively, she remains an active competitive runner. CONCLUSIONS: Osteosynthesis with screw fixation via two-portal hindfoot endoscopy was a less invasive procedure that successfully treated stress fracture of the lateral tubercle of the posterior talar process in this female long-distance runner.


Asunto(s)
Atletas , Endoscopía/métodos , Fijación Interna de Fracturas/métodos , Fracturas por Estrés/cirugía , Astrágalo/lesiones , Adolescente , Tornillos Óseos , Endoscopía/instrumentación , Femenino , Fijación Interna de Fracturas/instrumentación , Humanos , Aparatos Ortopédicos , Radiografía , Carrera , Astrágalo/cirugía , Resultado del Tratamiento
15.
Fisioter. Pesqui. (Online) ; 26(3): 247-257, jul.-set. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1039888

RESUMEN

ABSTRACT The purpose of this study is to analyze the effects of using customized insoles and leg and foot exercises on the feet of patients with neuropathy caused by leprosy. Thirty volunteers diagnosed with leprosy were assigned to one of three groups: (1) Exercise group (n=10): performed exercises for the intrinsic muscles of the foot; (2) Insole group (n=10): used insoles to correct foot positioning; (3) Insole and Exercise group (n=10): used insoles and performed an exercise routine. The results of the treatments were analyzed with photogrammetry using the Alcimagem® and AutoCAD® programs. Left hindfoot posture changed after treatment in the Exercise and Insole groups (hindfoot, pre versus post <0.001). We also found that combining exercise and insoles did not alter the alignment of the feet during the study's evaluation period (customized insoles and exercises, pre versus post <0.05), which suggests that follow-up for more than four months may be needed. The left hindfoot's alignment can be changed with supervised exercises and the use of insoles.


RESUMO O objetivo deste estudo é analisar a influência do uso de palmilhas personalizadas e exercícios para perna e pés nos ângulos do antepé, retropé e arco plantar de pacientes com neuropatia causada por hanseníase. Trinta voluntários diagnosticados com hanseníase foram designados para um dos três grupos: (1) grupo exercício (n=10): realização de exercícios para pernas e pés; (2) grupo palmilha (n=10): utilização de palmilhas para corrigir o posicionamento do pé; (3) grupo palmilha e exercícios (n=10): uso de palmilhas associado a uma rotina de exercícios. O resultado dos tratamentos foi analisado por meio de fotogrametria, com os softwares Alcimagem e AutoCAD. A postura do retropé esquerdo foi modificada após o tratamento no "grupo exercício" e "grupo palmilha" (retropé, pré versus pós<0,001). Também foi observado que a combinação entre exercícios e palmilhas não alterou o alinhamento dos pés durante o período de avaliação do estudo (palmilha e exercícios, pré versus pós>0,05), o que sugere que o acompanhamento por mais de quatro meses pode ser necessário. Assim, o uso isolado de exercícios supervisionados ou de palmilhas altera o alinhamento do retropé, como aferido por fotogrametria.


RESUMEN El presente estudio tiene como objetivo analizar la influencia del uso de plantillas personalizadas y la práctica ejercicios de piernas y pies en los ángulos del antepié, del retropié y del arco plantar de pacientes con neuropatía debido a lepra. Treinta voluntarios diagnosticados con lepra fueron asignados a uno de estos tres grupos: (1) grupo de ejercicios (n=10): hacer ejercicios de piernas y pies; (2) grupo de plantillas (n=10): utilizar plantillas para corregir la posición del pie; (3) grupo de plantillas y ejercicios (n=10): utilizar plantillas asociadas con una rutina de ejercicios. Los resultados de los tratamientos se analizaron mediante fotogrametría, con los softwares Alcimagem y AutoCAD. La postura del retropié izquierdo se modificó tras el tratamiento en el "grupo de ejercicios" y en el "grupo de plantillas" (retropié, pre versus pos <0,001). También se observó que la combinación de ejercicios y plantillas no alteró la alineación del pie durante el período de evaluación del estudio (plantilla y ejercicios, pre versus pos >0,05), lo que sugiere que puede requerirse seguimiento durante más de cuatro meses. Por lo tanto, la práctica aislada de ejercicios supervisados o el uso de plantillas altera la alineación del retropié, medido por fotogrametría.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Aparatos Ortopédicos , Enfermedades del Sistema Nervioso Periférico/rehabilitación , Terapia por Ejercicio , Fotogrametría , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Pie/etiología , Enfermedades del Pie/rehabilitación , Lepra/complicaciones
16.
J Pediatr Orthop ; 39(8): e614-e621, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31393304

RESUMEN

BACKGROUND: The proposed association between osteofibrous dysplasia and adamantinoma has led some to advocate resection of the entire lesion, which can require major subsequent reconstruction. However, this link remains unproven and there is some support in more recent literature for a less aggressive approach. This study aims to describe our experience managing pediatric tibial osteofibrous dysplasia with such an approach and to report functional outcomes in children treated thus. METHODS: A total of 28 cases of osteofibrous dysplasia in 25 patients were managed at a referral center for pediatric bone tumors with observation in the first instance, then limited surgical intervention if required to address pain and deformity. Surgery aimed to restore stability and alignment without excising the lesion. Clinical records provided basic clinical outcome measures involving walking, recreation, orthoses and school/work participation and patients provided a Musculoskeletal Tumour Society score (MSTS) where contactable. RESULTS: Mean age at presentation was 6.0 years and mean follow-up was 8.3 years. Only 8 patients required surgery. According to basic outcome measures, 13 patients were symptom-free. About 15 patients (17 cases) provided a MSTS and the mean score was 24 of 30. No transformation to adamantinoma was observed. Those who presented at a younger age and with bilateral disease more often required surgery and remained symptomatic. CONCLUSIONS: A less aggressive approach to pediatric tibial osteofibrous dysplasia achieves good functional outcomes and patient satisfaction in most cases. Surgery is required in the minority of cases. Transformation to adamantinoma was not observed in this series. We recommend patient education, clinical observation and reactive intervention if required, rather than proactive resection and reconstruction. LEVEL OF EVIDENCE: Level IV-case series.


Asunto(s)
Enfermedades del Desarrollo Óseo/terapia , Espera Vigilante , Adamantinoma/etiología , Adolescente , Enfermedades del Desarrollo Óseo/complicaciones , Enfermedades del Desarrollo Óseo/patología , Enfermedades del Desarrollo Óseo/cirugía , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Aparatos Ortopédicos , Satisfacción del Paciente , Tibia , Caminata
17.
World Neurosurg ; 132: e878-e884, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31382064

RESUMEN

BACKGROUND: Isolated unilateral alar ligament injury (ALI) is a very rarely diagnosed condition, with only 9 cases reported in the literature. The purpose of this study is to determine clinical, diagnostic, and biomechanical features of unilateral ALI. METHODS: A total of 6 patients diagnosed with ALI were included in this series. The hospital records and radiologic imaging of admission and follow-ups were investigated retrospectively. RESULTS: Rotation of the neck and/or hyperflexion was always present as a mechanism of injury. The patients were neurologically intact. All patients presented with mild neck pain aggravated by head rotation. On computed tomography (CT) scans, the dens was observed to be displaced to the opposite side. Magnetic resonance imaging (MRI) showed a widened lateral dens-atlas space with high signal intensity. All patients underwent lateral flexion-extension CTs for the confirmation of craniovertebral junction (CVJ) stability. The patients were treated with hard collars. The follow-up MRI of 3 patients obtained at the third month showed normal lateral dens-atlas interval and recovered ligaments. All patients were pain free after 6 months. CONCLUSIONS: Unilateral ALI appears to be more common but misdiagnosed than previously thought. Trauma mechanism consists of hyperflexion and contralateral rotation. Neck pain aggravated with rotation is the most significant clinical finding. Dens lateralization is the most important finding in CT scans. An MRI focusing on the CVJ is essential for the diagnosis. The stability of CVJ must be checked with a flexion-extension CT scan. Unilateral ALI is a stable condition and responds to conservative treatment.


Asunto(s)
Inmovilización , Ligamentos/lesiones , Traumatismos del Cuello/terapia , Hueso Occipital , Apófisis Odontoides , Aparatos Ortopédicos , Adolescente , Adulto , Anciano de 80 o más Años , Vértebra Cervical Axis , Atlas Cervical , Niño , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Adulto Joven
18.
IEEE Int Conf Rehabil Robot ; 2019: 1-6, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31374598

RESUMEN

Knee osteoarthritis (Knee-OA) is a disease caused by age-related muscle weakness, obesity, or sports injury, and it has been estimated to occur in approximately half of all people by the age of 85. One of the characteristics of knee-OA is rotation dyskinesia of the knee joint due to the degeneration of the system around the knee. This rotation movement, a key element of walking, is crucial for impact absorption, balanced walking, and stabilization of the knee joint. In the present study, we focused on the rotation of the lower leg relative to the movement of the ankle joint during the walking stance phase, and we developed a mechanical orthosis that induces rotation of the lower leg in conjunction with the movement of the ankle joint mechanically. The mechanical induction of rotation movement uses the movement difference due to the angle change of the inside and outside bars in conjunction with the ankle angle. We verified the effectiveness of the developed orthosis by measuring the amount of rotation and by administering the Womac test in 5 subjects with knee osteoarthritis. The results confirmed the effectiveness of our orthosis.


Asunto(s)
Articulación de la Rodilla/fisiología , Osteoartritis de la Rodilla/rehabilitación , Tibia/fisiología , Caminata/fisiología , Anciano de 80 o más Años , Fenómenos Biomecánicos , Diseño de Equipo , Femenino , Humanos , Masculino , Aparatos Ortopédicos , Rotación
19.
IEEE Int Conf Rehabil Robot ; 2019: 53-58, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31374606

RESUMEN

The human ankle provides significant positive power during the stance phase of walking, which has resulted in studies focusing on methods to reduce the energetic walking cost by augmenting the ankle with exoskeletons. Recently, a few devices have successfully reduced the metabolic cost of walking by replacing part of the biological ankle plantar flexor torque. Despite these achievements, development of assistive ankle devices remains challenging, partly because the current practice of design and control of powered exoskeletons is highly time and effort consuming, which prevents quickly exploring different design and control parameters. Predictive simulations using musculoskeletal models coupled with robotic devices may facilitate the process of design and control of assistive devices. In this study, we simulate human walking augmented by a powered ankle exoskeleton. The walking problem was formulated as a predictive dynamic optimization in which both the optimal assistive device torque and the gait were solved simultaneously. Cases with exoskeletons assisting one ankle and both ankles were considered. The results showed that the energetic cost of walking could be reduced by 45% with one ankle augmented, and by 52% with both ankles augmented. This study contributes towards the goal of providing optimal assistive torque through external devices and theoretical peak reductions that could be expected from such devices.


Asunto(s)
Tobillo/fisiología , Caminata/fisiología , Fenómenos Biomecánicos , Metabolismo Energético , Dispositivo Exoesqueleto , Humanos , Músculo Esquelético/fisiología , Aparatos Ortopédicos
20.
IEEE Int Conf Rehabil Robot ; 2019: 83-88, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31374611

RESUMEN

Wool harvesting remains an important industry in Australia, but its workers suffer from extreme rates of injury, in particular, the lower back injuries. Reducing injuries in sheep shearing could be as simple as extending shearer rest periods between sheep, but the effect of this has not previously been studied. The lumbar flexion-relaxation phenomenon is present in sheep shearing and the onset angle of this phenomenon can provide insight into lower back injury risk. The increase in the onset angle of lumbar flexion-relaxation over several work-rest periods for a simulated sheep shearing task is studied. The rate of increase in the onset angle of lumbar flexion-relaxation was higher when shorter breaks were taken for all participants at least unilaterally, indicating that longer rest breaks could reduce back injury risk. Due to the constraints of the sheep shearing occupation, this type of intervention is better suited to learner and novice shearers. Assistive robotic devices would be more suited to reduce injuries in expert shearers, and some insight is provided for the application of these within sheep shearing. Further study of this phenomenon in sheep shearing could provide additional insight to developing an assistive device that could reduce injury.


Asunto(s)
Crianza de Animales Domésticos/métodos , Región Lumbosacra/fisiología , Exposición Profesional/prevención & control , Traumatismos Vertebrales/prevención & control , Adulto , Animales , Australia , Humanos , Masculino , Aparatos Ortopédicos , Descanso , Ovinos , Lana , Adulto Joven
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