Epidemiology of clavicle shaft fractures in a public hospital in South Africa: differences between developing and developed countries.

PURPOSE: Describing the epidemiological profile of patients with acute clavicle shaft fractures in a developing country public state hospital where mainly low- to middle-income patients are treated. METHODS: This is a retrospective analysis of all clavicle shaft fractures between 2008 and 2018 (10 years) based on Picture Archiving and Communication System at the second largest public hospital in South Africa. RESULTS: One thousand and three patients, 729 male and 274 female, were included in the epidemiological review. Most common causes of clavicle shaft fractures, in which 23% of cases presented with other injuries, were road accidents, falls and interpersonal violence. The majority of fractures were displaced and most (72%) were treated conservatively. Only 28% of patients were treated surgically, 61% with contoured plating and a relatively high 39% with intramedullary nails. CONCLUSION: The epidemiology of clavicle shaft fractures in a public hospital in a developing country, where the majority of patients hail from low- to middle-income backgrounds, differs substantially from developed countries. Although similar types of fractures were reported, differences were noted in terms of patients' age, causes of injury, associated injuries and treatment approaches.

Management of clavicle shaft fractures with intramedullary devices: a narrative review.

INTRODUCTION: Displaced and shortened clavicle fractures are frequently treated surgically. Although extramedullary fixation using a plate and screws is most commonly used, intramedullary nailing has become increasingly popular over the last decade. Traditional intramedullary nailing is usually associated with a high risk of hardware migration as well as hardware irritation at its entry point. Newer devices, however, seem to mitigate these problems. The aim of this narrative review is to provide an overview of clavicle shaft fractures and treatment with intramedullary nails, in particular the newer, locked devices. AREAS COVERED: In general, this review covers current literature related to clavicle shaft fractures with a specific focus on the treatment of displaced and shortened fractures with intramedullary nails. EXPERT OPINION: Clavicle shaft fractures can be effectively treated with an intramedullary nail. The risk of hardware migration when employing the newer, improved designs appears to be minimal. The advantages of using intramedullary fixation include smaller incision sizes as well as the avoidance of routine procedures generally associated with the removal of prominent subcutaneous hardware as per extramedullary fixation.

Gait Pattern of Adults with Cerebral Palsy and Spastic Diplegia More Than 15 Years after Being Treated with an Interval Surgery Approach: Implications for Low-Resource Settings.

BACKGROUND: Single-event multilevel surgery (SEMLS) approach is regarded as the golden standard in developed countries to improve gait and functional mobility in children with cerebral palsy (CP). However, this approach is not always feasible in developing countries. Therefore, orthopedic surgery based on an interval surgery approach (ISA) is still commonly used in developing countries, although little is known about the long term outcomes of an ISA. Therefore, the aim of this study was to describe the gait patterns of adults with CP, who have been treated with ISA, which started more than 15 years ago. MATERIALS AND METHODS: Thirty adults with CP and spastic diplegia, who received ISA treatment 21.6-33.7 years ago, were recruited for this study and participated in three-dimensional gait analysis. Twenty kinematic and nondimensional temporal-distance parameters were captured, while the overall gait deviation index (GDI) was also calculated. Data of the adults with CP were compared to normative data of typically developing (TD) adults. RESULTS: Although all adults with CP were still ambulant, their gait parameters significantly differed from TD adults, with a lower GDI in the adults with CP. The CP gait patterns were characterized by excessive hip flexion and hip internal rotation as well as a stiff-knee gait. CONCLUSION: Although different to TD adults, the gait patterns observed in the adult with CP treated with ISA is in line with other studies. Gait patterns suggest that derotation osteotomies potentially could have improved the long term gait patterns. Although SEMLS might be the preferred treatment method, potentially resulting in better outcomes, ISA can also be used to treat children with CP in developing countries as India and South Africa, where a SEMLS approach is not always feasible.

Training Prescription Guided by Heart-Rate Variability in Cycling.

PURPOSE: Road cycling is a sport with extreme physiological demands. Therefore, there is a need to find new strategies to improve performance. Heart-rate variability (HRV) has been suggested as an effective alternative for prescribing training load against predefined training programs. The purpose of this study was to examine the effect of training prescription based on HRV in road cycling performance. METHODS: Seventeen well-trained cyclists participated in this study. After an initial evaluation week, cyclists performed 4 baseline weeks of standardized training to establish their resting HRV. Then, cyclists were divided into 2 groups, an HRV-guided group and a traditional periodization group, and they carried out 8 training weeks. Cyclists performed 2 evaluation weeks, after and before a training week. During the evaluation weeks, cyclists performed a graded exercise test to assess maximal oxygen uptake, peak power output, and ventilatory thresholds with their corresponding power output (VT1, VT2, WVT1, and WVT2, respectively) and a 40-min simulated time trial. RESULTS: The HRV-guided group improved peak power output (5.1% [4.5%]; P = .024), WVT2 (13.9% [8.8%]; P = .004), and 40-min all-out time trial (7.3% [4.5%]; P = .005). Maximal oxygen uptake and WVT1 remained similar. The traditional periodization group did not improve significantly after the training week. There were no differences between groups. However, magnitude-based inference analysis showed likely beneficial and possibly beneficial effects for the HRV-guided group instead of the traditional periodization group in 40-min all-out time trial and peak power output, respectively. CONCLUSION: Daily training prescription based on HRV could result in a better performance enhancement than a traditional periodization in well-trained cyclists.

Methods of prescribing relative exercise intensity: physiological and practical considerations.

Exercise prescribed according to relative intensity is a routine feature in the exercise science literature and is intended to produce an approximately equivalent exercise stress in individuals with different absolute exercise capacities. The traditional approach has been to prescribe exercise intensity as a percentage of maximal oxygen uptake (VO2max) or maximum heart rate (HRmax) and these methods remain common in the literature. However, exercise intensity prescribed at a %VO2max or %HRmax does not necessarily place individuals at an equivalent intensity above resting levels. Furthermore, some individuals may be above and others below metabolic thresholds such as the aerobic threshold (AerT) or anaerobic threshold (AnT) at the same %VO2max or %HRmax. For these reasons, some authors have recommended that exercise intensity be prescribed relative to oxygen consumption reserve (VO2R), heart rate reserve (HRR), the AerT, or the AnT rather than relative to VO2max or HRmax. The aim of this review was to compare the physiological and practical implications of using each of these methods of relative exercise intensity prescription for research trials or training sessions. It is well established that an exercise bout at a fixed %VO2max or %HRmax may produce interindividual variation in blood lactate accumulation and a similar effect has been shown when relating exercise intensity to VO2R or HRR. Although individual variation in other markers of metabolic stress have seldom been reported, it is assumed that these responses would be similarly heterogeneous at a %VO2max, %HRmax, %VO2R, or %HRR of moderate-to-high intensity. In contrast, exercise prescribed relative to the AerT or AnT would be expected to produce less individual variation in metabolic responses and less individual variation in time to exhaustion at a constant exercise intensity. Furthermore, it would be expected that training prescribed relative to the AerT or AnT would provide a more homogenous training stimulus than training prescribed as a %VO2max. However, many of these theoretical advantages of threshold-related exercise prescription have yet to be directly demonstrated. On a practical level, the use of threshold-related exercise prescription has distinct disadvantages compared to the use of %VO2max or %HRmax. Thresholds determined from single incremental tests cannot be assumed to be accurate in all individuals without verification trials. Verification trials would involve two or three additional laboratory visits and would add considerably to the testing burden on both the participant and researcher. Threshold determination and verification would also involve blood lactate sampling, which is aversive to some participants and has a number of intrinsic and extrinsic sources of variation. Threshold measurements also tend to show higher day-to-day variation than VO2max or HRmax. In summary, each method of prescribing relative exercise intensity has both advantages and disadvantages when both theoretical and practical considerations are taken into account. It follows that the most appropriate method of relative exercise intensity prescription may vary with factors such as exercise intensity, number of participants, and participant characteristics. Considering a method's limitations as well as advantages and increased reporting of individual exercise responses will facilitate accurate interpretation of findings and help to identify areas for further study.