Evaluation of bone remodeling in regard to the age of scaphoid non-unions.

AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions (SNU) with immunohistochemistry. METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin (HE), tartrate resistant acid phosphatase (TRAP), CD 68, osteocalcin (OC) and osteopontin (OP). Histological examination was performed in a blinded fashion. RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU (P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts (P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts (P = 0.008; r = 0.43). SNU older than 6 mo showed a significant decrease of the number of fibroblasts (P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU. CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible.

Postural control and functional ankle stability in professional and amateur dancers.

OBJECTIVE: The aim of this study was to compare the postural control and functional ankle stability between professional and amateur dancers as well as controls. METHODS: Thirty professional dancers were compared to thirty amateur dancers and thirty controls. All participants (n=90) completed a questionnaire. Range of motion (ROM), ankle position sense and peroneal reaction time (PRT) were measured. Postural control was investigated with the Biodex Stability System (BSS) for the stable level 8 and the unstable level 2. RESULTS: Professional dancers showed a significantly increased plantarflexion of both feet in comparison to all other groups (P ≤ 0.017). Even amateur dancers had a significantly increased plantarflexion of both feet in comparison to controls (P ≤ 0.017). The position sense test only showed significant differences between professionals, amateurs and controls at the position of 130° for the right leg (P ≤ 0.017). The PRT showed no significant differences among all groups except for the left peroneus brevis of amateur dancers in comparison to controls (P ≤ 0.017). Professional dancers had a significant better postural control in comparison to amateurs and controls for levels 8 and 2 at all tested positions (P ≤ 0.017). In addition, professional dancers had a specific balance distribution, whereas they balanced significantly more in the antero-lateral and less in the postero-medial part of their feet in comparison with amateur dancers and controls (P ≤ 0.017). CONCLUSIONS: Despite a greater ROM, professional dancers have a better control of postural stability due to a specific balance distribution. However, the position sense test and the PRT were not influenced by the profession. SIGNIFICANCE: The specific work-related demands of ankle joints did not improve all components of functional ankle stability in professional dancers. Therefore, the inclusion of proprioceptive exercises in the daily training program is highly recommended, aiming to improve functional ankle stability and thus to minimize the risk of ankle injuries.

The influence of playing level on functional ankle stability in soccer players.

OBJECTIVE: The aim of this study was to compare the functional ankle stability between professional and amateur soccer players as well as controls. MATERIALS AND METHODS: Thirty professional soccer players, 30 amateur soccer players and 30 controls were evaluated. All participants completed a questionnaire. Range of motion (ROM), peroneal reaction time (PRT) and ankle position sense were measured. Balance control was investigated with the Biodex Stability System, measuring the stable level 8 and the unstable level 2. RESULTS: Professional soccer players cited significantly more frequent ankle sprains than all other groups (P = 0.002). They showed a significantly decreased dorsiflexion of the right foot (amateur: P = 0.017; controls: P = 0.004), an increased pronation of both feet (amateurs: right: P = 0.0048, left: P = 0.006; controls: right: P = 0.017, left: P = 0.007) and a decreased supination of the left foot in comparison to all other groups (amateurs: P = 0.003; controls: P = 0.004). Balance control showed no significant differences among all groups. Significant differences in angle reproduction were observed between professionals and amateurs for the left ankle joint at the positions of 105° (P = 0.0018) and 140° (P = 0.013). Professionals (P = 0.004) and amateurs (P = 0.001) showed a significantly delayed PRT of the right peroneus longus muscle compared to controls. In addition, the PRT of the right peroneus brevis muscle was significantly increased in professional soccer players in comparison to controls (P = 0.017). CONCLUSIONS: Professional soccer players have shown more frequent ankle sprains, limited ROM, and delayed PRT of the right leg which reflects the higher risk of functional ankle instability due to intensified work-related use of feet. Therefore, proprioceptive exercises of the ankle in daily training programs are recommended in order to minimize the risk of ankle injuries and improve functional ankle stability.

The influence of profession on functional ankle stability in musicians.

OBJECTIVE: The aim of this study was to examine the influence of extensive work-related use of the feet on functional ankle stability among musicians. METHODS: Thirty professional organists were compared to professional pianists and controls. All participants completed a questionnaire. Range of motion (ROM), peroneal reaction time, and positional sense tests of the ankle were measured. The postural balance control was investigated with the Biodex Stability System for the stable level 8 and unstable level 2. Statistical analysis was done with the Kruskal-Wallis test, Mann-Whitney test with Bonferroni-Holm correction, and Fisher's exact test. RESULTS: Nine of 30 organists compared to 5 of 30 pianists and controls reported ankle sprains in their medical history. Pianists had a significant increased flexion of both ankle joints compared to organists (p < 0.01) and increased flexion of the right ankle joint compared to controls (p = 0.02). The positional sense test and postural balance control showed no significant differences among groups. The peroneal reaction time of the right peroneus longus muscle was significantly increased in pianists compared to controls (p = 0.008). CONCLUSIONS: Organists have shown a high incidence of ankle sprains. Despite their extensive work-related use of the ankle joints, organists have neither increased functional ankle stability nor increased ROM of their ankle joints in comparison to controls. Pianists have increased flexion of the ankle joint, perhaps due to the exclusive motion of extension and flexion while using the pedals. To minimize injuries of the ankle and improve functional ankle stability as well as balance control, proprioceptive exercises of the ankle in daily training programs are recommended.

Influence of age, body mass index and leg dominance on functional ankle stability.

BACKGROUND: The aim of this study was to examine the influence of age, body mass index (BMI) and leg dominance on the PRT, balance control and foot position sense. MATERIALS AND METHODS: The proprioception of the ankle was investigated in 210 participants. All participants completed a questionnaire. The PRT was measured on a tilting platform. The position sense test was performed. Balance control was assessed with the Biodex Stability System (BSS), measuring the overall stability index (OSI) at the stable level 8 and the unstable level 2. Correlation analyses were performed between these data and age, BMI and leg dominance, using the Spearman-Rho coefficient with a two-sided significance level of p < 0.05. RESULTS: Significant increases of the PRT and OSI in correlation to increased age and BMI were noted for both legs (p < 0.05). No positive correlation to age, BMI or leg dominance could be demonstrated for the foot position sense test. The PRT of the right leg was always significantly faster than that of the left leg, irrespective of leg dominance (p < 0.05). Surprisingly, individuals with a dominant right leg achieved better OSI scores in left single leg stance at the unstable level 2 (p < 0.05). CONCLUSION: The PRT and the postural stability correlate with age and BMI, whereas the position sense test of the ankle does not. Furthermore, the PRT in right legs is always faster. This should be noted when functional ankle stability is evaluated in patients.

Histopathological, radiological and clinical aspects of the temporal assignment of scaphoid non-union.

OBJECTIVE: The aim of this study was to evaluate the correlation between clinical, radiological and histopathological signs of scaphoid non-unions (SNU) with regard to the age of the fracture, primarily because this is relevant for therapy and compensation claims. MATERIALS AND METHODS: Thirty-eight patients with SNU underwent clinical and radiological examination of the wrist prior to surgery. Preoperative X-rays of the wrist were analysed using the scores of Herbert and Fisher, Filan and Herbert, Trojan and Jahna, Gupta as well as scaphoid non-union advanced collapse. Sclerotic bone of the SNU was resected during surgery. Resected material was evaluated histologically after staining with hematoxylin-eosin and periodic acid-Schiff reaction. Radiological and histological examinations were performed by independent investigators in a blinded fashion. RESULTS: The preoperative range of motion of the injured compared to the contralateral wrist was significantly reduced for the dorsi- and palmar flexion and for the radial and ulnar deviation; however, this reduction was not time dependent. There was no significant correlation between the radiological results and the age of the SNU, while fibrous tissue or fibrocartilage in the fracture gap was present in all cases. Significantly less fibrous or fibrocartilage bone cysts (p = 0.041) and bone remodelling (p = 0.031) were seen in older SNU (at 45 months). Definitive sclerotic bone covering of the fracture edges was significantly more common in older SNU (p = 0.035). CONCLUSION: Radiological and most of the conventional histological findings do not correlate with time after initial injury.

Evaluation of the proprioceptive influence of the cutaneous afferents to the ankle in patients after sural nerve harvesting.

OBJECTIVE: Cutaneous afferent nerves contribute to joint proprioception. The aim of this study was to retrospectively analyze the proprioceptive influence of the cutaneous afferents to the ankle in patients after sural nerve harvesting in comparison to controls. METHODS: The proprioception of the ankle in 24 patients after sural nerve harvesting was investigated. The sural nerve was harvested bilaterally in Group 1 (n = 10), in the right leg in Group 2 (n = 6), and in the left leg in Group 3 (n = 8). The proprioception of the ankle was also tested in controls (Group 4, n = 24). The peroneal reaction time (PRT) was measured on a tilting platform. The position sense test was performed. Balance control was investigated with the Biodex Stability System (Biodex Medical Systems, Shirley, NY) at the stable Level 8 and unstable Level 2. RESULTS: No significant differences among the groups were seen in the position sense test, the PRT, and all scores of the Biodex Stability System. The PRT showed significant differences in comparison to the contralateral leg for the peroneus brevis muscle in Group 1 (P = 0.005) and Group 4 (P = 0.001) as well as for the peroneus longus muscle in Group 3 (P = 0.036) and Group 4 (P = 0.001). CONCLUSION: The proprioception of the ankle in patients after sural nerve harvesting is not reduced in comparison to controls. Significant differences of the PRT between the left and right legs are attributable to leg dominance in most cases and not to a loss of innervation. Harvesting of the sural nerve does not result in ankle instability.