Spontaneous Reduction in the Intermetatarsal Angle in Distal First Metatarsal Osteotomies with No Lateral Head Displacement in Hallux Valgus.

BACKGROUND: The outcomes of first metatarsal (M1) distal osteotomies in hallux valgus (HV) can be improved, especially for intermetatarsal angle (IMA) correction, which is mainly based on lateral displacement of the M1 head (i.e., translation) through the osteotomy. Conversely, there is a spontaneous reduction in the IMA in first metatarsophalangeal joint (MTP1) arthrodesis. But we do not know whether this can be applied to distal osteotomies. We propose a distal osteotomy, called 3D chevron, which combines supination and varization of the M1 head. This might realign soft tissues around the MTP1, potentially leading to a spontaneous reduction in the IMA by an analogous mechanism to MTP1 fusion. Therefore, our study aimed to assess whether spontaneous reductions in IMAs exist in distal M1 osteotomies in the absence of lateral translations of M1 heads. METHODS: A prospective continuous series of 25 3D chevrons was performed. Two groups were formed during surgery. Patients requiring no M1 head lateral displacement were included in the "successful correction without translation" group, and patients requiring M1 head lateral displacement were included in the "failed correction without translation" group. Radiographic analysis was performed preoperatively and at 1 year postoperatively. RESULTS: Twenty-two women and three men, with a mean age of 44.8 ± 14.2 years and a mean body mass index of 22.6 ± 4.1 kg/m2, underwent follow-up at one year after surgery. The "successful correction without translation" group was composed of HV with milder deformities (13/25 HVs, median preoperative IMA = 13 (IQR 2)) compared to the "failed correction without translation" group (median IMA = 16 (IQR 2.25) p < 0.001). Spontaneous reductions in IMAs were observed in the "successful correction without translation" group, with a median decrease in the IMA of 6 degrees (CI95%[5.5; 8.0]; p < 0.001) between preoperative and 1-year radiographs. CONCLUSION: Distal osteotomies allow for spontaneous reduction in the IMA in HV. First metatarsal head translation through an osteotomy should not be considered as the only procedure to correct IMAs in distal osteotomies.

Effect of Forearm Supination and Pronation on Median & Ulnar Nerve Conduction Velocity Among Throwers, Archers, and Non-Athletes.

The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p < .05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function.

Dislocations deteriorate postoperative functional outcomes in supination-external rotation ankle fractures.

PURPOSE: To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures. METHODS: A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18-65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American orthopedic foot and ankle society score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test. RESULTS: During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, preoperative complications with diabetes, smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American orthopedic foot and ankle society score revealed no significant difference between dislocation and no-dislocation patients. CONCLUSION: Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.

Locked Distal Ulna Volar Dislocation Associated with a Malunited Fracture of the Distal Radius.

Background The volar dislocation of the distal ulna is an uncommon injury and often missed due to its rarity. If diagnosed early, it can be managed with a simple closed reduction followed by immobilization. Open reduction is recommended in case of any interposition preventing reduction. Case Description In this case report, we present a rare case of neglected volar distal ulna dislocation associated with a distal radius fracture presenting with a fixed supination deformity that was managed successfully with a Sauvé- Kapandji procedure using a modified approach to restore forearm rotation. At 10 months, the patient had a good union at the distal radio ulnar joint (DRUJ) with improved forearm rotations. Literature Review To our knowledge no previous cases of neglected volar distal ulna dislocation with distal radius fracture has been reported in the literature. Clinical Relevance If DRUJ stability cannot be restored after closed reduction of distal radius fracture, open reduction and internal fixation of the fracture should always be performed to avoid subsequent DRUJ subluxation/dislocations.

Exploring the relationship between the supination resistance test and the effects of foot orthoses on the foot and ankle biomechanics during walking.

BACKGROUND: The effects of foot orthoses on lower limb biomechanics during walking have been studied extensively. However, the lack of knowledge regarding the effects of various foot orthoses models for the same population complicates model selection in clinical practice and research. Additionally, there is a critical need to enhance our ability to predict the outcomes of foot orthoses using clinical tests, such as the supination resistance test. RESEARCH QUESTION: What are the effects of two commonly prescribed types of FO (thin-flexible and medially wedged) on lower limb biomechanics during gait? Is there a correlation on these effects with the results of the supination resistance test? METHODS: Twenty-three participants with flat feet were enrolled in this cross-sectional descriptive study. Participants underwent walking trials under three conditions: shod, thin-flexible FOs and medially wedged FOs. Midfoot, ankle, knee and hip angles, moments were calculated. Repeated measure ANOVAs were employed for within-group comparison across conditions. Correlations between the effects of FOs on foot and ankle angles/moments and supination resistance were determined using regression analyses using a statistical parametric mapping approach. RESULTS: Thin-flexible and medially wedged FOs reduced midfoot dorsiflexion angles and ankle inversion moments. Medially wedged FOs also decreased midfoot and ankle abduction angles, midfoot plantarflexion moments compared to thin-flexible FOs and shoes. Moderate to good correlations between the supination resistance test and the medially wedged FOs were observed for the frontal and transverse ankle angles and moments. SIGNIFICANCE: Medially wedged FOs are more effective in modifying lower limb biomechanics during walking compared to thin-flexible FOs. Greater supination resistance was associated with more pronounced effects for medially wedged FOs on foot and ankle biomechanics. These findings hold promise for refining orthotic prescription strategies, potentially offering advantages to individuals with musculoskeletal disorders.

Validity, reliability and responsiveness of a goniometer watch to measure pure forearm rotation.

Introduction: Innovative instruments have been designed to assess forearm rotation, an anatomically challenging motion to measure. This study assessed the concurrent validity, interrater reliability and responsiveness of a novel goniometer watch (GoWatch) to measure pure forearm rotation. The modified finger goniometer (MFG) was the criterion reference. Methods: Forty participants with restricted forearm rotation were recruited. Two raters measured supination and pronation using the GoWatch and MFG before and after a hand therapy session. Repeated-measures ANOVA assessed for systematic bias with an apriori residual error of 5° deemed as acceptable. Secondary analysis used intraclass coefficients (ICCs) to categorise interrater reliability. Responsiveness of the GoWatch was calculated using Cohen's d. Results: The GoWatch demonstrated acceptable agreement with the MFG with a mean difference for supination 1.19° and pronation 0.20°. Interrater reliability was also within acceptable limits with a mean difference GoWatch supination 4.43° and pronation 2.23°. Interrater reliability for GoWatch supination and pronation were categorized as excellent (ICC = 0.94) and good (ICC = 0.85) respectively. Systematic bias was observed in the instrument by rater interaction with rater two consistently underestimating GoWatch measures (p<.05). GoWatch supination showed small to medium responsiveness (Rater 1: d = 0.14; Rater 2: d = 0.29) and pronation very small to medium responsiveness (Rater 1: d = 0.29; Rater 2: d = 0.05). Conclusion: The GoWatch is a viable and user-friendly alternative to measure forearm rotation with demonstrable validity, interrater reliability and responsiveness. Further research is required to ensure systematic bias is not endemic when used across multiple raters.

A Muscle Energy Techniques-Based Physiotherapeutic Intervention Protocol for Managing Nightstick Fracture: A Case Report.

Distal ulna and radius fractures are the most frequent upper extremity fractures seen in emergency rooms. The axis of rotation for forearm pronation and supination runs through the radial head (proximal) and the ulnar fovea (distal). Throughout pronation and supination, the radius can rotate relative to the ulna, thanks to the way its head articulates with it. The ulna remains relatively stable during these movements. However, in cases of fractures of these bones, surgery to repair the radius is usually the best course of action for a distal ulna fracture. Most distal ulna fractures heal successfully with only conservative treatment once the radius is stabilized. To achieve the best results, medical personnel must take into account patient characteristics including age, level of activity, and aspirations. The majority of distal ulna injuries do not require surgery, but there are several circumstances where it is necessary. In therapeutic practice, muscle energy techniques (METs) are comparatively painless methods for restoring a restricted spectrum of motion. Malunion, reduced grasp, and other significant problems might result from a lack of understanding of this illness. The 48-year-old patient in the present study was reported to have sustained injuries to his left forearm in a road traffic accident (RTA) as he fell from his bike and slid during a traffic collision. X-ray imaging of the left forearm revealed an isolated ulnar shaft fracture. METs, isometric contractions, and active concentric and eccentric movements were all part of the physiotherapy intervention protocol to produce an active range of motion in the upper extremity. In this particular case, the specified physiotherapy management was found to be effective.

Time-resolved quantification of fine hand movements as a proxy for evaluating bradykinesia-induced motor dysfunction.

Bradykinesia is a behavioral manifestation that contributes to functional dependencies in later life. However, the current state of bradykinesia indexing primarily relies on subjective, time-averaged categorizations of motor deficits, which often yield poor reliability. Herein, we used time-resolved analyses of accelerometer recordings during standardized movements, data-driven factor analyses, and linear mixed effects models (LMEs) to quantitatively characterize general, task- and therapy-specific indices of motor impairment in people with Parkinson's disease (PwP) currently undergoing treatment for bradykinesia. Our results demonstrate that single-trial, accelerometer-based features of finger-tapping and rotational hand movements were significantly modulated by divergent therapeutic regimens. Further, these features corresponded well to current gold standards for symptom monitoring, with more precise predictive capacities of bradykinesia-specific declines achieved when considering kinematic features from diverse movement types together, rather than in isolation. Herein, we report data-driven, sample-specific kinematic profiles of diverse movement types along a continuous spectrum of motor impairment, which importantly, preserves the temporal scale for which biomechanical fluctuations in motor deficits evolve in humans. Therefore, this approach may prove useful for tracking bradykinesia-induced motor decline in aging populations the future.

A Novel Operation Technique for Forearm Deformities in Patients with Brachial Plexus Birth Injury: Retrospective Analysis of 14 Patients.

Background: We aimed to evaluate the effectiveness of our novel operation technique that included radial shaft shortening plus supination producing osteotomy and transfer of the biceps brachii tendon to the brachialis tendon in patients with chronic radial head dislocation secondary to brachial plexus birth injury (BPBI). Methods: Fourteen patients with chronic radial head dislocation resulting from BPBI were included in this study, with a minimum 1-year postoperative follow-up period. All patients underwent the same surgical procedure. The range of motion of affected elbow was measured with a standard goniometer. The Mayo Elbow Performance Score (MEPS) was used to measure for evaluation of functional result of these patients. The affected elbow radiograph also obtained in the last visit for evaluation of compatibility of the radiocapitellar joint. Results: Fourteen patients (10 males and 4 females) were included in the study. The average age at the time of surgery was 7.2 (5-8) years and average follow-up was 73.2 ± 19 (36-131) months. Although the forearm active-passive pronation decreased, active-passive supination significantly improved postoperatively (p < 0.001). Ten patients had excellent MEPS results (90 and above), two patients with good results (75 and 80), one patient with fair (65) and one patient with poor result (55). Radiocapitellar reduction was achieved in 78.5% (11/14) of the patients. Conclusions: The novel surgical techniques that included radial shaft shortening plus supination producing osteotomy and transfer of the biceps brachii tendon to the brachialis tendon improved the functional outcomes of patients with chronic radial head dislocation secondary to BPBI. Level of Evidence: Level IV (Therapeutic).

The additional value of weight-bearing radiographs in assessing stability of isolated type B fibular fractures.

INTRODUCTION: In isolated type B fibular fractures, the decision whether to operate or treat conservatively is principally based on congruency and stability of the ankle joint. The purpose of the current study is to examine the additional diagnostic value of the weight-bearing radiograph (WBR) in assessing stability of potentially unstable type B fibular fractures. MATERIALS AND METHODS: In this retrospective cohort study, patients were selected based on who presented an isolated type B fracture of the fibula. Unstable fractures were directly planned for surgery. Other patients underwent additional weight-bearing imaging 4-7 days after initial trauma, on which definitive treatment was based. The medial clear space (MCS) was compared between the WBR and the conventional radiograph. RESULTS: A total of 70 patients were included in the period January 2018-December 2021. The average MCS on conventional mortise radiograph was 3.56 mm compared to 3.02 mm on the WBR(p<0.05). The superior clear space (SCS) was equal between both groups (respectively 3.12 mm and 3.08 mm, p = 0.44). All 70 patients were initially treated conservatively with immediate weight-bearing in a brace or soft cast. One patient had the need for open repair and internal fixation due to non-union. DISCUSSION: Different techniques for the assessment of deep deltoid ligament integrity exist, such as the MRI, the ultrasonography and different kinds of stress test radiographs. As fractured ankles don't need direct fixation and operative treatment can be postponed, a stepped approach for the assessment of deep deltoid ligament (DDL) integrity can be of assistance in assessing ankle stability. In isolated type B fibular fractures a stepped approach, using the weight-bearing radiograph can be of additional value in assessing the stability. It is a low cost, prevents unnecessary surgery and contributes to a quick weight-bearing non-operative treatment.

Forearm Deformities in Birth Brachial Plexus Palsy - Patient Profile and Management Algorithm.

Forearm deformities are often seen in children with severe birth brachial plexus palsy (BBPP). They may be either a supination or a pronation deformity and both hinder normal use of the hand and parents often request for corrective surgery. However, the correction of these deformities can be challenging due to a paucity of options. Also, there is less information in literature on the management of forearm deformities in BBPP compared to the information with regard to nerve surgery or correction of shoulder deformities. This article presents a synopsis of incidence, pathogenesis, clinical presentation and parental concerns related to these deformities. The decision-making considerations, management strategies and outcome expectations are also discussed. Patient selection is very crucial, and the treatment plan must be individualised depending on the disability, parental expectations and existing motor power in the involved limb. Correction of both the deformities have different considerations; however, effective correction of these deformities is immensely satisfactory to the patient/parents in terms of improved function and appearance of the limb. Level of Evidence: Level V (Therapeutic).

A Deep Learning Approach for Automatic and Objective Grading of the Motor Impairment Severity in Parkinson's Disease for Use in Tele-Assessments.

Wearable sensors provide a tool for at-home monitoring of motor impairment progression in neurological conditions such as Parkinson's disease (PD). This study examined the ability of deep learning approaches to grade the motor impairment severity in a modified version of the Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) using low-cost wearable sensors. We hypothesized that expanding training datasets with motion data from healthy older adults (HOAs) and initializing classifiers with weights learned from unsupervised pre-training would lead to an improvement in performance when classifying lower vs. higher motor impairment relative to a baseline deep learning model (XceptionTime). This study evaluated the change in classification performance after using expanded training datasets with HOAs and transferring weights from unsupervised pre-training compared to a baseline deep learning model (XceptionTime) using both upper extremity (finger tapping, hand movements, and pronation-supination movements of the hands) and lower extremity (toe tapping and leg agility) tasks consistent with the MDS-UPDRS. Overall, we found a 12.2% improvement in accuracy after expanding the training dataset and pre-training using max-vote inference on hand movement tasks. Moreover, we found that the classification performance improves for every task except toe tapping after the addition of HOA training data. These findings suggest that learning from HOA motion data can implicitly improve the representations of PD motion data for the purposes of motor impairment classification. Further, our results suggest that unsupervised pre-training can improve the performance of motor impairment classifiers without any additional annotated PD data, which may provide a viable solution for a widely deployable telemedicine solution.

[Conservative treatment of supination and external rotation for type â ¢ and â £ankle fracture by bone setting].

OBJECTIVE: To explore curative effect of conservative treatment of supination-lateral rotation (SER) with type Ⅲ and Ⅳ ankle fracture by bone setting technique. METHODS: From January 2017 to December 2019, 64 patients diagnosed with SER with type Ⅲ and Ⅳ ankle fracture were treated with manipulative reduction and conservative treatment (manipulation group) and surgical treatment with open reduction and internal fixation (operation group), 32 patients in each group. In manipulation group, there were 17 males and 15 females, aged from 15 to 79 years old with an average of (51.42±13.68) years old;according to Lauge-Hansen classification, there were 8 patients with supination external rotation type Ⅲ and 24 patients with type Ⅳ. In operation group, there were 13 males and 19 females, aged from 18 to 76 years old with an average of (47.36±15.02) years old;7 patients with type Ⅲ and 25 patients with type Ⅳ. Displacement of ankle fracture was measured by Digimizer software, and compared before treatment, 3 and 12 months after treatment between two groups. Lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement were measured and compared between two groups. Mazur score was used to evaluate ankle joint function. RESULTS: All patients were followed up from 12 to 36 months with an average of (17.16±9.36) months. There were statistical differences in lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement in manipulation group before and after reduction(P<0.05). Compared with operation group, there were no statistically significant differences in lateral malleolus shift, lateral malleolus shift, lateral malleolus contraction shift(P>0.05), while there were statistically significant differences in lateral malleolus shift, posterior malleolus shift up and down (P<0.05). Mazur scores of ankle joint at 3 months after treatment in manipulation group and operation group were 68.84±13.08 and 82.53±7.31, respectively, and had statistical differences(P<0.05), while there was no difference in evaluation of clnical effect(P>0.05). There were no differences in Mazur score and evaluation of clnical effect between two groups at 12 months after treatment (P>0.05). CONCLUSION: Bone setting technique could effectively correct lateral displacement of medial malleolus, lateral displacement of medial malleolus, lateral displacement of lateral malleolus and lateral contraction displacement of lateral malleolus in supination lateral rotation type Ⅲ and Ⅳ ankle fracture, and has good long-term clinical effect, which could avoid operation for some patients and restore ankle function after fracture.

Pilot Study: The Relationship between Foot Posture and Movement Quality in Non-Professional Male Football Players.

(1) Background: This study focusses on establishing the relationship between quality of movement (based on the functional movement screen, or FMS) and foot posture (based on the foot posture index, or FPI-6). We hypothesised that a poor FMS test score may be derived from the foot position in the space measured by FPI-6. (2) Methods: a quasi-experimental and cross-sectional study was designed to analyse foot posture in 30 healthy football players, using the foot posture index and the functional movement screen. (3) Results: No significant relationships were found between movement quality and foot posture. Poor movement quality is present in more than half of all foot positions, supination, pronation, and neutral. Good quality seems to be more associated with a neutral foot position (23.3%) and supinated (16.6%) than a pronated foot position (6.6%). (4) Conclusions: this study found no relationship between the two tests; therefore, we cannot demonstrate that foot posture is relevant in the quality of the movement of the football players studied.

Biomechanical Comparison of Two Surgical Repair Techniques of the Distal Biceps Tendon.

Purpose: This study aimed to characterize the relationship between the distal biceps tendon force and the supination and flexion rotations during the initiation phase and to compare the functional efficiency of anatomic versus nonanatomic repairs. Methods: Seven matched pairs of fresh-frozen cadaver arms were dissected to expose the humerus and elbow while preserving the biceps brachii, elbow joint capsule, and distal radioulnar soft tissue complex. For each pair, the distal biceps tendon was severed with a scalpel and then repaired with bone tunnels placed at either the anterior (anatomic) or the posterior (nonanatomic) aspect of the bicipital tuberosity on the proximal radius. A supination test with 90° of elbow flexion and an unconstrained flexion test were conducted on a customized loading frame. The biceps tension was applied incrementally at 200 g per step, whereas the radius rotation was tracked with a 3-dimensional motion analysis system. The tendon force needed to produce a degree of supination or flexion was derived as the regression slope of the tendon force-radial rotation plots. A two-tailed paired t test was performed to compare the difference between the anatomic repair and the nonanatomic repair cadavers. Results: Significantly greater tendon force was required to initiate the first 10° of supination with the elbow in flexion for the nonanatomic group compared with the anatomic group (1.04 ± 0.44 N/degree vs 0.68 ± 0.17 N/degree, P = .02). The average nonanatomic to anatomic ratio was 149% ± 38%. No difference existed between the two groups in the mean tendon force needed to produce the degree of flexion. Conclusions: Our results show that anatomic repair is more efficient in producing supination than nonanatomic repair, but only when the elbow is in 90° of flexion. When the elbow joint is not constrained, the nonanatomic supination efficiency improved, and the difference between the techniques was not significant. Clinical relevance: The present study added to the body of evidence in comparing anatomic versus nonanatomic repair of the distal biceps tendon and serves as a foundation for future biomechanical and clinical studies in this topic. Given no difference when the elbow joint was not constrained, one could argue that surgeon comfort and preference could guide which technique to use when addressing the distal biceps tendon tears. More studies will be needed to clearly define whether there will be a clinical difference between the two techniques.

Effect of buttress plate in Herscovici type D vertical medial malleolar fractures and peripheral fractures: a retrospective comparative cohort study.

BACKGROUND: The purpose of current retrospective study was to review the surgical methods and to evaluate the clinical efficacy of supporting plate for the treatment of vertical medial malleolus fractures on the basis of stable fixation of ipsilateral fibula. METHODS: This retrospective study included a total of 191 patients with vertical medial malleolus fractures. Patients enrolled were divided into simple vertical medial malleolus fractures and complex types of fractures. General demographic information and surgical information, including age, sex, surgical procedure and postoperative complications, were collected. The functional prognosis of patients was evaluated by American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) and Visual Analog Scale (VAS). RESULT: Among patients with simple vertical fractures, the respective incidence of internal fixation failure in screw group, buttress plate group, and screw combined buttress plate fixation group (combined fixation group) was 10/61 (16.4%),1/54 (7.4%) and 1 (1.9%), and the difference was statistically significant (P = 0.024). The incidence of abnormal fracture growth and healing in screw group, buttress plate group and combined fixation group was, respectively, 13/61 (21.3%), 6/54 (12.5%) and 2 (3.85%), with statistically significant difference (P = 0.019). In the patients with complex types of fractures, after 2 years of postoperative follow-up, the AOFAS score and VAS score of the following subgroups had good results: 91.18 ± 6.05 and 2.18 ± 1.08 in patients with joint surface collapse, and 92.50 ± 4.80 and 2.50 ± 1.29 in patients with tibial fractures, with 100% excellent and good rate. CONCLUSION: For simple and complex vertical medial malleolus fractures, buttress plate showed excellent fixation. Despite poor wound healing and extensive soft tissue dissection with this approach, buttress plate may provide a novel insight into medial malleolar fractures, especially for extremely unstable medial malleolar fractures.

Forearm Pronation at Foot Contact: A Biomechanical Motion-Capture Analysis in High School and Professional Pitchers.

Background: It has previously been speculated that baseball pitchers who display excessive forearm pronation at foot contact (FC) have a higher propensity toward ulnar collateral ligament injury and subsequent surgery. Purpose: To evaluate the association between degree of forearm pronation/supination at FC and throwing arm kinetics in high school and professional pitchers, at both the individual (intrapitcher) and the group (interpitcher) level. Study Design: Descriptive laboratory study. Methods: High school (n = 41) and professional (n = 196) pitchers threw 8 to 12 fastballs while being assessed with a 3-dimensional motion-capture system (480 Hz). Pitchers at each playing level were divided into a supination or pronation subgroup depending on degree of forearm pronation at FC. Regression models were built to observe the relationship between forearm pronation at FC and kinetic and kinematic parameters of interest. Results: At both the individual and the group level of high school and professional pitchers, there was no significant correlation between forearm pronation at FC and elbow varus torque (P min = .21). For every 10° increase in forearm pronation at FC in the individual high school pitcher, elbow flexion at FC decreased by 5°, whereas maximum elbow extension velocity was achieved 0.6% later in the pitch. In addition, elbow medial force increased by 4.1 N and elbow varus torque increased by 0.8 N·m for every 10° increase in forearm supination at FC. For every 10° increase in forearm supination in the individual professional pitcher, ball velocity increased by 0.5 m/s, shoulder external rotation at FC decreased by 11°, and elbow medial force decreased by 5.5 N. Conclusion: Supination- or pronation-predominant forearm motion during the pitch did not significantly differ between playing levels. Excessive forearm pronation at FC was not a significant risk factor for increased throwing arm kinetics for high school or professional pitchers. There was a weak positive association between forearm supination at FC and elbow varus torque in the individual high school pitcher. Ultimately, coaches and pitchers may be better served by redirecting their focus to other mechanical aspects of the pitch that may have stronger associations with injury risk implications as well as performance.

Optimal Forearm Position Allowing Maximum Hand Function: A Quasi-experimental Study in Adolescent Children.

Purpose: The aim of this study was to determine the ideal forearm position that allows maximum upper-limb function. In certain congenital/acquired upper-limb disorders, the management boils down to sacrificing rotatory movements of the forearm. The position of fusion that facilitates maximum upper-limb function is a topic of debate and is decided upon by personal preferences and assumptions. Although the literature has many level five evidence reports, there is a lack of well-designed research to answer the same question and we intended to study it both in dominant and non-dominant limbs. Methods: 15 healthy adolescent volunteers were fitted with a custom adjustable brace that simulated forearm arthrodesis in five rotatory positions. They were asked to carry out a series of activities as per Sollerman's hand function test, and each activity was scored using the standardized scoring system. The test was carried out with the brace fitted first in the dominant side, followed by the non-dominant side, and finally in both the upper limbs together. Results: We found that the mid-prone position allowed for the best function overall in both dominant and non-dominant upper limbs, and if both upper limbs required simultaneous fusion, our results suggest that fixing the dominant side in mid-prone and non-dominant side in 45° supination would be ideal. Conclusions: For unilateral forearm arthrodesis, the ideal position of fusion is the same irrespective of the dominance of the limb, whereas, for bilateral arthrodesis, limb dominance is to be taken into consideration. Level of Evidence: Level III quasi-experimental study.

Pilot Study: Effect of Morton's Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation.

This study focuses on the assessment of the mechanical effect produced by Morton's extension as an orthopedic intervention in patients with bilateral foot pronation posture, through a variation in hindfoot and forefoot prone-supinator forces during the stance phase of gait. A quasi-experimental and transversal research was designed comparing three conditions: barefoot (A); wearing footwear with a 3 mm EVA flat insole (B); and wearing a 3 mm EVA flat insole with a 3 mm thick Morton's extension (C), with respect to the force or time relational to the maximum time of supination or pronation of the subtalar joint (STJ) using a Bertec force plate. Morton's extension did not show significant differences in the moment during the gait phase in which the maximum pronation force of the STJ is produced, nor in the magnitude of the force, although it decreased. The maximum force of supination increased significantly and was advanced in time. The use of Morton's extension seems to decrease the maximum force of pronation and increase supination of the subtalar joint. As such, it could be used to improve the biomechanical effects of foot orthoses to control excessive pronation.

Anatomy of the distal radioulnar ligament in cats.

OBJECTIVES: The aim of this study was to describe the anatomy of the distal radioulnar ligament in the cat, using gross and histological sections from cadaveric feline carpi. METHODS: Eight feline cadaveric distal radioulnar joints were included in the study, including six that were paraffin- and two that were polymethyl methacrylate-embedded. Each of the sections of the distal radioulnar joint and ligament were viewed macroscopically and microscopically using a dissection microscope and a standard light microscope with polarising capacity. RESULTS: On gross examination, the distal radioulnar ligament could be seen as a triangular-shaped structure extending between the dorsal surface of the distal radius and ulna. The centre of the ligament had a greater density of tightly packed collagen fibres, while fibrocartilage was identified at the site of both the radial and ulnar entheses. Articular cartilage was noted to extend to the most proximal part of the bulbous portion of the distal ulna and corresponding axial aspect of the distal radius. CONCLUSIONS AND RELEVANCE: In the cat, there appears to be a less extensive interosseous component of the distal radioulnar ligament compared with the dog and cheetah. Instead, the ligament follows the articular surfaces of the distal radius and ulna. These anatomical differences may account for increased rotation of the feline antebrachium and have clinical implications, particularly with regard to the management of antebrachiocarpal joint injuries.