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1.
Lancet ; 395(10222): 441-448, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-32035553

RESUMO

BACKGROUND: Patients with Achilles tendon rupture who have non-operative treatment have traditionally been treated with immobilisation of the tendon in plaster casts for several weeks. Functional bracing is an alternative non-operative treatment that allows earlier mobilisation, but evidence on its effectiveness and safety is scarce. The aim of the UKSTAR trial was to compare functional and quality-of-life outcomes and resource use in patients treated non-operatively with plaster cast versus functional brace. METHODS: UKSTAR was a pragmatic, superiority, multicentre, randomised controlled trial done at 39 hospitals in the UK. Patients (aged ≥16 years) who were being treated non-operatively for a primary Achilles tendon rupture at the participating centres were potentially eligible. The exclusion criteria were presenting more than 14 days after injury, previous rupture of the same Achilles tendon, or being unable to complete the questionnaires. Eligible participants were randomly assigned (1:1) to receive a plaster cast or functional brace using a centralised web-based system. Because the interventions were clearly visible, neither patients nor clinicians could be masked. Participants wore the intervention for 8 weeks. The primary outcome was patient-reported Achilles tendon rupture score (ATRS) at 9 months, analysed in the modified intention-to-treat population (all patients in the groups to which they were allocated, excluding participants who withdrew or died before providing any outcome data). The main safety outcome was the incidence of tendon re-rupture. Resource use was recorded from a health and personal social care perspective. The trial is registered with ISRCTN, ISRCTN62639639. FINDINGS: Between Aug 15, 2016, and May 31, 2018, 1451 patients were screened, of whom 540 participants (mean age 48·7 years, 79% male) were randomly allocated to receive plaster cast (n=266) or functional brace (n=274). 527 (98%) of 540 were included in the modified intention-to-treat population, and 13 (2%) were excluded because they withdrew or died before providing any outcome data. There was no difference in ATRS at 9 months post injury (cast group n=244, mean ATRS 74∙4 [SD 19∙8]; functional brace group n=259, ATRS 72∙8 [20∙4]; adjusted mean difference -1∙38 [95% CI -4∙9 to 2∙1], p=0·44). There was no difference in the rate of re-rupture of the tendon (17 [6%] of 266 in the plaster cast group vs 13 [5%] of 274 in the functional brace group, p=0·40). The mean total health and personal social care cost was £1181 for the plaster cast group and £1078 for the functional bract group (mean between-group difference -£103 [95% CI -289 to 84]). INTERPRETATION: Traditional plaster casting was not found to be superior to early weight-bearing in a functional brace, as measured by ATRS, in the management of patients treated non-surgically for Achilles tendon rupture. Clinicians may consider the use of early weight-bearing in a functional brace as a safe and cost-effective alternative to plaster casting. FUNDING: UK National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Tendão do Calcâneo/lesões , Braquetes , Moldes Cirúrgicos , Adulto , Braquetes/efeitos adversos , Braquetes/economia , Moldes Cirúrgicos/efeitos adversos , Moldes Cirúrgicos/economia , Análise Custo-Benefício , Feminino , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Ruptura/terapia , Suporte de Carga
2.
Bone Joint J ; 102-B(2): 254-260, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009436

RESUMO

AIMS: The aim of this study was to assess whether supine flexibility predicts the likelihood of curve progression in patients with adolescent idiopathic scoliosis (AIS) undergoing brace treatment. METHODS: This was a retrospective analysis of patients with AIS prescribed with an underarm brace between September 2008 to April 2013 and followed up until 18 years of age or required surgery. Patients with structural proximal curves that preclude underarm bracing, those who were lost to follow-up, and those who had poor compliance to bracing (<16 hours a day) were excluded. The major curve Cobb angle, curve type, and location were measured on the pre-brace standing posteroanterior (PA) radiograph, supine whole spine radiograph, initial in-brace standing PA radiograph, and the post-brace weaning standing PA radiograph. Validation of the previous in-brace Cobb angle regression model was performed. The outcome of curve progression post-bracing was tested using a logistic regression model. The supine flexibility cut-off for curve progression was analyzed with receiver operating characteristic curve. RESULTS: A total of 586 patients with mean age of 12.6 years (SD 1.2) remained for analysis after exclusion. The baseline Cobb angle was similar for thoracic major curves (31.6° (SD 3.8°)) and lumbar major curves (30.3° (SD 3.7°)). Curve progression was more common in the thoracic curves than lumbar curves with mean final Cobb angles of 40.5° (SD 12.5°) and 31.8° (SD 9.8°) respectively. This dataset matched the prediction model for in-brace Cobb angle with less mean absolute error in thoracic curves (0.61) as compared to lumbar curves (1.04). Reduced age and Risser stage, thoracic curves, increased pre-brace Cobb angle, and reduced correction and flexibility rates predicted increased likelihood of curve progression. Flexibility rate of more than 28% has likelihood of preventing curve progression with bracing. CONCLUSION: Supine radiographs provide satisfactory prediction for in-brace correction and post-bracing curve magnitude. The flexibility of the curve is a guide to determine the likelihood for brace success. Cite this article: Bone Joint J 2020;102-B(2):254-260.


Assuntos
Amplitude de Movimento Articular/fisiologia , Escoliose/diagnóstico por imagem , Escoliose/terapia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia , Decúbito Dorsal/fisiologia , Adolescente , Axila , Braquetes , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Escoliose/fisiopatologia
3.
Orthopade ; 49(1): 59-65, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30899990

RESUMO

BACKGROUND: It is understood that an effective brace therapy requires a primary curve angle reduction of 50% after administering the first orthotic brace. OBJECTIVES: The aim of the study was to determine the efficacy of conservative brace therapy for scoliosis with a curve angle above 20° and to determine possible influencing factors. MATERIALS AND METHODS: The current study included a cohort of 110 scoliosis patients with conservative brace therapy. The development of the scoliotic curve during brace therapy was documented for an average of 40 months. Influencing factors such as the initial Risser sign, age at the start of treatment, gender, curve patterns and body mass index were analyzed. RESULTS: The collective consisted of 88 patients with idiopathic and 22 with neuromuscular spinal deformities. At the beginning of the brace therapy, the average age was 12.2 ± 2.8 years with a mean scoliosis curve angle of 30.4°â€¯± 12.5°. The primary brace reduced the scoliotic curve by 31% to 20.9°. In children and adolescents with lower maturity status, the success of the brace therapy was greater than in patients with a higher Risser sign. In addition, children with obesity had less success during brace therapy than normal- or underweight children. CONCLUSIONS: The initial curvature correction of 50% required for effective brace therapy could only be achieved in one third of the patients. On average, the correction was 31%.


Assuntos
Escoliose/terapia , Adolescente , Braquetes , Criança , Estudos de Coortes , Tratamento Conservador , Humanos , Resultado do Tratamento
4.
J Pediatr Orthop ; 40(1): e25-e29, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30969199

RESUMO

BACKGROUND: Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients. METHODS: After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor. Dimeglio score and family demographic information were collected. Initial treatment was by the Ponseti method, with or without Achilles tenotomy. Following correction, patients had three months of full-time FAO bracing during which parents kept a log of compliance. Patients were followed until recurrence (need for further treatment) or age 5. RESULTS: In total, 42 patients with 64 affected feet met the above criteria and were included in the final analysis. Twenty-six feet (40%) went on to develop recurrence requiring further treatment, including casting, bracing, or surgery. Because of poor tolerance of the original FAO, 20 feet were transitioned to an alternative FAO, and 14 of these (70%) went on to recur (P<0.01). The casting duration (P=0.02) had a statistically significant relationship to recurrence. Patients who were casted for 9 weeks or more had a higher rate of recurrence (57.1% vs. 27.8%; P=0.02). Age at treatment start, Dimeglio score, demographic factors, and compliance during full-time bracing, whether by report or sensor, did not show a significant relationship with recurrence. CONCLUSIONS: The study showed a statistically significant relationship between the difficulty of CTEV correction and the risk of recurrent deformity requiring treatment. This relationship could be used to provide prognostic information for patients' families. Caregiver-reported compliance was not significantly related to recurrence. LEVEL OF EVIDENCE: Level III-Prognostic Retrospective Cohort Study.


Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/terapia , Órtoses do Pé , Tendão do Calcâneo/cirurgia , Braquetes , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cooperação do Paciente , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Tenotomia , Resultado do Tratamento
5.
Muscle Nerve ; 61(1): 52-57, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31588574

RESUMO

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.


Assuntos
Tornozelo , Braquetes , Distrofia Muscular de Duchenne/reabilitação , Distrofia Muscular de Duchenne/terapia , Articulação do Tornozelo , Criança , Pré-Escolar , Método Duplo-Cego , , Humanos , Masculino , Aparelhos Ortopédicos , Cooperação do Paciente , Modalidades de Fisioterapia , Amplitude de Movimento Articular , Resultado do Tratamento , Caminhada
6.
Bone Joint J ; 101-B(11): 1370-1378, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674249

RESUMO

AIMS: The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes. PATIENTS AND METHODS: This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores. RESULTS: Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores. CONCLUSION: Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life. Cite this article: Bone Joint J 2019;101-B:1370-1378.


Assuntos
Braquetes/efeitos adversos , Cifose/etiologia , Lordose/etiologia , Escoliose/terapia , Adolescente , Criança , Feminino , Humanos , Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Vértebras Lombares , Masculino , Estudos Retrospectivos , Vértebras Torácicas
8.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 4049-4054, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31612264

RESUMO

PURPOSE: To determine the management of torsional humeral shaft fractures in a group of expert shoulder and elbow surgeons and analyse the rate of return to sport of these throwing athletes. METHODS: A survey was sent to all physician members of two prominent sports medicine professional associations: the American Shoulder and Elbow Surgeons and the Herodicus Society. Due to the rare nature of this injury, a historical survey of management and return to play was performed to allow analysis of trends in treatment and return to play after both non-operative and operative management. RESULTS: The survey was emailed to 858 physician members. Out of the 95 respondents, 35 surgeons indicated they had treated ≥ 1 torsional humeral shaft fractures in throwing athletes (average 1.7 per surgeon). A total of 72 fractures were recorded with an average age of 20.4 years and the majority being male (68/72). Eighty-one percent (58/72) of the fractures were classified as simple spiral. Sixty-one percent (44/72) of the fractures were treated non-operatively, while 35% (25/72) of the fractures were treated by open reduction and internal fixation (ORIF). Patient age, return to sport rate and level, type of fracture, and fracture healing time did not significantly differ based on treatment type. Average time to return to sport was significantly shorter for patients who underwent ORIF compared to non-operative treatment (p = 0.001). Overall, 48 (92.3%) of the 52 athletes returned to sport, with 84% (36/43) returning to the same level of play. CONCLUSION: Torsional humeral shaft fractures in throwers are most commonly seen in young men and can be treated both operatively and non-operatively with overall similar results for healing time, rate of non-union, and return to sport. The only significant difference in the groups was an earlier return to sports in those fixed surgically, however, operative intervention also yielded a higher complication rate. Regardless of the treatment method, the overall rate of return to play was moderate. These finding are clinically relevant and can assist physicians with decision making for treatment and can help when advising throwers of appropriate expectations for recovery after this injury. LEVEL OF EVIDENCE: IV.


Assuntos
Fraturas do Úmero/terapia , Padrões de Prática Médica/estatística & dados numéricos , Volta ao Esporte , Adolescente , Adulto , Braquetes/estatística & dados numéricos , Criança , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Consolidação da Fratura , Fraturas Fechadas/terapia , Humanos , Imobilização/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Redução Aberta/estatística & dados numéricos , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Inquéritos e Questionários , Adulto Jovem
9.
J Bone Joint Surg Am ; 101(19): 1750-1760, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577680

RESUMO

BACKGROUND: Treatment outcomes and risk factors for neurological deficits in pediatric patients with an os odontoideum are unclear. METHODS: We reviewed the data for 102 children with os odontoideum who were managed at 11 centers between 2000 and 2016 and had a minimum duration of follow-up of 2 years. Thirty-one children had nonoperative treatment, and 71 underwent instrumented posterior cervical spinal arthrodesis for the treatment of C1-C2 instability. Nonoperative treatment consisted of observation (n = 29) or immobilization with a cervical collar (n = 1) or halo body jacket (n = 1). Surgical treatment consisted of atlantoaxial (n = 50) or occipitocervical (n = 21) arthrodesis. One patient also underwent transoral odontoidectomy. RESULTS: Thirty children (29%) presented with neurological deficits, 28 of whom had radiographic atlantoaxial instability (atlantoaxial distance >5 mm) or limited space (≤13 mm) available for the spinal cord (risk ratio, 7.8 [95% confidence interval, 2.0 to 31] compared with children with no radiographic risk factors). The 27 children without neurological deficits or atlantoaxial instability at presentation underwent nonoperative treatment and remained asymptomatic. Of the initial nonoperative cohort, one child developed atlantoaxial instability, and another had a persistent neurological deficit; both children underwent spinal arthrodesis during the study period. One child with cervical instability declined surgery and remained asymptomatic. Spinal fusion occurred in 68 patients in the surgical group by the end of the study period (mean, 3.7 years; range, 2.0 to 11.8 years). Surgical complications occurred in 21 children, including nonunion in 12, new neurological deficits in 4, cerebrospinal fluid leak in 2, symptomatic instrumentation requiring removal 2, and vertebral artery injury in 1. Nine children underwent revision surgery. In the surgical group, Japanese Orthopaedic Association neurological function scores improved significantly from preoperatively to the latest follow-up for the upper extremities (p = 0.026) and lower extremities (p = 0.007). CONCLUSIONS: The risk of developing a neurological deficit was strongly associated with atlantoaxial instability and limited space available for the spinal cord in children with os odontoideum. Nonoperative treatment was safe for asymptomatic patients without atlantoaxial instability. Spinal arthrodesis resolved the neurological deficits of children with symptomatic os odontoideum. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Articulação Atlantoaxial/cirurgia , Vértebra Cervical Áxis/anormalidades , Instabilidade Articular/cirurgia , Doenças do Sistema Nervoso/etiologia , Fusão Vertebral/métodos , Adolescente , Articulação Atlantoaxial/lesões , Vértebra Cervical Áxis/cirurgia , Braquetes , Criança , Pré-Escolar , Humanos , Imobilização/métodos , Lactente , Cervicalgia/etiologia , Cervicalgia/terapia , Doenças do Sistema Nervoso/terapia , Fatores de Risco , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/terapia , Resultado do Tratamento , Conduta Expectante
10.
Medicine (Baltimore) ; 98(43): e17666, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651894

RESUMO

RATIONALE: Traumatic AOD is rare but highly associated with upper cervical spine injuries. We found no references in the literature of traumatic posterior atlantooccipital dislocation (AOD) combined with type II dens fracture (Anderson-D'Alonzo classification) and C1 anterior arch fracture. PATIENT CONCERNS: The first case was a 93-year-old male patient who was admitted to the Emergency Department complaining of incomplete quadriplegia after a fall from a height. The second was a 53-year-old male patient who visited the emergency department complaining of posterior neck pain following a high-speed motor vehicle collision. DIAGNOSIS: Reconstructed computed tomography (CT) scans clearly demonstrated posterior AOD combined with type II dens fracture and C1 anterior arch fracture. In addition, magnetic resonance imaging (MRI) also revealed type II transverse atlantal ligament injury (Dickman's classification) in the first patient. INTERVENTIONS: The patients chose not to undergo surgery; instead, they were immobilized with a rigid cervical brace. OUTCOMES: The patients were lost to follow-up. LESSONS: A thorough clinical evaluation and radiologic investigation (CT and MRI) on concomitant upper cervical injuries should be evaluated in traumatic AOD patients.


Assuntos
Articulação Atlantoaxial/lesões , Braquetes , Vértebras Cervicais/lesões , Luxações Articulares/terapia , Fraturas da Coluna Vertebral/terapia , Acidentes por Quedas , Acidentes de Trânsito , Idoso de 80 Anos ou mais , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X
11.
Proc Inst Mech Eng H ; 233(11): 1132-1140, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31597554

RESUMO

Knee sleeves are often prescribed to alleviate pain in people with early knee osteoarthritis. However, the biomechanics underlying their pain-relieving effect are still not well understood. This pre-post study aims at evaluating and comparing the effects of two different types of knee sleeves on knee adduction moment. Patients with clinically diagnosed knee osteoarthritis were recruited from the University of Malaya Medical Centre and were randomly assigned to two test groups using (1) a simple knee sleeve and (2) a simple sleeve with patella cutout. Knee adduction moment was collected using the Vicon motion capture system with two Kistler force plates. Pain, stiffness and physical functions were recorded using the Western Ontario and McMaster Universities Osteoarthritis Index. All measurements were taken before, immediately after and at the completion of 6 weeks of application (primary time point). In total, 17 participants with early unilateral knee osteoarthritis (47.7 (9.7) years) completed the study. Overall results show significant reduction in pain, early stance and late stance knee adduction moment and increased walking speed after 6 weeks of both knee sleeves application. This study results suggest that knee sleeves can reduce knee adduction moments in early unilateral knee osteoarthritis by 14.0% and 12.1% using the simple sleeve and the sleeve with patella cutout, respectively, and can potentially delay disease progression. In addition, knee sleeve with patella cutout does not provide additional benefits when compared to the simple knee sleeve.


Assuntos
Braquetes , Fenômenos Mecânicos , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/terapia , Manejo da Dor , Dor/fisiopatologia , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Medicine (Baltimore) ; 98(42): e17338, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626090

RESUMO

RATIONALE: Unicompartmental knee arthroplasty (UKA) is an effective method to treat single compartment disease of the knee joint. Report about the complications of UKA, especially tibial plateau fractures, is rare. Given its rarity, its pathogenesis is not well described, and a standard of treatment is still not established. Therefore, relevant studies and analysis of this complication have a significant effect on helping physicians avoid risks and guide clinical diagnosis and treatment. PATIENT CONCERNS: The 1st case corresponds to a 70-year-old male patient who complained of knee pain, difficulty walking, nocturnal rest pain, and elevated skin temperature at 3 weeks after the left knee arthroplasty. The second case is a 72-year-old female patient who complained of left knee pain and swelling during movement at 2 weeks after the left knee arthroplasty. DIAGNOSIS: The 1st case showed a fracture of the medial malleolus of the left knee and a secondary depression of the medial tibial plateau in X-rays and the second case showed a fracture of the medial malleolus of the left knee in computed tomography (CT) and X-rays. INTERVENTIONS: The 1st case was treated with plate and screw fixation and the second case was treated conservatively and immobilized using brace and remained nonweight bearing for 6 weeks. OUTCOMES: After 1 year, both patients have good joint activity, and there was no pain or loosening of the prosthesis and fragment displacement. LESSONS: The incidence of tibial plateau fractures (TPF) related to UKA might be low, but fatal and difficult to treat. Its pathogenesis determines procedure-related factors; when fracture develops, treatment should be based on the degree of displacement, stability of implant fixation, etc.


Assuntos
Artroplastia do Joelho/efeitos adversos , Tratamento Conservador/métodos , Fixação Interna de Fraturas/métodos , Complicações Pós-Operatórias/terapia , Fraturas da Tíbia/terapia , Idoso , Idoso de 80 Anos ou mais , Braquetes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
J Pediatr Orthop ; 39(10): 505-509, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599859

RESUMO

BACKGROUND: Variation exists in the Pavlik harness (PH) treatment regimen for infantile developmental dysplasia of the hip (DDH). The purpose of this study was to determine if the daily PH wear duration (23 vs. 24 h) and frequency of follow-up visits affect the clinical and radiographic outcomes of infants with dislocated but reducible (Ortolani+) hips. METHODS: This study reviewed prospectively enrolled patients with DDH in a single center who presented at age <6 months with Ortolani+ hips and were treated with PH. Recommended daily PH wear duration (23 vs. 24 h) and the frequency of clinic visits in first 4 weeks after the initiation of PH treatment were analyzed. The clinical success (stable hip that did not require closed or open reduction or the use of an abduction orthosis) and radiographic success based on the acetabular index at 2-year follow-up were compared between different PH regimen groups. RESULTS: Sixty-two patients (74 hips, 53 females) with Ortolani+ hips had a mean age of presentation of 23±28 days (range, 4 to 128 d) and mean follow-up of 33.2±18.4 months (range, 8 to 85 mo). Overall clinical success rate of PH for Ortolani+ hips was 93% (69/74 hips) and radiographic success rate at 2 years was 84% (48/57 hips). There was no difference in clinical or radiographic success rate between the 23- and 24-hour wear groups (P>0.99, 0.73) or between hips assessed almost weekly compared with once or twice during the first 4 weeks of PH treatment (P>0.99 for both). CONCLUSIONS: The 23- versus 24-hour PH regimen and frequency of clinic visits in the first 4 weeks of PH treatment did not affect the clinical or radiographic success rate of Ortolani+ hips in infantile DDH. A strict weekly clinic visit and 24-hour PH regimen may not be necessary to obtain stable reduced hips in infants presenting <6 months of age with Ortolani+ hips. LEVEL OF EVIDENCE: Level III-therapeutic.


Assuntos
Braquetes , Luxação Congênita de Quadril/terapia , Visita a Consultório Médico , Criança , Pré-Escolar , Protocolos Clínicos , Feminino , Seguimentos , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Masculino , Radiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
J Pediatr Orthop B ; 28(6): 564-571, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31503104

RESUMO

We investigated the impact of changes in bar length of Steenbeek foot abduction brace on foot and ankle range of motion in 150 children. The ankle dorsiflexion and foot abduction was measured without brace, with standard brace size (0) as depicted in Steenbeek manual and after variations in bar length (-2˝ to +2˝). The bar length (0) was also compared with shoulder width for Indian population. The Steenbeek foot abduction brace bar length in current use (11.53±1.2˝) was longer than shoulder size (8.14±1.18˝) with no true correlation. Steenbeek foot abduction brace usefulness was evident for foot abduction (46°) but not for dorsiflexion. The varied bar lengths tested did not significantly altered available dorsiflexion or abduction. The currently used Steenbeek foot abduction brace were larger than shoulder widths. The Steenbeek foot abduction brace was dynamic but required prefabrication for its effectiveness. The changes in bar length did not significantly alter foot dynamics occurring with brace.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Pé Torto Equinovaro/diagnóstico por imagem , Desenho de Equipamento/normas , Órtoses do Pé , Pé/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Braquetes/normas , Criança , Pré-Escolar , Pé Torto Equinovaro/terapia , Estudos Transversais , Feminino , Órtoses do Pé/normas , Humanos , Lactente , Masculino , Projetos Piloto
16.
Artigo em Russo | MEDLINE | ID: mdl-31513171

RESUMO

Osteoporotic vertebral fractures (VF) have a negative impact on quality of life within a year after injury. A recent-onset vertebral body compression fracture in the presence of osteoporosis (OP) is generally accompanied by acute back pain, hypokinesia, and a reduction in daily physical and social activities, further leading to social isolation. Rehabilitation measures are of particular importance to restore quality of life in OP patients, especially in the people who have a history of fractures. Exercise therapy is the mainstay of management in patients with OP and VF; however, pain and limited mobility can be a barrier to exercises. Competent bracing is a method that can assist in reducing pain in VF, stabilizing the spine, and increasing motor activity. The use of an orthosis not only improves quality of life, but also gives an opportunity to take physical exercises. Semi-rigid and elastic corsets are preferable to rigid structures that are less convenient to use and associated with a large number of undesirable phenomena. Wearing a brace continuously (with its obligatory taking off overnight) is rational for 6-8 weeks. Above this period, there is an increased risk of muscle atrophy. It is acceptable to longer use orthoses situationally, if there is a need to be in an upright position, during long walks, trips, or physical exercises.


Assuntos
Braquetes , Terapia por Exercício , Fraturas por Compressão/terapia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento
17.
Emerg Nurse ; 27(5): 23-30, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31475502

RESUMO

AIM: Stable ankle injuries are highly prevalent in the UK. Prevention of complications and reoccurrence is essential. The literature shows that plaster of Paris and AirLoc brace are clinically effective treatments for such injuries. However, there is no research measuring patients' satisfaction with these treatments. This study compared options in the treatment of severe ankle sprains and distal fibular avulsion fractures from patients' perspectives. The aim was to determine patients' preferred treatment between below knee plaster cast and AirLoc brace in the management of stable ankle injuries. METHOD: A total of 39 patients who presented at an urban hospital with stable ankle injuries were recruited into a randomised controlled trial. Patient satisfaction levels were measured by questionnaire one week into treatment. The null hypothesis was 'there is no significant difference in satisfaction levels between the two devices'. FINDINGS: There were statistically significant higher patient satisfaction levels in the AirLoc group compared to the plaster cast group. After analysis by the unrelated t -test, the null hypothesis was rejected. Comfort, daily activities, sleep, work and social life were the main contributing factors. Additionally, 67% of the AirLoc group compared to 46% of the plaster cast group were able to return to work. The number needed to treat for one additional AirLoc patient to return to work was 4.8 (five patients). CONCLUSION: Patients' preferred treatment is the AirLoc brace. The inquiry method could be used to provide patient-centred care in other fields.


Assuntos
Fraturas do Tornozelo/terapia , Traumatismos do Tornozelo/terapia , Entorses e Distensões/terapia , Atividades Cotidianas , Adolescente , Adulto , Braquetes , Moldes Cirúrgicos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Inquéritos e Questionários , Reino Unido
18.
J Appl Biomech ; 35(5): 344-352, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31541064

RESUMO

Functional knee braces are frequently prescribed by physicians to ameliorate the function of individuals with anterior cruciate ligament (ACL) injuries. These braces have been shown in the literature to potentially enhance knee stability by augmenting muscle activation patterns and the timing of muscle response to perturbations. However, very few techniques are available in the literature to quantify how those modifications in lower-limb muscle activity influence stability of the knee. The aim of the present study was to quantify the effect of an off-the-shelf functional knee brace on muscle contributions to knee joint rotational stiffness in ACL-deficient and ACL-reconstructed patients. Kinematic, electromyography, and kinetic data were incorporated into an electromyography-driven model of the lower extremity to calculate individual and total muscle contributions to knee joint rotational stiffness about the flexion-extension axis, for 4 independent variables: leg condition (contralateral uninjured, unbraced ACL injured, and braced ACL injured); knee flexion (5°-10°, 20°-25°, and 30°-35°); squat stability condition (stable and unstable); and injury status (ACL deficient and ACL reconstructed). Participants had significantly higher (P < .05, η2 = .018) total knee joint rotational stiffness values while wearing the brace compared with the control leg. A 2-way interaction effect between stability and knee flexion (P < .05, η2 = .040) for total joint rotational stiffness was also found.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/fisiopatologia , Braquetes , Articulação do Joelho/fisiopatologia , Amplitude de Movimento Articular , Adulto , Eletromiografia , Humanos , Masculino , Músculo Esquelético/fisiologia , Rotação , Adulto Jovem
19.
J Pediatr Orthop ; 39(8): e586-e591, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393294

RESUMO

BACKGROUND: Multiple randomized trials have showed equivalent outcomes and improved patient/family satisfaction using a removable brace to treat pediatric distal radius buckle fractures (DRBF). We tested the hypothesis that we could use quality improvement (QI) methodology to increase the proportion of patients with DRBF treated with removable braces at 2 tertiary care orthopaedic clinics from a baseline of 34.8% to 80%. METHODS: Clinic billing records were reviewed monthly to determine treatment (brace vs. cast) of DRBF and tracked using control charts (p-chart). Balance measures including correct application of the diagnostic criteria and algorithm were monitored. Process measures including the number of follow-up visits, radiographs obtained, and total cost of treatment were collected. Baseline data were obtained over a 3-month period, followed by a 12-month period of interventions using Plan-Do-Study-Act cycles targeting both individuals and groups of providers. RESULTS: The proportion of DRBF treated in a brace increased from a combined baseline of 34.8% to a combined 84% at the end of the study period. Following intervention, 83% (15/18) of providers began using braces for a majority of patients (defined as >67%), with only 1 provider continuing to use casts 100% of the time. Patient preference was cited as the most common reason for use of cast treatment. There was a significant decrease in the number of radiographs obtained at 1 of 2 institutions. The charges for brace treatment averaged $630 less per patient than for cast treatment, leading to an estimated medical-cost savings of $205,000 following intervention. CONCLUSIONS: Implementation of brace treatment for pediatric DRBF using QI methodology resulted in a shift toward brace treatment in the majority of patients, leading to substantial medical and nonmedical cost savings. Although patient preference was cited as the most common reason for persistent cast treatment, the data show the use of cast treatment to be more dependent upon individual provider preference. LEVEL OF EVIDENCE: Level II-therapeutic.


Assuntos
Braquetes/tendências , Moldes Cirúrgicos/tendências , Melhoria de Qualidade , Fraturas do Rádio/terapia , Braquetes/economia , Moldes Cirúrgicos/economia , Criança , Redução de Custos , Medicina Baseada em Evidências , Humanos , Satisfação do Paciente , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/economia
20.
IEEE Int Conf Rehabil Robot ; 2019: 494-498, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374678

RESUMO

INTRODUCTION: People with arthrogryposis multiplex congenita (AMC) often have muscle weakness in the biceps that makes elbow flexion difficult. An elbow-flexion assist orthosis was designed using the force of springs, combined with a sliding joint, to apply appropriate elbow torque to aid a user in lifting her hand to her mouth. The sliding joint allows an increasing elbow torque despite a decreasing spring force. METHODS: The device was prototyped for a user with AMC. An occupational therapist measured the user's flexion with and without the device. Benchtop torque measurements were also determined and compared with user trials. RESULTS: The assist orthosis applied an increasing torque as the elbow flexed, thereby allowing the subject to reach her mouth for feeding and then extend her elbow to a position of no applied torque. Without the device, the subject had active elbow flexion of 87 degrees. With the device, this flexion increased to 120 degrees. CONCLUSION: The novel prototype is a lightweight, spring-powered flexion orthosis which can be made relatively easily and is potentially concealed under clothing. It provides the appropriate torque to move the hand against gravity and increases elbow-flexion of the user.


Assuntos
Artrogripose/fisiopatologia , Braquetes , Articulação do Cotovelo/fisiopatologia , Cotovelo/fisiopatologia , Músculo Esquelético/fisiopatologia , Feminino , Humanos
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