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1.
J Pediatr Orthop B ; 31(1): 55-59, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33528228

RESUMO

Distal radio-ulnar joint (DRUJ) injuries are under-reported in the paediatric population. No single study has discussed methods of DRUJ reconstruction in immature patients with chronic instability. We present a physeal sparing ligamentoplasty for chronic DRUJ instability and describe the outcomes in two patients. Two consecutive children with chronic DRUJ instability were treated using physeal sparing ligamentoplasy. After the failure of triangular fibrocartilage complex repair, reconstruction was done using palmaris longus tendon graft that was tunnelled through the distal radius epiphysis and wrapped subperiosteally around the ulnar neck. Graft was tied in a neutral forearm position. DRUJ stability was achieved in both patients. Grip strength averaged 90% of the healthy side. Prono-supination range of motion (ROM) averaged 88 and 86%, respectively, of the healthy side, without intraoperative nor postoperative complications. Our novel technique was effective in the regain of DRUJ stability with minor effect on the prono-supination ROM. Further studies are planned to experiment the biomechanical effectiveness of our technique. Level of evidence: Therapeutic IV.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Criança , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Ligamentos , Supinação , Ulna/diagnóstico por imagem , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
2.
BMC Musculoskelet Disord ; 22(1): 936, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34758803

RESUMO

BACKGROUND: A supination-adduction (SAD) ankle fracture is a special type of ankle fracture that results in collapse of the distal tibial articular surface; as such, orthopaedic surgeons require greater awareness of this type of fracture. The severity of this injury lies between that of an ordinary ankle fracture and a pilon fracture, and the treatment of such fractures based on the ankle fracture concept leads to extremely high rates of postoperative complications and a poor prognosis. In this retrospective study, we aimed to explore the treatment of SAD fractures based on the pilon fracture concept. METHODS: We retrospectively analysed the clinical data of 67 patients with Lauge-Hansen supination-adduction type II (SAD-II) ankle fractures, most of whom had a 44-A AO classification. Patients underwent surgical treatment at the Second Affiliated Hospital of Anhui Medical University from January 2009 to June 2019. The patients were divided into two groups based on the surgical concept employed: 43 patients were included in the ankle fracture surgical concept group, and 24 patients were included in the medial pilon fracture surgical concept group. The therapeutic effect was evaluated based on the Burwell-Charnley radiological reduction standard, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and postoperative visual analogue scale (VAS) pain score 1 year after surgery using regression with adjustment for confounding factors. RESULTS: All 67 patients were followed up. Twenty-four patients were treated according to the medial pilon fracture concept, and forty-three patients were treated according to the ankle fracture concept. The AOFAS score 1 year after surgery in the medial pilon group (89.83 ± 2.77) was higher than that in the ankle fracture group (83.63 ± 7.97) (p < 0.05). The VAS score 1 year after surgery in the medial pilon fracture group (1.17 ± 0.96) was significantly better than that in the ankle fracture group (2.28 ± 0.96) (p < 0.05). CONCLUSION: Patients with Lauge-Hansen SAD-II ankle fractures treated based on the medial pilon fracture surgical concept had better postoperative outcomes than those treated based on the ankle fracture surgical concept. LEVEL OF EVIDENCE: Level III, retrospective cohort study.


Assuntos
Fraturas do Tornozelo , Fraturas da Tíbia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Supinação , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
3.
BMC Musculoskelet Disord ; 22(1): 836, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34587928

RESUMO

BACKGROUND: Many solutions have been proposed in treating of forearm supination. Comparing with other supination function reconstructions, pronator teres rerouting is believed to be less effective due to its insufficient supination strength. The aim of this study is to introduce a modified procedure, and compare its result with two previous approaches. PATIENTS AND METHODS: From 2015 to 2020, 11 patients have restored forearm supination by rerouting of the pronator teres weave sutured with allogeneic tendons. The average follow-up period was 17.5 months (12 to 24). The range of active supination at the final follow-up was recorded. RESULTS: Almost all patients acquired good supination range. The average active post-operative supination was 72.7° (60° to 80°) at the final follow-up. No complication was observed. All patients retained full range of pronation. CONCLUSIONS: This study provides a modified supination function reconstruction with simple operating, fine results, low risks, and no affecting of pronation function. The use of allogeneic tendon makes up for the muscles with insufficient length, making it valuable to reconsider those rebuilding operations that were once considered unpromising by many.


Assuntos
Antebraço , Transplante de Células-Tronco Hematopoéticas , Humanos , Supinação , Transferência Tendinosa , Tendões/cirurgia
4.
JNMA J Nepal Med Assoc ; 59(240): 812-813, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34508479

RESUMO

Even though posterior or postero-lateral dislocations of elbow are more common, both isolated medial and lateral dislocations of elbow are extremely uncommon. Since there are subtle findings and minimum pain after medial dislocation of elbow, these are sometimes missed by attending physician at first presentation and changes into chronic type with guarded prognosis. We report a case of a 15-year old boy with isolated medial dislocation of elbow which was correctly identified and treated with closed reduction and posterior slab application. Flexion extension as well as supination pronation of elbow 3 months after injury was nearly normal.


Assuntos
Articulação do Cotovelo , Luxações Articulares , Adolescente , Cotovelo , Articulação do Cotovelo/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/terapia , Masculino , Pronação , Supinação
5.
Acta Orthop Traumatol Turc ; 55(4): 349-354, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34464312

RESUMO

OBJECTIVE: The aim of the study was to investigate the effect of different arm positions (hand pronation/supination and elbow flexion/extension) on fragment rotation in extra-articular distal radius fractures in a cadaveric model. METHODS: In this study, ten fresh-frozen cadaveric upper extremities from five donors with a mean age of 69 ± 12 years were used. Two cortical pins were inserted in the radius and the ulna. In a custom-made device, different forearm (30°, 60°, and 90° of pronation and supination) and elbow positions (full extension) were tested, using a fluoroscopic analysis. The degree of malrotation between the two pins was measured in these positions. At the last test sequence, the tendon of the brachioradialis muscle was released. RESULTS: A significant difference was found in concerns of the rotational angle between the distal fragment and the radial shaft at different degrees of pronation and supination if the elbow joint was in an extended and flexed position. The release of the brachioradialis tendon did not show any effect. CONCLUSION: The results of this study supported that rotational malpositions in distal radius fractures can be decreased if the forearm is in a neutral position. Accordingly, the forearm should be in a neutral position while initially immobilization in a plaster splint is performed.


Assuntos
Antebraço , Fraturas do Rádio , Idoso , Idoso de 80 Anos ou mais , Cadáver , Humanos , Pessoa de Meia-Idade , Pronação , Rádio (Anatomia)/diagnóstico por imagem , Rotação , Supinação
6.
Ann Palliat Med ; 10(7): 7802-7812, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353067

RESUMO

BACKGROUND: The purpose of the current study was to retrospectively clarify the anatomic character and evaluate the mid-term operative outcomes for vertical medial malleolar fractures (MMFs). METHODS: A total of 53 patients with supination adduction (SAD) type II MMFs treated with open reduction and internal fixation (ORIF) between March 2009 and June 2013 were included. We reviewed the patients' preoperative X-ray and computed tomography (CT) to determine the pathoanatomic characteristics of medial malleolus fractures. Buttress plate lag screws fixation had been applied. Complications and treatment failures were recorded; the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. RESULTS: For the 53 patients, only 39.6% cases with simple vertical MMFs. The mean distal tibial articular surface (DTAS) involvement in the MMF was 16.5%±11.6% (range, 0-47%). The mean follow up time was 62.4±14.1 [44-91] months. There were 7 cases of traumatic osteoarthritis (TOA), and 3 cases of failure were reported in the screw fixation group. The mean AOFAS score was 80.6±15.8 points, and the mean VAS score was 2.1±1.7 points, with a good to excellent rate (GTE) of 81.1%. No significant difference was found in comparing the AOFAS, VAS, GTE, incision relative complication rate, infection rate, loss of reduction (LoR) rate, and TOA rate between groups (P>0.05). The participants in the buttress plate group reached a shorter mean full weight-bearing (FWB) time (P=0.04). CONCLUSIONS: More than 60% vertical MMFs are with one or more characteristics of medial cortex comminuted fractures, or die-punch fragments, or medial joint compression. And patients with die-punch fragment, medial joint compression, LoR, large DTAS involvement and small fracture line angle (FLA) were positively correlated with the fair to poor results. Lag screw fixation should be cautiously used in vertical MMF patients with comminuted medial cortex.


Assuntos
Fraturas do Tornozelo , Fraturas do Tornozelo/cirurgia , Estudos de Coortes , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Supinação , Resultado do Tratamento
7.
Med Eng Phys ; 94: 16-25, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34303497

RESUMO

Upper limb prostheses can greatly improve the condition of amputees. However, prosthetic mechanisms have different topologies and there is no consensus on the choice of an appropriate mechanism. This paper evaluates the impact of prosthetic mechanism topology on the prosthesis' performance during daily tasks. The proposed multibody model is compared to four open-loop and one closed-loop existing mechanisms according to: (1) consumed energy, (2) global and local movement reconstruction errors during inverse kinematics, (3) movement smoothness, which reflects the dynamic appearance of the prosthesis, also called 'dynamic cosmesis'. Flexion-extension (FE) and pronation-supination (PS) tasks were studied in 15 healthy subjects. All parameters identified at least one group difference (p < 0.0001) in both tasks. Most closed-loop mechanisms (50% in FE and 100 % in PS) including the proposed model were among the most energy-efficient mechanisms. Out of all models, the proposed model was the most energy efficient in FE (2.07 ± 0.69 KJ) and in PS (0.25 ±  0.16 KJ). This model also reproduced the studied movements with the lowest errors (1.39 ± 0.2 mm in FE and 1.38 ± 0.25 mm in PS), especially at the forearm level. The results show that the wrist plays a major role in motion smoothness and that two series mechanisms have exhibited a poor dynamic cosmesis because of their higher jerk cost ((1.73 ± 0.30) × 1010) in FE and (9.29 ± 17) × 1013 in PS tasks)). Finally, the mechanism topology affects the performance of upper limb prostheses and represents a novel aspect in the prostheses design which can be applied to exoskeleton design.


Assuntos
Membros Artificiais , Fenômenos Biomecânicos , Humanos , Movimento , Supinação , Extremidade Superior , Punho
8.
Injury ; 52(10): 2835-2840, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34281690

RESUMO

INTRODUCTION: 8-10% of all Ulnar styloid fractures (USF) accompanying distal radius fractures are addressed surgically. The surgical fixation has to counteract forces of translation and rotation acting on the distal radioulnar joint (DRUJ). The different technics used were never compared biomechanically. Our study aims to compare the effects of different techniques of USF fixation on the forearm rotation and the dorsal-palmar (DP)-translation of the DRUJ. MATERIAL AND METHODS: 9 forearm specimens were mounted on a custom testing system. Load was applied for Pronosupination and DP-translation with the forearm placed in neutral position, pronation and supination. The positional change of the DRUJ was measured using a MicroScribe. Six different, sequential conditions were tested in the same specimen: intact, USF and 4 repair techniques (2 K-wire, tension band wiring (TBW), headless compression screw, suture anchor). RESULTS: The USF significantly increased DP-translation and pronosupination compared to the intact condition. The DP-translation in neutral was reduced significantly with all four techniques compared to the USF condition. TBW and suture anchor also showed a significant difference to the K-wire fixation. In supination only the TBW and suture anchor significantly decreased DP-Translation. The rotational stability of the DRUJ was only restored by the K-wire fixation and the TBW. CONCLUSIONS: All four USF repair techniques partially restored translational stability; however, only K-wire fixation and TBW techniques restored rotational stability. TBW was biomechanically superior to the other techniques as it restored translational stability and rotational stability.


Assuntos
Instabilidade Articular , Fraturas do Rádio , Fraturas da Ulna , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Pronação , Fraturas do Rádio/cirurgia , Supinação , Fraturas da Ulna/cirurgia , Articulação do Punho/cirurgia
9.
Injury ; 52(10): 2827-2834, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34281692

RESUMO

OBJECTIVE: To investigate changes in the Garden index and other radiological parameters during reduction of femoral neck fractures. METHODS: Ten healthy, human femoral specimens were obtained. A 2.0 mm diameter Kirschner wire was implanted in the centre of the femoral head. A perpendicular osteotomy was made in the middle of the femoral neck. The distal osteotomy surface was used as the angle of rotation (pronation and supination up to 90° at 10° intervals). Anterior-posterior and lateral view radiographs were taken at different angles. The Garden index and other relevant data were analysed using the picture archiving and communication system. Changes in the area of the femoral head fovea at different rotation angles were measured. RESULTS: There were no significant differences in the Garden index between 0-30° of pronation and supination (p > .05). For angles of 40-90°, there were statistically significant differences in the Garden index (p < .05). The area of femoral head fovea decreased with increasing pronation angle, and increased with increasing supination angle. CONCLUSIONS: The Garden index does not change significantly if the angle of fracture rotation is 0-30° (in either pronation or supination) during femoral neck fracture reduction. Therefore, it is impossible to judge the rotation of fracture in this range of angles. The Garden index can detect the rotation of fracture for rotation angles of 40-90° (in either pronation or supination). Changes in the area of the femoral head fovea can help determine the rotation of femoral neck fractures. LEVEL OF EVIDENCE: Level V.


Assuntos
Fraturas do Colo Femoral , Cadáver , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Humanos , Pronação , Radiografia , Supinação
10.
J Orthop Trauma ; 35(Suppl 2): S16-S17, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34227594

RESUMO

SUMMARY: Treatment principles in the management of radial shaft fractures, congruent with all fracture care, are to restore anatomy and function of the limb. Radial shaft fractures are unique in that preserving the anatomic bow of the radius, which allows for its rotation around the ulna during pronation and supination, is essential for proper function. The 2 main approaches for exposure of the proximal or middle third radial diaphyseal fractures are the volar "Henry" and the dorsal "Thompson." This article highlights the benefits of the dorsal Thompson approach, describes the key points of the operative technique, which allow for protection of the posterior interosseous nerve, and provides an overview of the measurable outcomes when using this approach. In the accompanying video, the steps of operative exposure to the proximal radial shaft with careful avoidance of the posterior interosseous nerve are demonstrated.


Assuntos
Fraturas do Rádio , Rádio (Anatomia) , Antebraço , Humanos , Pronação , Fraturas do Rádio/cirurgia , Supinação
11.
Orthop Traumatol Surg Res ; 107(6): 103000, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34216839

RESUMO

INTRODUCTION: Supination-external rotation ankle fracture is one of the most common fractures. Studies on the fracture line distribution of this fracture type are limited. The purpose of this study is to explore the distribution characteristics of intra-articular posterior malleolus fracture lines in supination-external rotation. HYPOTHESIS: Most of the fracture lines are concentrated in a particular area. MATERIAL AND METHODS: Computed tomography scans of a consecutive series of 70 ankle fractures of supination-external rotation were used for this study. The DICOM files were loaded into Mimics 16.0 for 3D reconstruction of the distal tibial articular surface. The intra-articular posterior malleolus fracture lines were identified after virtual fracture reduction. All the fracture lines were drawn on one picture of the distal tibial articular surface after standardization before a heat map was created based on the frequency of fracture lines. RESULTS: Although the distribution of posterior malleolus intra-articular fracture lines varied, most of them were concentrated in an arcuate zone. The ratios of the area of posterior fracture fragment to the total area of articular surface averaged 14.96% (range, from 2.23% to 38.45%). They were most likely to enter the articular surface at 20.4% of the tangent of the posterior edge in a standardized image and exit at 58.7% of the tangent of the lateral edge. CONCLUSIONS: In ankle fractures of supination-external rotation, most intra-articular posterior malleolus fracture lines may be distributed regularly in an arcuate zone of the articular surface. LEVEL OF PROOF: V; Descriptive research.


Assuntos
Fraturas do Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Fixação de Fratura , Fixação Interna de Fraturas , Humanos , Supinação
12.
Work ; 69(2): 403-409, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092689

RESUMO

BACKGROUND: Novice nurses, occupational and physical therapist's injury rates are alarming. OBJECTIVE: To test for differences in peak elbow flexion forces (PEFF) by profession using different forearm positions. METHODS: Entry-level RN, OT, and PT students performed 3-repetitions of standing PEFF in forearm supination, pronation, and neutral. A one-way repeated measures ANOVA determined the forearm position with the greatest PEFF. A one-way ANOVA assessed differences in PEFF between professions. The alpha level was set at p≤0.05 for all analyses. RESULTS: Thirty 30 RN, 25 OT, and 30 PT students (x = 23.27 + /-3.29 yrs.) were studied. A one-way repeated measures ANOVA revealed a significant difference in PEFF between positions (F(2,168) = 144.3, p < 0.0001). A significant (p < 0.0001) pairwise comparison revealed neutral produced the greatest (28.15 + /-12.64 kg) and pronation the least PEFF (17.27 + /-7.40). PEFF was significantly different between position by profession (supination: F(2,82) = 10.14, p < 0.0001; pronation: F(2,82) = 10.33, p < 0.0001; neutral: F(2,82) = 13.39, p < 0.0001). PTs were significantly stronger than OTs and RN students in all forearm positions (p < 0.01). CONCLUSIONS: Neutral PEFF was greatest and PT students demonstrated greater PEFF than OT and RN students.


Assuntos
Articulação do Cotovelo , Cotovelo , Antebraço , Humanos , Modalidades de Fisioterapia , Pronação , Estudantes , Supinação
13.
Orthop Traumatol Surg Res ; 107(5): 102975, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34087499

RESUMO

INTRODUCTION: To avoid the DRUJ surgical procedures disadvantages, a new intraosseous distal radioulnar prosthesis designed on Sauvé-Kapandji procedure has been introduced. Stability of the prosthesis and biomechanics are to be evaluated in this article. MATERIALS AND METHODS: On a cadaveric study, during placement of the prosthesis, biometry of the bones, prosthesis stability (in axial and lateral tractions, wrist pronation and supination, and squeeze test), wrist range of motion before and after implantation, and radiographic evaluation were done on 16 cadavers. RESULTS: Range of motion of the wrist joint before and after the insertion of the prosthesis, had no significant difference in all six directions. Stability of the prosthesis, when rotational pronation force was exerted, was greater than when rotational supination force was exerted. The prosthesis showed significant stability against longitudinal traction forces in a way that no prosthesis dislocation was observed up to 150N forces. Stability of the prosthesis was investigated when lateral force was applied to different wrist positions. The most stable position of the prosthesis was in the case of lateral traction forces in supination where no case of dislocation was observed. CONCLUSIONS: The intraosseous distal radioulnar prosthesis demonstrated stable structure with no effect on wrist range of motion. LEVEL OF EVIDENCE: IV.


Assuntos
Membros Artificiais , Prótese Articular , Humanos , Amplitude de Movimento Articular , Supinação , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
14.
Foot Ankle Clin ; 26(2): 361-371, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33990258

RESUMO

The most common injury mechanism for ankle fractures with concomitant deltoid ligament injury is a supination external rotation type 4 trauma. In the acute setting, malalignment, ecchymosis, and profound edema of the affected ankle can be found. Clinical examination is a poor indicator for deltoid ligament injury. There is a lack of high-quality studies with suturing the deltoid as the primary question. The authors found 4 comparative studies that found it unnecessary to explore and to reconstruct the deltoid ligament and 4 comparative studies that find it unnecessary to explore and to reconstruct the deltoid ligament.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/cirurgia , Humanos , Ligamentos Articulares/cirurgia , Ruptura/cirurgia , Supinação
15.
Foot Ankle Int ; 42(10): 1245-1253, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34018419

RESUMO

BACKGROUND: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. METHODS: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. RESULTS: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. CONCLUSION: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Fraturas do Tornozelo , Osteoartrite , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Supinação , Resultado do Tratamento
16.
J Hand Surg Am ; 46(8): 710.e1-710.e4, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33757665

RESUMO

PURPOSE: To describe and study a test for distal biceps tendon pathology other than complete tears. METHODS: In this prospective study, the biceps provocation test (BPT) was performed in a cohort of 30 patients with suspected distal biceps tendon pathology and 30 patients with another elbow pathology. Patients with a complete tear were excluded. Diagnosis was confirmed on magnetic resonance imaging or from surgical findings. The BPT is a 2-part test. The elbow is flexed to 70° with the forearm supinated. The examiner's hands are placed on the patient's forearm and the patient is asked to flex the elbow against resistance (BPTs). The forearm is then pronated and the test is repeated (BPTp). Pain is documented for both supination and pronation using a visual analog scale from 0 to 10. The test is positive when the patient indicates an increase in pain with BPTp compared with BPTs. RESULTS: The BPT was positive in all patients with distal biceps tendon pathology. The average visual analog scale score in this group was 1 (range, 0-7) for the supinated part of the test (BPTs) and 7 (range, 4-10) with the forearm in pronation (BPTp), with an average increase of 5 points (range, 2-8). This difference was significant. No significant difference was found in the control group. Among the controls, BPTp and BPTs were rated as equally painful by 27 patients, and BPTp was less painful than BPTs in 3. Sensitivity and specificity were both 100% in this small group of 60 patients, with a high prevalence of distal biceps tendon pathology. CONCLUSIONS: The BPT appears to be highly sensitive and specific for distal biceps partial injury or tendinitis. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.


Assuntos
Traumatismos dos Tendões , Humanos , Estudos Prospectivos , Ruptura , Supinação , Traumatismos dos Tendões/diagnóstico , Tendões
17.
Surg Radiol Anat ; 43(10): 1587-1594, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33751178

RESUMO

PURPOSE: The lacertus fibrosus (LF) is involved in various surgeries. However, the biomechanical contribution of the LF remains unclear. The aim of this study was to determine the role of the lacertus fibrosus on the elbow and forearm kinematics and on the biceps brachii muscle lever arms. METHODS: This biomechanical study was performed on seven fresh-frozen upper limbs of cadavers. Elbow flexion, forearm supination, and biceps brachii muscle lever arms were analyzed in the intact conditions (I) and after superficial (R) and deep part (R2) of the lacertus fibrosus release, respectively. RESULTS: Elbow flexion shows a significant difference (p < 0.0001) between I, R, R2. Abduction/adduction shows a significant difference between I-R (p < 0.0001) and I-R2 (p < 0.0001). Supination does not show a significant difference in mean maximum amplitude, but between 40 and 70%, there are significant differences. There is a significant mean decrease of lever arm in flexion (28%) and supination (50%) after superficial and deep part of the lacertus fibrosus release. CONCLUSION: The results of this study show that the lacertus fibrosus increases the lever arm during flexion and supination. It limits the flexion and abduction of the elbow and supination of the forearm. Lacertus fibrosus maintains the rhythmicity between the elbow flexion and supination of the forearm. LEVEL OF EVIDENCE: Basic science study, biomechanics.


Assuntos
Articulação do Cotovelo/fisiologia , Músculo Esquelético/fisiologia , Amplitude de Movimento Articular/fisiologia , Supinação/fisiologia , Idoso , Fenômenos Biomecânicos/fisiologia , Cadáver , Feminino , Humanos , Masculino
18.
J Hand Surg Am ; 46(9): 816.e1-816.e7, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33722471

RESUMO

PURPOSE: A complete ulnar head replacement may be indicated in cases of distal radial ulnar joint (DRUJ) dysfunction to address bony pathology in lieu of using a constrained total DRUJ prosthesis. Complete ulnar head implants are simple, but they may be unstable if soft tissue tension is not adequately restored. We hypothesized that incorporating an increased offset in the complete ulnar head replacement would lead to increased tension on the distal oblique interosseous ligament, increased contact force at the DRUJ, and improved joint stability. METHODS: Using a specially designed jig, we measured instability by comparing displacement under load (stiffness) of the DRUJ in 10 cadaveric specimens under 4 different conditions: (1) intact, (2) native head after excision of the triangular fibrocartilage complex, (3) replacement of the ulnar head with a standard offset ulnar head, and (4) replacement of the ulnar head with an increased offset ulnar head. No soft tissue repair was done. We measured anteroposterior displacement under load with maximum translation of 10 mm or maximum loads of 50 N. We tested all specimens with the forearm positioned in neutral, supination, and pronation. RESULTS: Excising the triangular fibrocartilage complex decreased the average stiffness of the DRUJ to 46% of the intact state, creating a simulated state of DRUJ instability. Replacing the ulnar head with the standard offset head increased average stiffness to 54% of the intact state. Increasing the ulnar head offset with the simulated total ulnar head replacement increased average stiffness to 77% of the intact state. CONCLUSIONS: An increased offset ulnar head replacement improves DRUJ stability compared with a standard anatomic offset ulnar head replacement. CLINICAL RELEVANCE: Understanding DRUJ morphology and offset is important in the treatment of DRUJ arthritis and instability.


Assuntos
Instabilidade Articular , Articulação do Punho , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Pronação , Supinação , Ulna/cirurgia , Articulação do Punho/cirurgia
20.
BMC Musculoskelet Disord ; 22(1): 136, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536011

RESUMO

BACKGROUND: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch. METHODS: We retrospectively reviewed patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients. RESULTS: We enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36-179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average reverse oblique of 14.9o (range, 11o-23o; SD, 3.4o) preoperatively to a more parallel 5.1o (range, 0o-11o; SD, 3.2o) at the final follow-up. The functional results at the final follow-up were good, with a mean visual analogue scale for pain of 0.2 (range, 0-1; SD, 0.4) at rest and 1.3 (range, 0-3; SD, 0.9) during activity, QuickDASH of 15.1 (range, 2.3-34.1; SD, 8.8), and modified Mayo Wrist Score of 91.6 (range, 70-100; SD, 6.4). Seven wrists (31.8%) had changes compatible with OA, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength. CONCLUSIONS: For patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.


Assuntos
Ulna , Articulação do Punho , Humanos , Pessoa de Meia-Idade , Osteotomia , Amplitude de Movimento Articular , Estudos Retrospectivos , Supinação , Ulna/diagnóstico por imagem , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
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