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Journal articles on the topic 'Physical orthopedic tests'
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White, Nancy T. "Orthopedic Physical Examination Tests: An Evidence-based Approach." Journal of Physical Therapy Education 22, no. 1 (2008): 87–88. http://dx.doi.org/10.1097/00001416-200801000-00019.
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TAKAHASHI, Kuniyasu. "Orthopedic Manual Tests and Signs in Sports Physical Therapy." Rigakuryoho Kagaku 23, no. 3 (2008): 357–62. http://dx.doi.org/10.1589/rika.23.357.
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Bellew, James W. "Special Tests for Orthopedic Examination, ed 3." Physical Therapy 86, no. 9 (September 1, 2006): 1311. http://dx.doi.org/10.2522/ptj.2006.86.9.1311.1.
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Li, Hong Zhou, Jie Lu, Nan Nan Liu, and Xv Zhang. "Development on Rehabilitation Instrument of Genu Varus or Valgum Based on Biomechanics." Advanced Materials Research 614-615 (December 2012): 1606–9. http://dx.doi.org/10.4028/www.scientific.net/amr.614-615.1606.
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This paper analyses deeply therapeutic theory of the genu varus or valgum and puts forward a physical orthopedic model that the patients are in different external force environment based on biomechanics and cartilage-derived growth theory. The mechanism structure and working principle of stretching unit, orthopedic unit and vibration unit are introduced and respective mechanical equations of above unit are established. The paper develops a prototype with which a lot of experiments and tests were made, the experiment results show that the structure of the prototype is reasonable and it can work effectively and reliably.
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Greenberger, Hilary B., and Marilyn Dispensa. "Usage and Perceived Value of Video Podcasts by Professional Physical Therapist Students in Learning Orthopedic Special Tests." Journal of Physical Therapy Education 29, no. 3 (2015): 46–57. http://dx.doi.org/10.1097/00001416-201529030-00007.
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Haskell, Andrew, and Todd Kim. "Implementation of Patient-Reported Outcomes Measurement Information System Data Collection in a Private Orthopedic Surgery Practice." Foot & Ankle International 39, no. 5 (January 24, 2018): 517–21. http://dx.doi.org/10.1177/1071100717753967.
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Background: The authors describe a method of collecting patient-reported outcomes (PROs) using computerized adaptive tests (CATs) in a high-volume orthopedic surgery practice with limited resources and no research coordinator. Methods: Patient-Reported Outcomes Measurement Information System CATs were collected prospectively for all clinic patients using a tablet and recorded in the electronic medical record. Scores were compared with validated national norms using single-variable t tests. Linear regression was used to assess age effects. Preoperative and postoperative pain scales were compared using paired t tests. Results: In total, 4,524 CATs were administered during 10,719 visits (42%), reaching 70% as more tablets were introduced. Completing the CATs required 157 seconds. Older patients took more time than younger ones ( P < .05). Compared with normalized t scores of 50 ± 10 for the US population, pain intensity was 48.0 (95% confidence interval [CI], 47.8-48.2), pain interference 58.9 (95% CI, 58.6-59.1), physical function 40.1 (95% CI, 39.9-40.3), global physical health 43.4 (95% CI, 41.9-44.9), and global mental health 41.1 (95% CI, 40.89-41.4) ( P < .05 for all). Age had a small effect on all domains ( P < .05). Approximately 20 patients would be required to demonstrate a 15% change for a 2-tailed, paired study with α = 0.05 and 80% power. After surgery, pain intensity improved from 51.9 ± 8.2 to 44.1 ± 8.5, pain interference improved from 62.5 ± 6.9 to 55.7 ± 8.4, and physical function improved from 37.3 ± 8.9 to 41.5 ± 7.9 ( P < .05 for all). Conclusions: Using tablets to administer CATs and entering the data in the electronic medical record for later retrieval was an effective technique to collect PROs. An adequate number of tablets are needed for acceptable completion rates. Modest sample size requirements for comparative studies highlight the potential of these tools and techniques. Level of Evidence: Level II, Prospective Comparative Study
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Vilela, Maria J. C., Bruno J. A. Colaço, José Ventura, Fernando J. M. Monteiro, and Christiane L. Salgado. "Translational Research for Orthopedic Bone Graft Development." Materials 14, no. 15 (July 24, 2021): 4130. http://dx.doi.org/10.3390/ma14154130.
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Designing biomaterials for bone-substitute applications is still a challenge regarding the natural complex structure of hard tissues. Aiming at bone regeneration applications, scaffolds based on natural collagen and synthetic nanohydroxyapatite were developed, and they showed adequate mechanical and biological properties. The objective of this work was to perform and evaluate a scaled-up production process of this porous biocomposite scaffold, which promotes bone regeneration and works as a barrier for both fibrosis and the proliferation of scar tissue. The material was produced using a prototype bioreactor at an industrial scale, instead of laboratory production at the bench, in order to produce an appropriate medical device for the orthopedic market. Prototypes were produced in porous membranes that were e-beam irradiated (the sterilization process) and then analysed by scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), dynamic mechanical analysis (DMA), cytotoxicity tests with mice fibroblasts (L929), human osteoblast-like cells (MG63) and human MSC osteogenic differentiation (HBMSC) with alkaline phosphatase (ALP) activity and qPCR for osteogenic gene expression. The prototypes were also implanted into critical-size bone defects (rabbits’ tibia) for 5 and 15 weeks, and after that were analysed by microCT and histology. The tests performed for the physical characterization of the materials showed the ability of the scaffolds to absorb and retain water-based solvents, as well as adequate mechanical resistance and viscoelastic properties. The cryogels had a heteroporous morphology with microporosity and macroporosity, which are essential conditions for the interaction between the cells and materials, and which consequently promote bone regeneration. Regarding the biological studies, all of the studied cryogels were non-cytotoxic by direct or indirect contact with cells. In fact, the scaffolds promoted the proliferation of the human MSCs, as well as the expression of the osteoblastic phenotype (osteogenic differentiation). The in vivo results showed bone tissue ingrowth and the materials’ degradation, filling the critical bone defect after 15 weeks. Before and after irradiation, the studied scaffolds showed similar properties when compared to the results published in the literature. In conclusion, the material production process upscaling was optimized and the obtained prototypes showed reproducible properties relative to the bench development, and should be able to be commercialized. Therefore, it was a successful effort to harness knowledge from the basic sciences to produce a new biomedical device and enhance human health and wellbeing.
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Elias, David A., Vance V. MacLaren, Erin K. Brien, and Arron W. S. Metcalfe. "Exaggerated Functional Impairment due to Malingered Neurocognitive Dysfunction Following Mild Traumatic Brain Injury." Archives of Clinical Neuropsychology 34, no. 5 (November 14, 2018): 648–56. http://dx.doi.org/10.1093/arclin/acy086.
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Abstract Objective Functional impairment associated with Neurocognitive Disorder is often claimed in medico-legal settings after mild Traumatic Brain Injury (mTBI). This case–control study examined self-reported functional impairment and the plausibility of chronic disability claims following uncomplicated mTBI. Method Independent Medical Evaluations included a battery of performance and symptom validity tests, along with self-reports of physical or emotional complaints and functional impairment. Slick and colleagues’ (Slick, D. J., Sherman, E. M., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13, 545–561.) criteria ruled out probable malingering in 21 mTBI cases without psychiatric comorbidity and their self-reports were compared to those of seven non-malingering cases with a psychiatric comorbidity, 17 who were probable malingerers, and 31 orthopedic pain sufferers. Coherence Analysis of medical documentation corroborated assignment of mTBI cases to non-malingering versus probable malingering groups. Results Probable malingerers reported more postconcussion symptoms than non-malingerers (d = 0.79) but they did not differ significantly on tests of neurocognitive performance. Probable malingerers and orthopedic pain patients gave significantly higher ratings of functional impairment (d = 1.28 and 1.26) than non-malingerers. Orthopedic pain patients reported more disability due to pain than non-malingerers (d = 1.03), but pain catastrophizing was rated more highly by the probable malingerers (d = 1.21) as well as by the orthopedic pain patients (d = 0.98). The non-malingerers reported lower emotional distress than the other three groups, but only the probable malingerers reported elevated depression symptoms compared to the non-malingerers (d = 1.01). Conclusions The combined evaluation of performance validity, function, and coherence analysis would appear to enhance the difficult clinical evaluation of postconcussion symptoms in the medical-legal setting.
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Scherbina, K. K., V. G. Suslyaev, Yu B. Golubeva, A. V. Sokurov, T. V. Ermolenko, and V. M. Yankovskiy. "The analysis of prosthetic and orthopedic factories production in the branch of lower extremities prothesis with possibilities of import substitution." Bulletin of the Russian Military Medical Academy 20, no. 4 (December 15, 2018): 131–37. http://dx.doi.org/10.17816/brmma12317.
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The needs and possibilities of import substitution in the prosthetic and orthopedic industry for prosthetics and orthotics of lower limbs from local and imported component materials were determined. We analyzed the stock list of special equipment, materials, and modules used in the manufacture of prostheses and orthoses of the lower limbs, indicating local and foreign suppliers. The technical characteristics of equipment, materials, and modules of lower limb prostheses that are not manufactured in the Russian Federation were determined. We indicated the stock list, components, equipment, and materials, which production is more reasonable to be organized in Russia instead of using imported products of similar purpose. We carried out operational tests and clinical trials of prosthetic and orthopedic products that were made from new thermoplastic materials. These materials are developed by local manufacturers for the production of a bucket of the prosthesis for lower and upper limbs, orthoses and orthopedic devices, actively correcting braces, stop holders, etc. We indicated the ways of implementing the state policy to eliminate reliance of local prosthetic and orthopedic industry on import. Proposals for the optimization of reference documentation were developed. The role and position of research organizations that solve the problems of import substitution and that focus on the creation of new and improvement of existing technologies of physical medical rehabilitation of patients with muscle-skeleton disorders were defined. We determined the importance of institutions of advanced training for doctors and other specialists who work in prosthetic and orthopedic enterprises and rehabilitation centers.
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Malanga, Gerard A., Steven Andrus, Scott F. Nadler, and James McLean. "Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests." Archives of Physical Medicine and Rehabilitation 84, no. 4 (April 2003): 592–603. http://dx.doi.org/10.1053/apmr.2003.50026.
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Brown-Taylor, Lindsey, Andrew Lynch, Randi Foraker, Marcie Harris-Hayes, Bryant Walrod, W. Kelton Vasileff, Kathryn Glaws, and Stephanie Di Stasi. "Physical Therapists and Physicians Evaluate Nonarthritic Hip Disease Differently: Results From a National Survey." Physical Therapy 100, no. 6 (March 4, 2020): 917–32. http://dx.doi.org/10.1093/ptj/pzaa028.
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Abstract Background Physical therapy and surgery are viable treatment options for nonarthritic hip disease (NAHD). Interdisciplinary collaboration can help patients make informed treatment decisions. Understanding how each provider can contribute is a critical first step in developing collaborative evaluation efforts. Objective The objective of this study was to describe the current evaluation of NAHD by both physical therapists and physicians, and evaluate national use of expert-recommended evaluation guidelines. Design A national survey study distributed in the United States was implemented to accomplish the objective. Methods A survey was distributed to 25,027 potential physical therapist and physician respondents. Respondents detailed their evaluation content for patients with NAHD across the following domains: patient-reported outcomes, patient history, special tests, movement assessment, clinical tests, and imaging. Respondents ranked importance of each domain using a 5-point Likert scale (not important, slightly important, important, very important, or extremely important). Odds ratios (ORs [95% CIs]) were calculated to identify the odds that physical therapists, compared with physicians, would report each evaluation domain as at least very important. Fisher exact tests were performed to identify statistically significant ORs. Results Nine hundred and fourteen participants (3.6%) completed the survey. Physical therapists were more likely to indicate movement assessment (OR: 4.23 [2.99–6.02]) and patient-reported outcomes (OR: 2.56 [1.67–3.99]) as at least very important for determining a diagnosis and plan of care. Physical therapists had lower odds of rating imaging (OR: 0.09 [0.06–0.14]) and special tests (OR: 0.72 [0.53–0.98]) as at least very important compared with physicians. Limitations This survey study did not include many orthopedic surgeons and thus, primarily represents evaluation practices of physical therapists and nonsurgical physicians. Conclusions Physical therapists were more likely to consider movement assessment very important for the evaluation of patients with NAHD, whereas physicians were more likely to consider imaging and special testing very important.
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Zanca, Claudio, Bernardo Patella, Elisa Capuana, Francesco Lopresti, Valerio Brucato, Francesco Carfì Pavia, Vincenzo La Carrubba, and Rosalinda Inguanta. "Behavior of Calcium Phosphate–Chitosan–Collagen Composite Coating on AISI 304 for Orthopedic Applications." Polymers 14, no. 23 (November 24, 2022): 5108. http://dx.doi.org/10.3390/polym14235108.
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Calcium phosphate/chitosan/collagen composite coating on AISI 304 stainless steel was investigated. Coatings were realized by galvanic coupling that occurs without an external power supply because it begins with the coupling between two metals with different standard electrochemical potentials. The process consists of the co-deposition of the three components with the calcium phosphate crystals incorporated into the polymeric composite of chitosan and collagen. Physical-chemical characterizations of the samples were executed to evaluate morphology and chemical composition. Morphological analyses have shown that the surface of the stainless steel is covered by the deposit, which has a very rough surface. XRD, Raman, and FTIR characterizations highlighted the presence of both calcium phosphate compounds and polymers. The coatings undergo a profound variation after aging in simulated body fluid, both in terms of composition and structure. The tests, carried out in simulated body fluid to scrutinize the corrosion resistance, have shown the protective behavior of the coating. In particular, the corrosion potential moved toward higher values with respect to uncoated steel, while the corrosion current density decreased. This good behavior was further confirmed by the very low quantification of the metal ions (practically absent) released in simulated body fluid during aging. Cytotoxicity tests using a pre-osteoblasts MC3T3-E1 cell line were also performed that attest the biocompatibility of the coating.
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Elsen, S. Renold, T. Ramesh, and B. Aravinth. "Optimization of Process Parameters of Zirconia Reinforced Alumina by Powder Forming Process Using Response Surface Method." Advanced Materials Research 984-985 (July 2014): 129–39. http://dx.doi.org/10.4028/www.scientific.net/amr.984-985.129.
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Powder forming process is used for fabrication of bulk ceramic components. Optimization of powder forming process parameters in the fabrication of alumina-zirconia composite used in orthopedic implants is done for desired physical property. In this research work, process parameters such as composition of zirconia, compaction pressure and sintering temperature were analyzed using Response Surface Method (RSM). The physical properties such as density, porosity and water absorption characteristics of the proposed composite were studied. To study the influence of the different process parameters over the physical properties of the fabricated composites materials, experimental runs were framed by using Box behnken method. Three factors and two levels were selected with a total of 17 runs and their consecutive tests were carried out. The validity of the model was checked and the significant parameters were identified using Analysis of variance (ANOVA). The results indicate that the sintering temperature is influencing predominantly the physical properties of composites compared to other process parameters.
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Bulut, B., N. Demirkol, Ziya Engin Erkmen, and E. S. Kayali. "Characterization and Bioactivity of Hydroxyapatite-ZrO2 Composites with Commercial Inert Glass (CIG) Addition." Key Engineering Materials 631 (November 2014): 166–72. http://dx.doi.org/10.4028/www.scientific.net/kem.631.166.
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Hydroxyapatite is a kind of calcium phosphate that has generated great interest as an advanced orthopedic and dental implant candidate. Although HA has excellent biocompatibility, it’s poor mechanical properties limit its use as an implant material. Therefore HA is preferred as a main component in composite materials. The aim of this study is to determine the characterization and bioactivity of HA-ZrO2composites with the addition of 5 and 10 wt% commercial inert glass (CIG). The highest density and Vickers microhardness were obtained in HA-ZrO2-5 wt% CIG composite sintered at 1300 °C. The highest compression strength was measured in HA-ZrO2-5 wt% CIG composite sintered at 1200 °C. Thein vitrobioactivity tests were performed on the composites having the highest physical and mechanical properties. The apatite formation was observed on all samples subjected to bioactivity tests. As a result, the optimum mechanical properties and bioactivity were obtained on HA-ZrO2- 5 wt% CIG composite sintered at 1200 °C.
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Zaniolo, Karina M., Sonia R. Biaggio, Joni A. Cirelli, Mariana A. Cominotte, Nerilso Bocchi, and Romeu C. Rocha-Filho. "Physical characterization and biological tests of bioactive titanium surfaces prepared by short-time micro-arc oxidation in green electrolyte." Materials Research Express 9, no. 2 (February 1, 2022): 025401. http://dx.doi.org/10.1088/2053-1591/ac4d53.
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Abstract Titanium (Ti) and its alloys are the most used biomaterials in dental and orthopedic implant applications. However, despite the good performance of these materials, implants may fail; therefore, several surface modification methodologies have been developed to increase the bioactivity of the metal surface, accelerating the osseointegration process while promoting improved corrosion performance. In this work, the production of a TiO2 coating on titanium through a short-time micro-arc oxidation (MAO) in a green electrolyte (obtained by a mixed solution of K3PO4 and Ca(CH3COO)2.H2O) is proposed, aiming at obtaining a porous oxide layer with Ca and P incorporation through an environmentally friendly experimental condition. The morphology, chemical composition, crystalline structure, wettability, hardness and bioactivity of the modified Ti surfaces were characterized. The MAO process at 250 V for 1 min in the green electrolyte solution allowed the production of a highly porous oxide surface in the anatase crystalline phase, with effective Ca and P incorporation. Pre-osteoblastic cells were used in in-vitro assays to analyze viability, adhesion, proliferation and ability to perform extracellular matrix mineralization on the Ti surfaces (polished and MAO-treated Ti). The MAO-treated Ti surface exhibited better results in the bioactivity tests, presenting more calcium phosphate precipitates. This surface also presented higher hardness, lower hydrophilicity and better performance in biological tests than the polished surface. The here-reported MAO-treated Ti surface is promising for dental implants, especially in patients having poor bone quality that requires greater stimulation for osteogenesis.
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Larkins, Lindsay W., Russell T. Baker, and Jayme G. Baker. "Physical Examination of the Ankle: A Review of the Original Orthopedic Special Test Description and Scientific Validity of Common Tests for Ankle Examination." Archives of Rehabilitation Research and Clinical Translation 2, no. 3 (September 2020): 100072. http://dx.doi.org/10.1016/j.arrct.2020.100072.
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C, Cooper, Trahan E, Muncy C, Higa J, Link J, Reid M, Seegmiller R, Kennedy J, and Lu L. "A-228 Are Those Who Fail Performance Validity Measures High Utilizers of Healthcare?" Archives of Clinical Neuropsychology 35, no. 6 (August 28, 2020): 1023. http://dx.doi.org/10.1093/arclin/acaa068.228.
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Abstract Objective One study reported that suboptimal effort on performance validity tests (PVTs) is associated with higher healthcare utilization within a VA setting, defined as the number of Emergency Department visits and inpatient hospitalizations. The current study sought to expand on this by examining whether PVT failure is associated with higher number of outpatient visits in a military sample with a history of mild traumatic brain injury (mTBI). Method The medical records of 43 participants, 13 of whom failed the PVT Green’s Word Memory Test (WMT), were reviewed for the number of encounters since the mTBI and the reason for the encounter. The two groups (passed vs. failed) did not differ significantly on demographic variables (39 males, mean age 39, 65% Caucasian). Results The overall number of medical encounters was not significant between the two groups after controlling for years since the mTBI (F(1, 40) = 2.67, p = .11); however, once three participants with (>2 years) missing records were excluded (final n = 40), the PVT failure group was seen significantly more often, (F(1, 37) = 8.23, p = .01). The PVT failures had a higher number of encounters with physical therapy (t(38) = −2.79, p = .01) and orthopedics (t(38) = −2.10, p = .04). Conclusions Preliminary results suggest that suboptimal effort is not associated with higher healthcare utilization; however, when participants with more than two years of missing records were excluded, those who failed PVTs were seen more frequently by physical therapy and orthopedic specialties. Limitations for future investigations are highlighted.
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Lalosevic, V., Z. Poleksic, Z. Blagojevic, S. Tomic, and S. Milickovic. "Low back pain: Differential diagnosis, prognosis and treatment." Acta chirurgica Iugoslavica 53, no. 4 (2006): 49–52. http://dx.doi.org/10.2298/aci0604049l.
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From January 2002 to February 2003, 137 patients complaining of low back pain were treated at the Institute for Orthopedic Surgery "Banjica", Belgrade, Serbia. There were 89 male and 48 female patients aged 13 to 77, mean age 42.2. Their condition was diagnosed through use of radiography, CT, MRI, EMNG, standard battery of neurological tests, and laboratory analyses (urine and blood analysis). Surgical treatment was performed on 39 patients; all other patients received some form of non-surgical care (physical therapy, medication or corset). Treatment efficacy was evaluated by use of the visual analog scales (VAS) and the Oswestry index, before and after treatment. The use Wilcoxon?s pair test revealed statistically significant difference between before and after treatment data on VAS and Oswestry index for all patients.
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Zanca, C., S. Carbone, B. Patella, F. Lopresti, G. Aiello, V. Brucato, F. Carfì Pavia, V. La Carrubba, and R. Inguanta. "Composite Coatings of Chitosan and Silver Nanoparticles Obtained by Galvanic Deposition for Orthopedic Implants." Polymers 14, no. 18 (September 19, 2022): 3915. http://dx.doi.org/10.3390/polym14183915.
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In this work, composite coatings of chitosan and silver nanoparticles were presented as an antibacterial coating for orthopedic implants. Coatings were deposited on AISI 304L using the galvanic deposition method. In galvanic deposition, the difference of the electrochemical redox potential between two metals (the substrate and a sacrificial anode) has the pivotal role in the process. In the coupling of these two metals a spontaneous redox reaction occurs and thus no external power supply is necessary. Using this process, a uniform deposition on the exposed area and a good adherence of the composite coating on the metallic substrate were achieved. Physical-chemical characterizations were carried out to evaluate morphology, chemical composition, and the presence of silver nanoparticles. These characterizations have shown the deposition of coatings with homogenous and porous surface structures with silver nanoparticles incorporated and distributed into the polymeric matrix. Corrosion tests were also carried out in a simulated body fluid at 37 °C in order to simulate the same physiological conditions. Corrosion potential and corrosion current density were obtained from the polarization curves by Tafel extrapolation. The results show an improvement in protection against corrosion phenomena compared to bare AISI 304L. Furthermore, the ability of the coating to release the Ag+ was evaluated in the simulated body fluid at 37 °C and it was found that the release mechanism switches from anomalous to diffusion controlled after 3 h.
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Santana, Adolfredo, Geovanny Oleas-Santillán, Jeanne M. Franzone, L. Reid Nichols, J. Richard Bowen, and Richard W. Kruse. "Orthopedic Manifestations of Bruck Syndrome: A Case Series with Intermediate to Long-term Follow-Up." Case Reports in Orthopedics 2019 (March 13, 2019): 1–7. http://dx.doi.org/10.1155/2019/8014038.
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The aim of this study was to evaluate the association of contractures, fractures, and deformities in four patients with Bruck syndrome treated in our facility. Data were collected from medical records, radiographs, dual-energy X-ray absorptiometry (DEXA) scans, genetic tests, and gait analysis. All had contractures at birth and genotypic findings including mutations in PLOD2 or FPKB10. Three cases were treated with bisphosphonates with improvement in bone density verified by DEXA. In Bruck syndrome, orthopedic deformities include the following sequential aspects: contractures, characterized by upper and lower extremity contractures such as clubfeet; fractures, characterized by multiple diaphyseal fractures in the long bones of the extremities; and deformities, characterized by malalignment of extremities and the spine. Physical therapy and bracing proved helpful for the contractures to try to stop progression. Bone fragility needs to be considered when deciding to attempt cast correction. Surgeries in the soft tissues can be performed to retain joint movement. In fractures with angulation, intramedullary nail fixation was useful, and in cases without deformity, casting alone was successful. We suggest monitoring the bone density with DEXA, nutrition support with vitamin D and calcium, and treatment with bisphosphonates. Spine deformities were successfully treated by spinal fusion and instrumentation.
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De Kegel, Alexandra, Inge Dhooge, Wim Peersman, Johan Rijckaert, Tina Baetens, Dirk Cambier, and Hilde Van Waelvelde. "Construct Validity of the Assessment of Balance in Children Who Are Developing Typically and in Children With Hearing Impairments." Physical Therapy 90, no. 12 (December 1, 2010): 1783–94. http://dx.doi.org/10.2522/ptj.20100080.
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Background Children with hearing impairments have a higher risk for deficits in balance and gross motor skills compared with children who are developing typically. As balance is a fundamental ability for the motor development of children, a valid and reliable assessment to identify weaknesses in balance is crucial. Objective The purpose of this study was to investigate the construct validity of posturography and clinical balance tests in children with hearing impairments and in children who are developing typically. Methods The study involved 53 children with typical development and 23 children with hearing impairments who were between 6 and 12 years of age and without neuromotor or orthopedic disorders. All participants completed 3 posturography tests (modified Clinical Test of Sensory Interaction of Balance [mCTSIB], unilateral stance, and tandem stance) and 4 clinical balance tests (one-leg stance with eyes open and with eyes closed, balance beam walking, and one-leg hopping). Results Three conditions of the mCTSIB, unilateral stance, and 2 clinical balance tests were able to distinguish significantly between the 2 groups. Children with hearing impairments showed more difficulties in balance tasks compared with children who were developing typically when 1 or 2 types of sensory information were eliminated or disturbed. The study showed only low to moderate correlations among the different methods of evaluating balance. Conclusions Clinical balance tests and posturography offer different but complementary information. An assessment protocol for balance consisting of posturography and clinical balance tasks is proposed. Static and dynamic balance abilities could not be differentiated and seem not to be a valid dichotomy.
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Santecchia, Eleonora, Marcello Cabibbo, Abdel Hamouda, Farayi Musharavati, Anton Popelka, and Stefano Spigarelli. "Investigation of the Temperature-Related Wear Performance of Hard Nanostructured Coatings Deposited on a S600 High Speed Steel." Metals 9, no. 3 (March 15, 2019): 332. http://dx.doi.org/10.3390/met9030332.
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Thin hard coatings are widely known as key elements in many industrial fields, from equipment for metal machining to dental implants and orthopedic prosthesis. When it comes to machining and cutting tools, thin hard coatings are crucial for decreasing the coefficient of friction (COF) and for protecting tools against oxidation. The aim of this work was to evaluate the tribological performance of two commercially available thin hard coatings deposited by physical vapor deposition (PVD) on a high speed tool steel (S600) under extreme working conditions. For this purpose, pin-on-disc wear tests were carried out either at room temperature (293 K) or at high temperature (873 K) against alumina (Al2O3) balls. Two thin hard nitrogen-rich coatings were considered: a multilayer AlTiCrN and a superlattice (nanolayered) CrN/NbN. The surface and microstructure characterization were performed by optical profilometry, field-emission gun scanning electron microscopy (FEGSEM), and energy dispersive spectroscopy (EDS).
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Goldstein, Marion Zucker, Barry Steven Fogel, and Bruce Leonard Young. "Effect of Elective Surgery Under General Anesthesia on Mental Status Variables in Elderly Women and Men: 10-Month Follow-Up." International Psychogeriatrics 8, no. 1 (March 1996): 135–49. http://dx.doi.org/10.1017/s1041610296002530.
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Mental status changes were assessed and compared in 172 general surgical and orthopedic patients and 190 nonsurgical patients, all aged 55 and over, during a 10-month period. Assessments included a structured psychosocial questionnaire and standardized tests of cognition, affect, and function. The relationship of surgery, type of surgery, age, gender, and postoperative delirium to long-term postoperative decline was evaluated. Analyses of variance directly tested main effects pertaining to each of the five hypotheses and interactions of surgery with background variables. Hierarchical multiple regression analyses assessed the unique contributions of demographic and surgical variables to cognitive, affective, and functional change. None of the independent variables tested made a significant contribution to changes from baseline to long-term follow-up. The findings may be due to the physical and psychological health of this sample, and replication of this work in more impaired populations may be productive.
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Marchand, Robert, Nipun Sodhi, Anton Khlopas, Assem Sultan, Steven Harwin, Arthur Malkani, and Michael Mont. "Patient Satisfaction Outcomes after Robotic Arm-Assisted Total Knee Arthroplasty: A Short-Term Evaluation." Journal of Knee Surgery 30, no. 09 (October 13, 2017): 849–53. http://dx.doi.org/10.1055/s-0037-1607450.
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AbstractRobotic arm-assisted total knee arthroplasty (RATKA) presents a potential, new added value for orthopedic surgeons. In today's health care system, a major determinant of value can be assessed by patient satisfaction scores. Therefore, the purpose of the study was to analyze patient satisfaction outcomes between RATKA and manual total knee arthroplasty (TKA). Specifically, we used the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to compare (1) pain scores, (2) physical function scores, and (3) total patient satisfaction outcomes in manual and RATKA patients at 6 months postoperatively. In this study, 28 cemented RATKAs performed by a single orthopedic surgeon at a high-volume institution were analyzed. The first 7 days were considered as an adjustment period along the learning curve. Twenty consecutive cemented RATKAs were matched and compared with 20 consecutive cemented manual TKAs performed immediately. Patients were administered a WOMAC satisfaction survey at 6 months postoperatively. Satisfaction scores between the two cohorts were compared and the data were analyzed using Student's t-tests. A p-value < 0.05 was used to determine statistical significance. The mean pain score, standard deviation (SD), and range for the manual and robotic cohorts were 5 ± 3 (range: 0–10) and 3 ± 3 (range: 0–8, p < 0.05), respectively. The mean physical function score, SD, and range for the manual and robotic cohorts were 9 ± 5 (range: 0–17) and 4 ± 5 (range, 0–14, p = 0.055), respectively. The mean total patient satisfaction score, SD, and range for the manual and robotic cohorts were 14 points (range: 0–27 points, SD: ± 8) and 7 ± 8 points (range: 0–22 points, p < 0.05), respectively. The results from this study further highlight the potential of this new surgical tool to improve short-term pain, physical function, and total satisfaction scores. Therefore, it appears that patients who undergo RATKA can expect better short-term outcomes when compared with patients who undergo manual TKA.
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Novack, Joseph C., Wesley J. Manz, Juliet Fink, Joseph E. Jacobson, Rishin J. Kadakia, Michelle M. Coleman, and Jason T. Bariteau. "Does the Reduction Matter? Non-Emergent Ankle Fractures and the Effect of Near-Anatomic Reduction." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0085. http://dx.doi.org/10.1177/2473011421s00852.
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Category: Ankle; Other Introduction/Purpose: Ankle fractures are a common orthopedic injury observed in a wide variety of patient populations. Prior to being seen by an orthopedic specialist, patients with ankle fractures may have already undergone several procedures in the field or in the emergency department to stabilize or reduce the injured bone. While a paradigm that near-anatomic reduction improves outcomes in non-urgent ankle fractures exists, no study to date has shown objective evidence of this in postoperative patient- reported outcomes. The present study aims to evaluate whether adequate reduction of non-emergent ankle fractures within 24 hours of inciting injury influenced postoperative outcomes. Methods: All non-emergent ankle fractures treated by a single foot and ankle, fellowship-trained surgeon were queried over a period of 5 years and retrospectively evaluated through the electronic medical record. 97 patients over the age of 18 years with traumatic ankle fracture etiologies were considered. Plain film radiographs from initial presentation to the emergency department or first visit to orthopedics clinic were evaluated by the attending physician for adequate reduction based on AP and lateral tibiotalar congruency. Patient demographics and surgical outcomes data were collected from electronic medical record review. In the cases deemed to be dislocated or subluxated on initial injury films, the days until adequate reduction were calculated along with patient-reported VAS and SF-36 scores. Non-continuous data were compared using chi-squared tests, while continuous, non- normally distributed data were compared utilizing a Mann-Whitney U test. Alpha and beta for this study were assumed to be 0.05 and 0.8, respectively. Results: The average age was 46, with 68.9% of the patient population that was female. 51 patients were found to be adequately reduced within 24 hours, while 39 were not. The average time to final PRO follow-up was 12.6 months +- 1.9. No differences in preoperative VAS, SF-36 physical nor mental scores were noted between adequately and inadequately reduced cohorts (p= 0.654, p=0.262, p=0.760 respectively). Similarly, no differences in final postoperative follow up VAS, SF-36 physical nor mental scores were observed (p=0.503, p=0.252, p=0.296 respectively). VAS pain scores in both cohorts also improved to a similar degree over the preoperative to final postoperative follow up time point (p=0.261). Conclusion: These data show no difference in patient-reported pain or physical and mental functioning scores over 1 year after surgical fixation of the ankle, regardless of whether the ankle joint was adequately reduced within 24 hours of injury. We assert that anatomic reduction of the ankle joint following traumatic, non-emergent ankle fracture does not play a significant role in overall patient outcomes over 1 year following surgical correction.
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Chien, Ching-Fang, Ling-Chun Huang, Yang-Pei Chang, Chung-Fen Lin, Chih-Cheng Hsu, and Yuan-Han Yang. "What factors contribute to the need for physical restraint in institutionalized residents in Taiwan?" PLOS ONE 17, no. 11 (November 17, 2022): e0276058. http://dx.doi.org/10.1371/journal.pone.0276058.
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Background In Taiwan, physical restraint is commonly used in institutions to protect residents from falling or injury. However, physical restraint should be used cautiously to avoid side effects, such as worse cognition, mobility, depression, and even death. Objectives To identify the rate of physical restraint and the associated risk factors in institutionalized residents in Taiwan. Methods A community-based epidemiological survey was conducted from July 2019 to February 2020 across 266 residential institutions. Among the estimated 6,549 residents being surveyed, a total of 5,752 finished the study. The questionnaires were completed by residents, his/her family or social workers. The cognition tests were conducted by specialists and a multilevel analysis approach was used to identify cognition/disability/medical history/special nursing care/BPSD risk factors for physical restraints. Results Of the 5,752 included institutionalized residents, 30.2% (1,737) had been previously restrained. Older age, lower education level, lower cognitive function, higher dependence, residents with cerebrovascular disease, pulmonary disease, dementia, and intractable epilepsy, all contributed to a higher physical restraint rate, while orthopedic disease and spinal cord injury were associated with a lower physical restraint rate. Furthermore, residents with special nursing care had a higher restraint rate. Residents with most of the behavior and psychological symptoms were also associated with an increased restraint rate. Conclusions We studied the rate of physical restraint and associated risk factors in institutionalized residents in Taiwan. The benefits and risks of physical restraint should be evaluated before application, and adjusted according to different clinical situations.
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Vukomanovic, Aleksandra, Aleksandar Djurovic, Zoran Popovic, and Dejan Ilic. "The A-test: Reliability of functional recovery assessment during early rehabilitation of patients in an orthopedic ward." Vojnosanitetski pregled 71, no. 7 (2014): 639–45. http://dx.doi.org/10.2298/vsp130118042v.
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Background/Aim. There are few tests for evaluation of functional abilities of patients surgically treated for hip fractures or osteoarthritis during early rehabilition period. The aim of this study was to investigate reliability (interobserver reproducibility and internal consistency) of the A-test, an original test for functional recovery evaluation during early rehabilitation of patients in an orthopedic ward. Methods. The investigation included 105 patients (55 patients with hip osteoarthritis that underwent arthroplasty and 50 surgically treated patients with hip fracture). It was conducted in an orthopedic ward during early inpatient rehabilitation (from 1st to 5th day). For their functional recovery evaluation during early rehabilitation we used the A-test, a performance-based test with 10 items for assessing basic activities by six level ordinal scale (0-5). For internal consistency of the test the Cronbach coefficient alpha was calculated for the A-test results collected during early rehabilitation for all patients (105 patients x 5 days = 525 measures) and separately for the results of patients with hip osteoarthritis (275 measures) and hip fracture (250 measures). Values of this coefficient > 0.7 imply good internal consistency of the test. Interobserver reproducibility was estimated as follows: two physiotherapists together conducted physical therapy with the patients, and then, separately, rated the performance of each activity from the test (78 measures). The agreement between their estimations was expressed by the linear weighted kappa coefficient (for very good agreement values of kappa coefficient have to be in the range 0.81-1). Results. The Cronbach coefficient alpha was 0.98 (the results of all the patients and the results of the patients with hip osteoarthritis) and 0.97 (the results of the patients with hip fracture). The values of kappa coefficient were in the range 0.81-0.92 for all items. Conclusion. The A-test is a reliable instrument for everyday evaluation of functional recovery during early rehabilitation of patients surgically treated in an orthopedic ward.
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Afanador-Restrepo, Diego Fernando, Carlos Rodríguez-López, Yulieth Rivas-Campo, Mateo Baena-Marín, Yolanda Castellote-Caballero, Raúl Quesada-Ortiz, María Catalina Osuna-Pérez, María del Carmen Carcelén-Fraile, and Agustín Aibar-Almazán. "Effects of Myofascial Release Using Finding-Oriented Manual Therapy Combined with Foam Roller on Physical Performance in University Athletes. A Randomized Controlled Study." International Journal of Environmental Research and Public Health 20, no. 2 (January 12, 2023): 1364. http://dx.doi.org/10.3390/ijerph20021364.
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Sport is a science of constant reinvention that is always searching for strategies to improve performance. Objective: This study seeks to compare the effects of myofascial release with Findings-Oriented Orthopedic Manual Therapy (OMT) combined with Foam Roller (FR), versus FR by itself, on the physical performance of university athletes. A randomized controlled study was conducted with a total of twenty-nine university athletes, measuring Range of Motion (ROM), jump height and flight time, strength and dynamic flexibility using Goniometer pro, CMJ protocol in OptoGait, 1 Repetition Maximum (1RM) and Mean Propulsive Velocity (MPV) and the Sit and Reach (V) test, correspondingly. This study was registered at clinicaltrials.gov prior to the initial measurement of the participants under the code NCT05347303. Through a univariate analysis, together with an analysis of independent groups with ANOVA and an analysis of covariance, it was evidenced that OMT combined with FR generated more and better effects in all the evaluated ROM, jump height and flight time, RM and VMP tests. Finally, it was found that OMT combined with FR is better when it is desired to improve ROM, muscle power, strength and flexibility, while FR alone only improves dynamic flexibility.
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Holcomb, Kelly R., Cheryl A. Skaggs, Teddy W. Worrell, Mark DeCarlo, and K. Donald Shelbourne. "Assessment of Knee Laxity Following Anterior Cruciate Ligament Reconstruction." Journal of Sport Rehabilitation 2, no. 2 (May 1993): 97–103. http://dx.doi.org/10.1123/jsr.2.2.97.
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A paucity of information exists concerning reliability of the KT-1000 knee arthrometer (MEDmetric Corp., San Diego, CA) when used by different clinicians to assess the same anterior cruciate ligament-deficient patient. The purpose of this study was to determine the reliability and standard error of measurement of four clinicians who routinely report KT-1000 arthrometer values to referring orthopedic surgeons. Two physical therapists and two athletic trainers performed anterior laxity tests using the KT-1000 on 19 subjects. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to determine reliability. Intratester ICC ranged from .98 to 1.0 and intratesterSEMranged from 0.0 to .28 mm. Intertester ICC andSEMfor all four testers were .53 and 1.2 mm, respectively. A 95% confidence interval (M ± 1.96 ×SEM) of the intertester variability ranged from −0.18 to 4.52 mm. Therefore, large intertester variation existed in KT-1000 values. Each facility should standardize testing procedures and establish intratester and intertester reliability for all clinicians reporting KT-1000 values.
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Bulut, Berrak, Ziya Engin Erkmen, and Eyup Sabri Kayali. "Characteristics and Biocompatibility of the Hydroxyapatite Based Two Ternary Biocomposites." Key Engineering Materials 720 (November 2016): 130–40. http://dx.doi.org/10.4028/www.scientific.net/kem.720.130.
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Hydroxyapatite (HA) is a very popular bioceramic for orthopedic and dental applications. Although HA has excellent biocompatibility, its inferior mechanical properties make it unsuitable for load-bearing implant applications. Therefore, HA should be strengthened by a secondary phase for robust mechanical properties. The aim of this study was to compare the properties of HA-Al2O3 (HAC) and HA-ZrO2 (HZC) composites with the addition of 5 and 10 wt% commercial inert glass (CIG); independently. The mixture powders were pressed and then, the pellets were sintered between 1000-1300 °C for 4 hours. Microstructural characterizations were carried out using SEM + EDS and XRD, while hardness and compression tests were done to measure mechanical properties. In order to investigate the biocompatibility behavior of the samples in vitro and in vivo tests were performed. The mechanical properties of HAC composites increased with rising CIG content and increasing sintering temperature. For HZC composites, increasing CIG content caused an elevation in hardness and a decrease in compressive strength values at 1300 °C. The composites having the best physical and mechanical properties also showed improved bioactive properties at in vitro test. In this study, the ideal composite was selected as HZC5 sintered at 1200 °C depending on the microstructure, mechanical and biocompatibility properties.
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Piekarska, Andżelika, Monika Gałczyk, Wojciech Kułak, Arkadiusz Komorowski, Aneta Klejment, and Izabela Tuczapska. "The Process of Improving the Patient’s Motor After a S troke Due to Craniocerebral Trauma – Case Report." Acta Balneologica 62, no. 3 (September 2020): 186–90. http://dx.doi.org/10.36740/abal202003110.
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Introduction: Stroke is the most common disease of the central nervous system. Whereas craniocerebral trauma is defined as the function of the skull bones, broken soft tissue continuity and / or brain contents, including cranial nerves and cerebrospinal opponents. Aim: The aim of the study was to present the importance of kinesitherapy in the process of improving a 72-year-old patient with craniocerebral trauma after an ischemic stroke of the left hemisphere of the brain. Material and Methods: The method of individual case was used in the work. The study included a patient aged 72 with craniocerebral trauma after an ischemic stroke of the left hemisphere of the brain. The description of the individual case study was based on the subject and subject tests performed before and after rehabilitation. Results: The physical examination used the Lovett test to assess muscle strength, range of joint mobility using a goniometer, measurement of limb circumferences and the Ashworth scale to assess spasticity. The tests and functional scales were carried out twice in the patient, in whom her clinical condition was assessed. Conclusions: Based on the case report, it was found that the kinesitherapy used improved the patient’s physical condition. The pain and lymphoedema she was struggling with decreased. A significant increase in the range of mobility, strength and muscle mass of the limbs affected by hemiparesis was also observed. Individually selected rehabilitation program has improved proprioception, standing and gait re-education. The patient moved with the help of orthopedic equipment in the form of elbows.
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Jones, Jared M., Phillip R. Worts, and Aaron J. Guyer. "Comparison of Diabetic and Non-Diabetic Individuals Outcomes Following Ankle ORIF Surgery Based on Physical Therapy Start Times." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0071. http://dx.doi.org/10.1177/2473011421s00712.
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Category: Ankle; Trauma Introduction/Purpose: The surgical correction of ankle fractures are one of the most common orthopedic procedures performed and about 13% of individuals undergoing these procedure are classified as diabetic. Diabetes, as a disease, impairs fracture healing due to decreased bone quality and cardiometabolic dysfunction. The use of early mobilization following ankle surSgery has improved post-operative outcomes in the 'healthy' populations; however, early mobilization or early physical therapy initiation in the diabetic populations has not been elucidated. Methods: Surgical correction CPT codes for ankle fracture were used to identify eligible patients followed by a retrospective chart review to confirm diagnosis and procedure(s) as well as collection of demographic information and pertinent medical history. Patient cases were examined over a two year period. Once the inclusion criteria was met, 209 unique patients were included in the analyses. Patients were grouped by diabetes status and early (i.e., <=8 weeks) or late mobilization (i.e., days post- op until physical therapy referral). Generalized linear models and a series Chi-squared tests, Fisher's Exact tests, one-way ANOVAs, and Mann Whitney U Tests were used to assess recovery duration, fracture healing, time to PT referral, medical history, and demographic information. Results: The diabetic group in our study was significantly older [60 (IQR:18) vs. 58 (26) years; p = 0.019] and had a higher BMI [34(8) vs. 29(10); p = 0.041] compared to our non-diabetic group but there were no differences in the proportions for sex or the fracture type by diabetic status. The non-diabetic group displayed a quicker fracture healing time [86(35) vs. 111(45) days; p = 0.04] but there were no differences in recovery duration or days until physical therapy was prescribed. The GLM analysis performed with recovery duration (i.e., time to medical clearance) found that late mobilization was a significant predictor (p < 0.001) of recovery duration but not diabetic diagnosis (p = 0.738). Conclusion: There appears to be a different demographic profile for diabetic patients experiencing an ankle fracture when compared to non-diabetic patients. The delay in physical therapy referral and presumably early mobilization appears to be the strongest predictor of recovery duration. Future research should utilize randomized controlled trials to determine if early mobilization is safe and effective at facilitating quicker fracture healing and recovery following the surgical correction of an ankle fracture in diabetic patients.
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Kilgas, Matthew A., Alicia E. DenHerder, Lydia L. M. Lytle, Cameron T. Williams, and Steven J. Elmer. "Home-Based Exercise With Blood Flow Restriction to Improve Quadriceps Muscle and Physical Function After Total Knee Arthroplasty: A Case Report." Physical Therapy 99, no. 11 (August 8, 2019): 1495–500. http://dx.doi.org/10.1093/ptj/pzz110.
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Abstract Background and Purpose After total knee arthroplasty (TKA), persistent quadriceps muscle atrophy and weakness impairs physical function. Blood flow restriction (BFR) exercise is emerging as a potential method to improve muscle size and strength in clinical populations with orthopedic limitations. There are no randomized controlled studies documenting BFR exercise after TKA. This case report describes the use of home-based BFR exercise to increase quadriceps size, strength, and physical function after TKA. Case Description A 59-year-old man (6 months post-TKA) performed body weight and walking exercises with BFR 5×/wk for 8 weeks. Blood flow in the TKA leg was restricted using a thigh cuff inflated to 50% of limb occlusion pressure. Lean leg mass, vastus lateralis thickness, knee extensor strength, and physical function were measured at baseline (6 months post-TKA), posttraining (8 months post-TKA), and long-term follow-up (14 months post-TKA). Outcomes After training, lean leg mass, vastus lateralis thickness, and knee extensor strength in the TKA leg increased by 4%, 14%, and 55%, respectively. Compared with baseline, posttraining knee extensor strength symmetry (TKA/uninvolved leg) increased from 64% to 98%. The patient’s performance improved for the 30-second chair stand, 40-m fast walk, and 6-minute walk tests. Increased quadriceps and physical function were maintained at the long-term follow-up. Discussion With enhanced quadriceps and physical function, the patient resumed independent physical activity. Muscle and strength gains surpassed those typically reported after TKA. Outcomes suggest that home-based BFR exercise was feasible, safe, and effective. BFR exercise after TKA is promising and warrants further research.
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Гусева, О. В., and Н. Г. Жукова. "THE ASSESSMENT OF PHYSICAL FITNESS LEVEL, THE FUNCTIONAL STATUS AND THE SOCIAL FEATURES OF THE ELDERLY THAT DECIDED TO ENGAGE IN PHYSICAL EXERCISES." Успехи геронтологии, no. 1 (April 19, 2021): 122–27. http://dx.doi.org/10.34922/ae.2021.34.1.017.
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Для сохранения активного долголетия пожилого человека необходима адекватная, индивидуально подобранная с помощью комплексной оценки физического состояния, функционального статуса и социальных характеристик, физическая нагрузка. В исследование была включена 121 женщина (средний возраст 66,77±5,37 года), пожелавшая заниматься в группе здоровья. У участников исследования выясняли профессиональный, социальный и спортивный анамнез, наличие заболеваний, проводили объективный осмотр, функциональные тесты (Штанге, ортостатический, 6-минутной ходьбы, «Встань и иди»). Выявлено, что 75,21 % участников исследования имели в анамнезе артериальную гипертензию. Нормальный тип реакции по САД определен у 71,07 % человек, по показателям ДАД - у 84,29 %. ИМТ соответствовал избыточной массе тела. Показатели динамометрии, спирометрии были снижены, но не являлись критическими. Показатели динамометрии справа и слева были взаимосвязаны с возрастом (R=-0,33; p<0,01; R=-0,31; p<0,01). Значения тестов «Встань и иди» и 6-минутной ходьбы оценены как нормальные. При ортопедическом осмотре выявлено наличие плоскостопия и сколиоза. 91,73 % пенсионеров не работали. Причиной выхода на пенсию для большинства участников исследования явилось сокращение штатов в возрасте около 60 лет, что не соответствует удовлетворительному функциональному состоянию участников исследования. Поэтому на сегодняшний день актуальными являются программы по частичной трудовой занятости пожилых людей, по переобучению лиц старше 50 лет по программам «50+» и по физической культуре этих двух групп. For the sake of maintaining active longevity of the elderly the adequate, individually selected physical activity, that was get after the integrated assessment of physical fitness level, the functional status and the social features, is necessary. 121 women (mean age 66,77±5,37) who decided to engage in physical exercises were included in the study. For every participant professional, social and sport anamnesis, the presence of illnesses, the clinical information and the functional tests (Stange, orthostatic, «6 minutes walking», «Up and go») were evaluated. Was get, that 75,21 % participants of the study had hypertension. The normal type of systolic blood pressure reaction during orthostatic test was present in 71,07 % people, by diastolic blood pressure - in 84,29 % people. The body mass index corresponded to the excess body weight. The indices of the grip strength, spirometry were decreased, but were not critical. The indices of the grip right and left arm correlated with age (R=-0,33; p<0,01; R=-0,31; p<0,01). The results of the tests «Up and Go» and «6 minutes walking» were evaluated as normal. The orthopedic examination has revealed the flatfoot and scoliosis. 91,73 % of the retired individuals did not have a job. Cause of retirement for the majority of patients were stuff cuts after the age 60, which was not in accordance with the satisfactory physical state of the participants of the investigation. Therefore, nowadays the questions of part-time employment of the elderly and re-education of the people with the age «50+», together with the development of physical exercise programs are of great importance.
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Gulick, Dawn T. "Reliability and Validity of an Innovative Device for ACL Testing: The Mobil-Aider™." Journal of Sport Rehabilitation 29, no. 2 (February 1, 2020): 257–61. http://dx.doi.org/10.1123/jsr.2018-0472.
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Background: Knee disorders prevalence is estimated at more than 50% in a lifetime. There are over 250,000 anterior cruciate ligament (ACL) injuries per year in the United States. There are over 175,000 ACL reconstructions annually. This study was a double-blinded design to establish the reliability and validity of a new orthopedic device to measure linear translation of the tibia on the femur (ACL testing). Methods: A Zeiss Smartzoom microscope was used as the gold standard to assess the ability of the Mobil-Aider™ to measure linear translation. Sixty blinded measures were taken with each of 6 different devices. Results: Both the intraclass correlation and the Pearson correlation were .986. The Cronbach alpha reliability analysis was 0.992. Independent 1-sample t tests were performed on the differences between the Mobil-Aider™ and Zeiss values, and were not found to be significant (P = .42); that is, they were the same. Bland–Altman plot and a linear regression revealed no propositional bias. Finally, with 360 measures over 6 devices, the power of this study was calculated to be 100%. Discussion: This data are the first step in establishing reliability and concurrent validity of a new device. As a result of the current data, the Mobil-Aider™ device is deemed a promising orthopedic tool for use in assessing the laxity of the ACL. Additional testing needs to be performed on both healthy and injured knees. Conclusions: There is potential for the Mobil-Aider™ to contribute to the assessment of ACL injuries, but additional human testing is needed.
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Borsa, Paul A., Eric L. Sauers, and Derald E. Herling. "In Vivo Assessment of AP Laxity in Healthy Shoulders Using an Instrumented Arthrometer." Journal of Sport Rehabilitation 8, no. 3 (August 1999): 157–70. http://dx.doi.org/10.1123/jsr.8.3.157.
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Arthrometric assessment for glenohumeral (GH) laxity is currently unprecedented in orthopedic practice. Clinical evaluation of GH laxity is based on manual tests that lack objectivity and reliability. We have developed an arthrometer that quantifies AP laxity relative to applied load. Forty healthy shoulders were assessed for AP laxity at 67-, 89-, 111-, and 134-N load levels. A factorial ANOVA revealed significant mean (±SD) differences between directions (p <.0001) and between loads (p <.001). Our results demonstrate the quantified relationship between applied directional loads and GH translation in vivo. We determined bilateral symmetry within subjects and demonstrated excellent reproducibility of the device. Frequency distributions for AP laxity revealed a bell-shaped curve, indicating a normal distribution. Anterior laxity was significantly greater then posterior laxity, and it demonstrated better compliance between the selected load levels.
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Frey, Martin, Jens Hoogen, Rainer Burgkart, and Robert Riener. "Physical Interaction with a Virtual Knee Joint—The 9 DOF Haptic Display of the Munich Knee Joint Simulator." Presence: Teleoperators and Virtual Environments 15, no. 5 (October 1, 2006): 570–87. http://dx.doi.org/10.1162/pres.15.5.570.
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In specific fields, medical education at many universities is rather theoretical and the amount of practical training is limited. A significant improvement can be achieved using virtual reality training stations with lifelike visual, acoustic, tactile, and kinesthetic feedback. Particularly, when simulating procedures that require direct contact with the patient body, a realistic haptic simulation addressing tactile and kinesthetic senses can be essential for the acceptance of virtual simulation stations. A purely passive phantom may provide realistic haptic feedback, but its properties cannot be changed over time. This paper presents the haptic display of the Munich Knee Joint Simulator, which was developed to improve training and education of physical knee joint examinations. The haptic interface comprises a combination of passive phantom segments providing realistic tactile sensations, and strong actuators generating highly dynamic kinesthetic force feedback. A 3 degree of freedom (DOF) manipulator was developed in this study to drive the thigh prosthesis and one 6 DOF industrial robot was used to actuate the shank prosthesis. Both manipulators are driven by hybrid admittance-impedance controllers capable of simulating the complex dynamics of the thigh and the shank. Both actuators are equipped with a 6 DOF force torque sensor and they are virtually coupled by an analytical knee joint model. The proposed setup is capable of simulating a mechanical stiffness as high as 80 kN/m in the translatory DOF and simultaneously allows free motion in the rotatory DOF. Experimental tests of the simulator with orthopedic physicians proved the usability of the proposed concept.
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Fletcher, Cary, Derrick Mcdowell, Camelia Thompson, and Kenneth James. "Predictors of hospitalization and surgical intervention among patients with motorcycle injuries." Trauma Surgery & Acute Care Open 4, no. 1 (August 2019): e000326. http://dx.doi.org/10.1136/tsaco-2019-000326.
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BackgroundTo describe the distribution of injuries, hospitalization rates by body areas injured, and surgery-requiring admissions, and to identify independent predictors of admission to a regional hospital in Jamaica.MethodsA cross-sectional study was conducted among persons presenting to the St Ann’s Bay Regional Hospital in Jamaica (2016–2018) with injuries sustained from motorcycle crashes. A census was done of patients admitted to the surgery ward from the emergency room, as well as those referred to the Orthopaedic Outpatient Department. Trained members of the orthopedic team administered a pretested questionnaire within 24 hours of presenting to the orthopedic service to elicit data on sociodemographic characteristics, motor vehicle collision circumstance and motor bike specifications, physical injuries sustained and medical management, as well as compliance with legal requirements for riding a motorcycle. Associations between variables were examined using χ2 tests and logistic regression.ResultsThere were 155 participants in the study, and 75.3% of motorcyclists with injuries required admission. The average length of stay was approximately 10 days. Surgery was required for 71.6% of those admitted. Lower limb injuries constituted 55% of all injuries. The independent predictors for admission were alcohol use and total body areas involved. Motorcycle crash victims who used alcohol close to the time of crash were three times more likely to be admitted to hospital than those who did not consume alcohol. As the total body areas involved increased by one, there was a threefold increase in the likelihood of being admitted. Additionally, the greater the number of body areas involved, the greater was the likelihood of admission.DiscussionLower limb injuries are the most commonly reported injuries among victims of motorcycle crashes. Alcohol and total body areas involved are independent predictors of admission to hospital. In the planning of trauma delivery services, this information should be taken into account.Level of EvidenceLevel IV.
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Yerra, Sandeep. "Telemedicine During COVID-19 and Beyond: A Practical Guide and Best Practices Multidisciplinary Approach for the Orthopedic and Neurologic Pain Physical Examination." Pain Physician 4S;23, no. 8;4S (August 14, 2020): S205—S237. http://dx.doi.org/10.36076/ppj.2020/23/s205.
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Background: The COVID pandemic has impacted almost every aspect of human interaction, causing global changes in financial, health care, and social environments for the foreseeable future. More than 1.3 million of the 4 million cases of COVID-19 confirmed globally as of May 2020 have been identified in the United States, testing the capacity and resilience of our hospitals and health care workers. The impacts of the ongoing pandemic, caused by a novel strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have far-reaching implications for the future of our health care system and how we deliver routine care to patients. The adoption of social distancing during this pandemic has demonstrated efficacy in controlling the spread of this virus and has been the only proven means of infection control thus far. Social distancing has prompted hospital closures and the reduction of all non-COVID clinical visits, causing widespread financial despair to many outpatient centers. However, the need to treat patients for non-COVID problems remains important despite this pandemic, as care must continue to be delivered to patients despite their ability or desire to report to outpatient centers for their general care. Our national health care system has realized this need and has incentivized providers to adopt distance-based care in the form of telemedicine and video medicine visits. Many institutions have since incorporated these into their practices without financial penalty because of Medicare’s 1135 waiver, which currently reimburses telemedicine at the same rate as evaluation and management codes (E/M Codes). Although the financial burden has been alleviated by this policy, the practitioner remains accountable for providing proper assessment with this new modality of health care delivery. This is a challenge for most physicians, so our team of national experts has created a reference guide for musculoskeletal and neurologic examination selection to retrofit into the telemedicine experience. Objectives: To describe and illustrate musculoskeletal and neurologic examination techniques that can be used effectively in telemedicine. Study Design: Consensus-based multispecialty guidelines. Setting: Tertiary care center. Methods: Literature review of the neck, shoulder, elbow, wrist, hand, lumbar, hip, and knee physical examinations were performed. A multidisciplinary team comprised of physical medicine and rehabilitation, orthopedics, rheumatology, neurology, and anesthesia experts evaluated each examination and provided consensus opinion to select the examinations most appropriate for telemedicine evaluation. The team also provided consensus opinion on how to modify some examinations to incorporate into a nonhealth care office setting. Results: Sixty-nine examinations were selected by the consensus team. Household objects were identified that modified standard and validated examinations, which could facilitate the examinations.The consensus review team did not believe that the modified tests altered the validity of the standardized tests.Limitations: Examinations selected are not validated for telemedicine. Qualitative and quantitative analyses were not performed. Conclusions: The physical examination is an essential component for sound clinical judgment and patient care planning. The physical examinations described in this manuscript provide a comprehensive framework for the musculoskeletal and neurologic examination, which has been vetted by a committee of national experts for incorporation into the telemedicine evaluation. Key words: COVID, pain, telemedicine, physical examination, spine, shoulder, elbow, hand, hip, knee
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Coulon, Christian L., and Dennis Landin. "Lyme Disease as an Underlying Cause of Supraspinatus Tendinopathy in an Overhead Athlete." Physical Therapy 92, no. 5 (May 1, 2012): 740–47. http://dx.doi.org/10.2522/ptj.20110220.
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Background and Purpose Supraspinatus tendinopathy is a common cause of shoulder pain seen in overhead athletes, but there appear to be no published cases that present Lyme disease as the underlying cause of tendinopathy. Lyme disease is diagnosed primarily by clinical signs and symptoms and then supported by laboratory tests, including enzyme-linked immunosorbant assay (ELISA) and Western blot testing. This case demonstrates the importance of a physical therapist's input and clinical role in reaching the correct diagnosis in an athlete with Lyme disease who had a diagnosis of rotator cuff impingement and tendinitis. Case Description A 34-year-old male tennis player was seen for physical therapy for right shoulder impingement and tendinitis diagnosed by an orthopedic surgeon. He was unable to participate in sporting activities due to impairments in strength and pain. Initial examination revealed distal supraspinatus impingement and tendinopathy. Outcomes The patient was not progressing with commonly accepted interventions and began to have “arthritis-like” shoulder pain in the uninvolved left shoulder. Suspicious of an underlying condition, the physical therapist informed the physician of the patient's updated status and referred the patient to the physician to discuss the current symptoms in therapy. After testing, the patient was diagnosed with chronic Lyme disease and underwent antibiotic therapy. Discussion Many active patients spend time in the outdoors, increasing their risk of exposure to a vector for Borrelia burgdorferi. Physical therapists spend a larger portion of time with patients than other health care professionals and due to this extended contact and musculoskeletal knowledge are able to recognize atypical musculoskeletal disorders or musculoskeletal manifestations of unusual pathologies, including Lyme disease.
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Pascoalino, Shayany Dalbem, Daniela Dero Lüdtke, Ana Caroline Heymanns, Daiana Salm, Déborah M. Costa, Daniel Fernandes Martins, Verônica V. Horewicz, Franciane Bobinski, and Anna Paula Piovezan. "Antihyperalgesic effect of exercise is augmented by the oral pretreatment with extract of Casearia sylvestris in an animal model of osteoarthritis." Journal of Orthopaedics, Trauma and Rehabilitation 27, no. 2 (July 7, 2020): 148–56. http://dx.doi.org/10.1177/2210491720935614.
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Background/Purpose: Osteoarthritis (OA) is the main orthopedic disease to cause pain and edema in humans. This study evaluated the influence of complementary medicine on the hyperalgesia and edema induced by exercise in an animal model of OA as well as possible role for interleukin (IL)-1β to these outcomes. Methods: Mice (25–35 g) were subjected to intraplantar injection of Freund’s complete adjuvant and were subjected to exercise and oral treatment with ethanolic crude extract of Casearia sylvestris (ECE-CS) or vehicle (alone or in combination) and evaluated through behavioral and biochemical tests. Results: At day 5, exercise and ECE-CS alone did not reduce hyperalgesia, while the combination of both enhanced this effect. In muscle and skin tissues from the treated paw of mice, both treatments alone or in combination reduced in similar extent the levels of IL-1β in relation to the control group. Conclusion: Association of both complementary therapies may bring benefits on pain associated with OA in humans.
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Oron, Amir, Izhar Arieli, Tamir Pritsch, Einat Even-Sapir, Nahum Halperin, and Gabriel Agar. "SPECT versus Planar Scintigraphy as a Clinical Aid in Evaluation of the Elderly with Knee Pain." ISRN Orthopedics 2013 (January 22, 2013): 1–11. http://dx.doi.org/10.1155/2013/842852.
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Chronic knee pain is a common complaint among the elderly and appears in 30%–40% of the population over the age of 65. This study was performed in order to evaluate correlation between clinical presentation of chronic knee pain and the imaging findings of SPECT and planar bone scintigraphy. Methods. We prospectively recruited 116 patients over the age of 50 who had neither knee surgery nor trauma. Patients were divided into symptomatic and asymptomatic groups. All patients were examined by an experienced orthopedic surgeon; on the same day imaging was performed. Statistical analysis was performed to correlate physical examination findings with planar scintigraphy and SPECT findings and blood pool images. Results. In symptomatic patients, planar scintigraphy correlated significantly () with the presence of excessive joint fluid, synovial condensation, and decrease in range of motion as measured in extension and flexion and patellar grinding test. SPECT findings correlated with all of the above tests as well as with medial and patellofemoral joint tenderness. Conclusions. We believe a finding of tenderness at the medial articular crease or of the patellofemoral compartment of the knee should be considered an indication for the use of SPECT scintigraphy rather than planar scintigraphy.
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Parikh, Harin B., Tessa N. Mandler, Alexia G. Gagliardi, David R. Howell, and Jay C. Albright. "FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0020. http://dx.doi.org/10.1177/2325967120s00204.
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Background: The long-term outcomes of femoral nerve blockade following ACL reconstruction are not well defined. Femoral nerve blocks are typically administered as either a single-injection nerve block (FNB) or a continuous femoral nerve catheter (FNC). Prior work among pediatric patients found knee extension and flexion strength deficits 6 months postoperatively using FNB. However, this work was limited by the use of multiple graft choices and orthopedic surgeons. Purpose/Hypothesis: The purpose of this study was to investigate functional recovery after primary ACL surgery with quadriceps tendon-patellar autograft (QPA) in patients receiving a sciatic nerve block and either FNB or FNC. Our hypothesis was that short-term functional performance would be worse among those who underwent FNC compared to FNB. Methods: We conducted a retrospective chart review of pediatric patients 10-19 years of age who underwent ACL reconstruction with QPA by a single orthopedic surgeon. Surgery was performed at two locations: one of which administered FNB and the other FNC. Both were combined with sciatic nerve block. A physical therapist performed functional asymmetry assessments at approximately 6 months postoperative. We compared single-leg squat symmetry between groups using independent samples t-tests. We compared the proportion of patients in each group who achieved 80% symmetry on single-leg squat and Y-Balance tests, had initiated ballistics and running programs, and demonstrated functional symmetry at the 6-month post-operative appointment using Chi-square analyses. Results: Demographics were similar between groups (Table 1). Single leg percent symmetry of the operative limb was significantly greater in the FNB group compared to the FNC group (Table 2). In addition, a greater proportion of those in the FNB group demonstrated functional symmetry compared to the FNC group during the 6-month assessment (Table 2). There were no proportional differences between the groups for the number of patients who demonstrated 80% symmetry during single-leg squat or Y-Balance test, or had initiated a ballistics or running program at the time of assessment. Conclusion: Pediatric patients in the FNC group demonstrated poorer single-leg squat symmetry and functional symmetry compared to those in the FNB group at 7 months following ACL reconstruction with QPA. These preliminary findings may relate to increased concentration and duration of local anesthetic in the FNC group postoperatively. Providers should be cognizant of the implications of FNC on long-term outcomes of ACL reconstruction. [Table: see text][Table: see text]
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Block, Andrew M., Arya Minaie, Meghan Merklein, and Jeffrey Nepple. "Establishing A Crosstalk Between Pediatric and Adult Promis Domains in Sports Medicine." Orthopaedic Journal of Sports Medicine 10, no. 5_suppl2 (May 1, 2022): 2325967121S0050. http://dx.doi.org/10.1177/2325967121s00506.
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Introduction: Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in athletes participating in orthopedic research and clinical care. PROMIS domains are separately validated in both pediatric (<18 years) and the adult (>18 years) populations. However, the utilization of PROMIS in the adolescent athlete is complicated by the inability to convert between pediatric and adult PROMIS domains. Purpose: This study sought to establish conversion factors to transition between pediatric and adult values of the commonly tested PROMIS domains. Methods: This study consisted of 100 participants, aged 14-21 years old, who presented to orthopedic outpatient clinics with lower extremity complaints in various stages from initial presentation to postoperative recovery (excluding any within three months of surgery). All participants completed both adult and pediatric versions of the following PROMIS domains: Adult/Pediatric Mobility, Adult/Pediatric Pain Interference (PI), and Adult Physical Function (PF). Linear regression was utilized to determine a conversion factor between the two age groups within each domain by the mean difference. To evaluate the clinical significance of this difference, a 5-point threshold (representing minimally clinically important difference) between the two scores was set and 1-sided t-tests were performed. Results: Overall, 50 pediatric patients (mean age of 15.6 ± 1.1) and 50 young adult patients (18.9 ± 1.0) were included. Each group had roughly the same ratio of males to females (18:32 v. 17:33 for the pediatric and adult groups, respectively). Adult and Pediatric domains were all strongly correlated (range of r=0.85-0.87). In both groups, subjects scored higher on Adult domains than Pediatric domains (mean difference ranging from 4.2-6.3 points), all of which were significantly different (p<0.05 for all domains). When assessed for clinical significance, only Mobility and Pain Interference performance in the pediatric group were found to be significantly different (mean difference of 5.8 and 5.4, respectively). To convert between the scores for both populations, the following were calculated: Adult Mobility to Pediatric Mobility -4.2, Adult Physical Function to Pediatric Mobility -6.3, and Adult Pain Interference to Pediatric Pain Interference -4.3. Conclusion: This study demonstrated that while Adult and Pediatric domains are highly correlated, over half of patients demonstrated clinically significant differences between scores. This study established correction factors to allow conversion between Pediatric and Adult PROMIS domains with high correlation.
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Kostopoulos, Vassilis, Athanasios Kotrotsos, Kalliopi Fouriki, Alexandros Kalarakis, and Diana Portan. "Fabrication and Characterization of Polyetherimide Electrospun Scaffolds Modified with Graphene Nano-Platelets and Hydroxyapatite Nano-Particles." International Journal of Molecular Sciences 21, no. 2 (January 16, 2020): 583. http://dx.doi.org/10.3390/ijms21020583.
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Solution electrospinning process (SEP) is a versatile technique for generating non-woven fibrous materials intended to a wide range of applications. One of them is the production of fibrous and porous scaffolds aiming to mimic bone tissue, as artificial extracellular matrices (ECM). In the present work, pure and nano-modified electrospun polyetherimide (PEI) scaffolds have been successfully fabricated. The nano-modified ones include (a) graphene nano-platelets (GNPs), (b) hydroxyapatite (HAP), and (c) mixture of both. After fabrication, the morphological characteristics of these scaffolds were revealed by using scanning electron (SEM) and transmission electron (TEM) microscopies, while porosity and mean fiber diameter were also calculated. In parallel, contact angle experiments were conducted so that the hydrophilicity level of these materials to be determined. Finally, the mechanical performance of the fabricated scaffolds was investigated by conducting uniaxial tensile tests. Ιn future work, the fabricated scaffolds will be further utilized for investigation as potential candidate materials for cell culture with perspective in orthopedic applications.
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Lafave, Mark R., and Larry Katz. "Validity and Reliability of the Standardized Orthopedic Assessment Tool (SOAT): A Variation of the Traditional Objective Structured Clinical Examination." Journal of Athletic Training 49, no. 3 (June 1, 2014): 373–80. http://dx.doi.org/10.4085/1062-6050-49.1.12.
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Context: Health care professions have replaced traditional multiple choice tests or essays with structured and practical, performance-based examinations with the hope of eliminating rater bias and measuring clinical competence. Objective: To establish the validity and reliability of the Standardized Orthopedic Assessment Tool (SOAT) as a measure of clinical competence of orthopaedic injury evaluation. Design: Descriptive laboratory study. Setting: University. Patients or Other Participants: A total of 60 undergraduate students and 11 raters from 3 Canadian universities and 1 standardized patient. Intervention(s): Students were required to complete a 30-minute musculoskeletal evaluation in 1 of 2 randomly assigned mock scenarios involving the knee (second-degree medial collateral ligament sprain) or the shoulder (third-degree supraspinatus muscle strain). Main Outcome Measure(s): We measured interreliability with an intraclass correlation coefficient (ICC) (2,k) and stability of the tool with standard error of measurement and confidence intervals. Agreement was measured using Bland-Altman plots. Concurrent validity was measured using a Pearson product moment correlation coefficient whereby the raters' global rating of a student was matched to the cumulative mean grade score. Results: The ICCs were 0.75 and 0.82 for the shoulder and knee cases, respectively. Bland-Altman plots indicated no systematic bias between raters. In addition, Pearson product moment correlation analysis demonstrated a strong relationship between the overall cumulative mean grade score and the global rating score of the examinees' performances. Conclusions: This study demonstrated good interrater reliability of the SOAT with a standard error of measurement that indicated very modest stability, strong agreement between raters, and correlation indicative of concurrent validity.
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Nevola Teixeira, Luiz Felipe, Visnu Lohsiriwat, Paolo Veronesi, Mario Rietjens, Luiz Carlos Teixeira, Cristina Garusi, Alberto Luini, et al. "Predictive factors for winged scapula in breast cancer patients after immediate axillary dissection." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e20634-e20634. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e20634.
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e20634 Background: Axillary lymph node dissection is an inevitable part of breast cancer surgery in certain cases. Definitive data regarding the incidence of postoperative winged scapula remains inconsistent. Ignorance of its diagnosis may lead to under-treatment and result in physical morbidity. Methods: All breast cancer patients who underwent axillary lymph node dissection procedures were recruited. In the early postoperative period, within 24 hours after surgery, the physiotherapy staff performed physical examinations to evaluate and identify the physical signs of long thoracic nerve injury by means of two specific orthopedic evaluation tests. The factors that may relate to winged scapula were recorded and analyzed. Results: From July to October 2012, 51 out of 187 patients were diagnosed with winged scapula (27.2%). The median age was 49.0 years old. 130 patients had undergone mastectomy and 100 cases had immediate breast reconstruction. Age, BMI, history of shoulder joint morbidity and previous breast surgery were not significantly associated with winged scapula. Administration of neoadjuvant treatment, mastectomy or breast conservative surgery, immediate reconstruction and its type, tumor size and nodal involvement also did not show any correlation. Conclusions: The winged scapula is not an infrequent sequela after axillary lymph node dissection in the breast cancer patient. It is usually underestimated and overlooked. There is no association between age, BMI, neoadjuvant treatment, type of breast surgery, tumor size or nodal stage. As breast reconstruction plats an ever-increasing role in current breast surgery practice it is interesting to note that reconstruction with prosthesis, even with serratus muscle dissection does not increase the incidence of winged scapula. Post reconstruction morbidity could interfere with the physical evaluation and outcome, but the result of our subgroup analysis showed no significant correlation among them. In our clinical experience, this sequela is not irreversible, being a transitory problem. Our series show only immediate 24 hr result that lack of long term follow-up and still need physical therapy proctocols to evaluate the recovery.
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Comini, Sara, Rosaria Sparti, Bartolomeo Coppola, Mehdi Mohammadi, Sara Scutera, Francesca Menotti, Giuliana Banche, Anna Maria Cuffini, Paola Palmero, and Valeria Allizond. "Novel Silver-Functionalized Poly(ε-Caprolactone)/Biphasic Calcium Phosphate Scaffolds Designed to Counteract Post-Surgical Infections in Orthopedic Applications." International Journal of Molecular Sciences 22, no. 18 (September 21, 2021): 10176. http://dx.doi.org/10.3390/ijms221810176.
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In this study, we designed and developed novel poly(ε-caprolactone) (PCL)-based biomaterials, for use as bone scaffolds, through modification with both biphasic calcium phosphate (BCP), to impart bioactive/bioresorbable properties, and with silver nitrate, to provide antibacterial protection against Staphylococcus aureus, a microorganism involved in prosthetic joint infections (PJIs). Field emission scanning electron microscopy (FESEM) showed that the samples were characterized by square-shaped macropores, and energy dispersive X-ray spectroscopy analysis confirmed the presence of PCL and BCP phases, while inductively coupled plasma–mass spectrometry (ICP–MS) established the release of Ag+ in the medium (~0.15–0.8 wt% of initial Ag content). Adhesion assays revealed a significant (p < 0.0001) reduction in both adherent and planktonic staphylococci on the Ag-functionalized biomaterials, and the presence of an inhibition halo confirmed Ag release from enriched samples. To assess the potential outcome in promoting bone integration, preliminary tests on sarcoma osteogenic-2 (Saos-2) cells indicated PCL and BCP/PCL biocompatibility, but a reduction in viability was observed for Ag-added biomaterials. Due to their combined biodegrading and antimicrobial properties, the silver-enriched BCP/PCL-based scaffolds showed good potential for engineering of bone tissue and for reducing PJIs as a microbial anti-adhesive tool used in the delivery of targeted antimicrobial molecules, even if the amount of silver needs to be tuned to improve osteointegration.
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Bilal, Ökkeş, Mustafa Kınaş, Ahmet Güney, and Fatih Doğar. "Cruciate Ligament Repair with Nitinol Wire Synthetic Allograft." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0019. http://dx.doi.org/10.1177/2325967114s00198.
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Objectives: To present two cases who underwent cruciate ligament repair by nitinol wire synthetic allograft and to discuss outcomes. Methods: Although definitive incidence of anterior cruciate ligament injuries is unknown, it is estimated that annual 200.000 rupture occurs with 100.000 reconstructions in United States [1]. Therapeutic options include medical treatment, isolated or augmented anterior cruciate ligament repair and reconstruction with autograft, allograft and synthetic grafts. Debates on the treatment of such injury focus on selection of graft rather than need for surgery. Once anterior cruciate ligament reconstruction was decided, surgeon should have to select a graft. In general, an autograft is preferred. There are also allograft and synthetic grafts. Autograft have advantages of low risk for cross-inflammatory response and lack of risk for disease transmission. Nitinol is a material produced from nickel and titanium. It is more often used in vascular stents, orthodontic wires, implants used in mandible surgery and some orthopedic implants [2]. We presented 2 patients who underwent reconstruction with synthetic grafts produced from flexible nitinol wire. Results: Case 1: A 31-year old man presented to our clinic with pain at right knee. The patient underwent cruciate ligament surgery 10 years ago at another facility. His right knee was sprained again 12 months ago; thus, he was re-operated ad anterior cruciate reconstruction was performed in a facility. The patient had pain after surgery. On the physical examination, there was limitation in knee flexion by 100 degree and in knee extension by 10 degree at the right. It was seen that there was painful knee movements. It was found that there was tenderness at medial joint space and patellofemoral grind test was positive while Lachman and anterior drawer tests were negative. On the plain radiographs, it was observed that reconstruction was performed by using flexible nitinol wire synthetic graft and that occasional fractures in nitinol wire existed. The patient accepted removal of graft when he was informed. Thus, we removed flexible nitinol wire synthetic graft and interference screw. In the arthroscopic examination, it was seen that there was grade 4 cartilage defect in patellofemoral joint with occasional fracture in flexible nitinol wire synthetic graft. Endo-button was localized at suprapatellar pouch and removed via artrhroscopy. Micro-fracture procedure was performed for cartilage defect. The patient was scheduled for physical therapy after surgery. After 3 months, it was seen that complaints were resolved and he had almost full range of motion without instability signs. Case 2: A 23-year old man presented to our clinic with pain at right knee. He reported that his knee was injured during sports 9 months ago and he underwent anterior cruciate ligament reconstruction in another facility. However, he had persistent pain. On the physical examination, it was seen that there was full range of motion at knee but diffuse knee pain in hyperflexion. It was seen that medial McMurray test was positive and there was tenderness at medial joint space while Lachman and anterior drawer tests were negative. On the plain radiographs, it was observed that reconstruction was performed by using flexible nitinol wire synthetic graft and that occasional fractures in nitinol wire existed. Revision surgery was recommended but the patient didn’t attend control visit. Conclusion: Orthopedic surgeons tend to have appreciation against novel instruments; however, novel techniques should be adopted by meticulously considering outcomes without fascinating. It is clear that use of synthetic grafts without sufficient experimental and biomechanical in vivo and in vitro studies will result in some complications.
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Dias, Felipe C., Cosme R. M. Silva, Palloma Vieira Muterlle, Vinicius A. R. Henriques, and José A. Araújo. "Wear Resistance of Ti-40Zr Alloy with TiN and ZrN Multilayer Coatings." Advanced Materials Research 936 (June 2014): 1056–65. http://dx.doi.org/10.4028/www.scientific.net/amr.936.1056.
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Production and processing of titanium alloys are expensive and its alloys show low wear resistance. Substrates of Ti-40Zr, used for orthopedic implants, were obtained from the elemental mixture of hydrogenated powders, followed by a sequence of cold uniaxial and isostatic pressing and vacuum sintering. Aiming wear resistance increase, samples were coated by physical vapor deposition using electron beam technique (EB-PVD). Multilayer coatings with three different configurations were undertaken: Ti/TiN, Ti/TiN/ZrN and Ti/TiN/ZrN/TiN. Micro-abrasive wear tests were conducted by ball-cratering, with abrasive slurry of silicon carbide (SiC). The wear craters were measured at intervals corresponding to increments in the sliding distance of approximately 14 m. Range of the normal force were between 0.35 and 0,45 N. Scanning electron microscopy was used to evaluate the wear crater and the wear mode. All experiments showed three-body abrasive wear and a reduction of one order of magnitude in wear coefficient for two coated samples: 2,58∙10-12m³(Nm)-1to substrate, 5,4∙10-13m³(Nm)-1to Ti+TiN film and 7,22∙10-13m³(Nm)-1to Ti+TiN+ZrN film. In the Ti+TiN+ZrN+TiN experiment the wear coefficient of film is nearer to the substrate, 7,58∙10-13m³(Nm)-1. The multi-layers containing ZrN presented wear coefficient higher than Ti/TiN films, possibly due to existing residual stresses.