POS1536-HPR THE RELATIONSHIP BETWEEN POSTURAL CHANGES AND TRUNK MUSCLE ENDURANCE IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Body posture is defined as relative biomechanical alignment of body’s head, trunk, and extremities as well as position of the body in the space. Body posture might be altered due to different musculoskeletal pathologies. Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease characterized by musculoskeletal problems including bone and muscle geometry alterations which may lead a deteriorated posture. However, it is not known whether trunk muscle endurance is associated with body posture in children with JIA.

Objectives

To investigate the relationship between postural changes and trunk muscle endurance in children with JIA.

Methods

Thirty-four children (eighteen female, sixteen male) were included in the study. Postural changes were assessed by a three-dimensional evaluation system (PosturePrint System, Biotonix, Canada). The system provides Posture Index (PI) score which is a composite score from three postural regions including head, ribcage, and pelvis. Higher PI scores indicate a more deteriorated posture. Biering–Sørensen Test (BST), Flexor Endurance Test (FET), Lateral Endurance Test (LET) were used to assess trunk muscle endurance, and Static Scapular Endurance Test (SSET) were used to assess scapular muscle endurance. Spearman Rank Correlation test was employed to determine the possible relationships.

Results

Enthesitis related arthritis was the most common JIA subtype in the study (38.2%) followed by oligoarthritis (26.5%), polyarthritis (20.6%), and systemic arthritis (14.7%). Significant negative correlations were detected between SSET and PI-head score (rho= -0.467, p=0.005), SSET and PI-ribcage score (rho= -0.381, p=0.026); FET and PI-head score (rho= -0.469, p=0.005); LET and PI-head score (rho= -0.441, p=0.009).

Table 1.

Demographics, muscle endurance and Posture Index scores of children

VariableMedian (IQR 25th/75th)Age (years)12.0 (10.0/14.0)Height (cm)145.50 (140.00/158.25)Weight (kg)42.75 (33.00/49.50)Body mass index (kg/m2)19.17 (16.09/21.42)Biering– Sørensen Test (sec)49.70 (28.42/80-78)Flexor Endurance Test (sec)38.91 (30.59/60.19)Lateral Endurance Test (sec)32.52 (19.99/59.68)Static Scapular Endurance Test (sec)23.19 (15.93/44.74)Posture Index-Head (score)7.0 (5.0/8.0)Posture Index-Ribcage (score)5.0 (4.0/6.0)Posture Index-Pelvis (score)6.0 (3.0/8.0)

IQR: Interquartile range

Conclusion

These results indicated that postural displacements of head and ribcage are linked with decreased trunk and scapular muscle endurance in children with JIA. Exercise and physical activity programs targeting muscle endurance may result improvements in posture in these children.

Disclosure of Interests

None declared

A Scoring System to Demonstrate the Risk for Bone Injury in Patients with Clinically Suspected or Occult Scaphoid Fracture

BACKGROUND

It is important to diagnose a scaphoid fracture accurately and start the correct treatment in the shortest time possible. However, the fracture of bone may not be visible on x-ray. In such cases, patients are clinically diagnosed with suspected or occult scaphoid fractures. The aim of this study was to define a scoring system based on physical examination to demonstrate the risk for bone injury in patients with clinically suspected and occult scaphoid fractures with negative radiographs and anatomical snuff box tenderness and to decrease the costs and workforce loss due to unnecessary treatment and magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Patients were initially evaluated by the attendant orthopedic physician in the emergency service with X-ray of the wrist, and ten wrist physical examination techniques were used. The X-rays of patients were evaluated by three orthopedic surgeons. Finally sixty patients, who were diagnosed as having no fracture by all three orthopedic surgeon, were included in the study. The wrists of these patients were evaluated with MRI.

RESULTS

There were 46 male (77%) and 14 female (23%) patients with a mean age of 21.5 years (range 7-61 years). About 3.3% had triquetrum fracture, 15% had bone edema in the scaphoid and radius, 18.3% had distal radius fracture, 31.6% had scaphoid fracture, and 31.8% had no bone injury. A scoring system was also proposed. It can be predicted that in the physical examination of the wrist if the total score is higher than 6.5, the probability of fracture is 2.87 (positive likelihood ratio) fold compared to scores below 6.5.

CONCLUSIONS

Proposal of this new scoring system was thought to be useful for predicting the risk for bone injury in patients with clinically suspected scaphoid fractures and making decision regarding therapeutic options.

Fracture of biphalangeal fifth toe: A diagnostic pitfall in the emergency department

Biphalangeal toe is a normal anatomic variant where distal and middle phalanges fuse to each other. In the context of trauma, biphalangeal toes may pose a diagnostic challenge and fractures may be interpreted as normal which can lead to misdiagnosis and under treatment. Here, we present a rare case of fracture through a biphalangeal fifth toe with delayed diagnosis. This variation should be kept in mind during the evaluation of a patient with foot trauma and assessment of foot radiographs, particularly in the emergency department where the majority of initial cases are presented.

Reverse Segond fracture and associated knee injuries: A case report and review of 13 published cases

Reverse Segond fracture is originally described as an indirect radiographic clue for a specific injury complex of the knee joint that includes posterior cruciate ligament (PCL) rupture and medial meniscal tear. Herein, we describe a case with reverse Segond fracture associated with PCL avulsion fracture instead of PCL rupture. According to current literature review, reverse Segond fracture is not only associated with PCL and medial meniscal injuries, but also frequently associated with anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries. Furthermore, medial meniscus and PCL may remain intact.

Calcaneal Insufficiency Fracture Secondary to Celiac Disease-Induced Osteomalacia: A Rare Cause of Heel Pain

Plantar fasciitis is a common cause of plantar heel pain; however, a broad spectrum of disorders may also present with plantar heel pain. A detailed history, physical examination, laboratory testing, and imaging studies may be necessary to reach an accurate diagnosis. Herein, the clinical presentation of a 33-year-old woman with calcaneal insufficiency fracture secondary to celiac disease-induced osteomalacia is presented, and its diagnosis and treatment are discussed. Calcaneal insufficiency fractures should be kept in mind in a patient with celiac disease that presents with heel pain.

LEVEL OF EVIDENCE

Therapeutic, Level IV: Case study.

Comparison of effects of static, proprioceptive neuromuscular facilitation and Mulligan stretching on hip flexion range of motion: a randomized controlled trial

The aim of this study was to compare the effects of static stretching, proprioceptive neuromuscular facilitation (PNF) stretching and Mulligan technique on hip flexion range of motion (ROM) in subjects with bilateral hamstring tightness. A total of 40 students (mean age: 21.5±1.3 years, mean body height: 172.8±8.2 cm, mean body mass index: 21.9±3.0 kg · m^-2) with bilateral hamstring tightness were enrolled in this randomized trial, of whom 26 completed the study. Subjects were divided into 4 groups performing (I) typical static stretching, (II) PNF stretching, (III) Mulligan traction straight leg raise (TSLR) technique, (IV) no intervention. Hip flexion ROM was measured using a digital goniometer with the passive straight leg raise test before and after 4 weeks by two physiotherapists blinded to the groups. 52 extremities of 26 subjects were analyzed. Hip flexion ROM increased in all three intervention groups (p<0.05) but not in the no-intervention group after 4 weeks. A statistically significant change in initial–final assessment differences of hip flexion ROM was found between groups (p<0.001) in favour of PNF stretching and Mulligan TSLR technique in comparison to typical static stretching (p=0.016 and p=0.02, respectively). No significant difference was found between Mulligan TSLR technique and PNF stretching (p=0.920). The initial–final assessment difference of hip flexion ROM was similar in typical static stretching and no intervention (p=0.491). A 4-week stretching intervention is beneficial for increasing hip flexion ROM in bilateral hamstring tightness. However, PNF stretching and Mulligan TSLR technique are superior to typical static stretching. These two interventions can be alternatively used for stretching in hamstring tightness.

Evaluation of results of conservative therapy in patients with transient osteoporosis of hip

The present study aimed to review the general characteristics of 18 cases diagnosed with transient osteoporosis of the hip (TOH) in our hospital within a 3-year period and to present their follow-up results after conservative treatment. A retrospective evaluation was made of the treatment and results of follow-up of TOH cases using physical examination and laboratory findings, hip radiographs and magnetic resonance imaging (MRI) and Harris Hip Scores (HHS). The mean duration of complaints of 6 females (mean age, 34.3±4.3 years) and 12 males (mean age, 40.7±10.5 years) was 6.1±2.7 weeks before the treatment. Three female patients had a history of giving birth by cesarean delivery. None of the patients had any history of trauma. MRI revealed increased intensity in T2 sequences and decreased intensity in T1 sequences in the proximal aspect of the femur. None of the patients had subchondral collapse or intra-articular effusion. For 3 female patients who were breastfeeding, no medical therapy was given, but only hyperbaric oxygen (HBO) therapy and forearm crutches. As standard management, the other patients were prevented from weight-bearing with the use of forearm crutches and medical therapy of diclofenac sodium, acetylsalicylic acid, and risedronate sodium was administered and additional HBO therapy. Clinical and radiological improvements were observed in all patients. None of the patients had avascular necrosis (AVN) of the femoral head. There was no record of therapy-related complications. While HHS was 55.6±7.8 before the treatment, it increased to 88.8±5.8 in the 3rd month and to 96.0±1.8 in the 6th month after the treatment. This change in score over time was found to be significant.

Comparison of two treatment strategy for Lenke I adolescent idiopathic scoliosis

The aim of the study study is to determine whether bilateral pedicle screw placement and posterior only spinal fusion improves sagittal correction parameters compared to alternate posterior segmental fixation in adolescent idiopathic scoliosis. 49 patients with Lenke Type 1 main thoracic curves who underwent single stage posterior only instrumentation and spinal fusion at a single center were retrospectively evaluated according to coronal radiological parameters. Patients divided into two groups of treatment strategy. Bilateral segmental fixation group's results were similar to alternate fixation group. Although quality of life or cosmetic evaluation of patients not involved in this study, alternate fixation provides similar results as bilateral segmental fixation in adolescen idiopathic scoliosis.

Avulsion fracture of the anterior inferior iliac spine mimicking a bone tumor: a case report

This is a case of a 17-year-old boy who was admitted to the clinic suffering from right hip-inguinal region pain which began after a soccer match. He had an avulsion fracture in the anterior inferior iliac spine and CT/MR images showed similarities to a bone tumor. These fractures are especially seen in the apophyses which are within the ossification process. The radiological appearance of these fractures during the healing period may be involved with bone tumors. In the control MRI of the patient after one year, the fracture was almost healed completely. Treatment is generally conservative. Good results have been reported with rest, analgesic and anti-inflammatory drugs. Familiarity with radiological findings of these avulsion fractures in this region not only protects the patient from invasive procedures but also avoids the involvement of the practitioner in legal consequences resulting from a misdiagnosis of sarcoma.

A usual cause of tumoural mass of the index finger

We present a case of an unusual appearance of a tumoural mass on the right index finger. A 52-year-old farmer was administered to our outpatient clinic due to a large tumoural mass in his right index finger. He has been reporting of the mass for 32 years. Upon examination there was a rubbery soft, fixed, painless tumoural mass on the right index finger, covering all proximal phalanx volar and dorsal causing no surface skin reaction. The entire mass was excised and sent for pathological examination. The pathological result was a fatty degenerated fibroma. This kind of tumour may easily be misinterpreted as a lipoma even radiologically. So it is believed that any surgeon should always be suspicious of the diagnosis of long-term masses of any kind.

Isolated slipped-retroverted osteochondral fracture of second metatarsal head

Although metatarsal fractures are common, isolated intraarticular metatarsal head fractures are rare, and retroversion of the fracture segment is even rarer. Herein, a retroverted fracture of the second metatarsal head, which happened with a direct trauma from jumping from a height, was discussed with treatment options and finally a simple surgical trick was advised. There are only a few cases of isolated osteochondral and retroverted fractures of the metatarsal head in literature. The following is a rare case report of such an injury in a 19-year-old male.

Successful Closed Manipulation of Simple Lateral Dislocation of the Elbow Joint: A Case Report

The elbow is the second most commonly dislocated joint in adults. Simple lateral dislocation of the elbow joint is a rare traumatic injury, and successful closed reduction is difficult and even rarer. Our proposition is to report this rare case of traumatic simple lateral dislocation treated with closed reduction under sedation emphasizing the use of this simple technique initially in order to avoid possible complications with general anesthesia and surgery.

Ankylosing pelvitrochanteric heterotopic ossification in a patient with spinal cord injury

Heterotopic ossification is a frequent complication after spinal cord injury. It usually develops around major weight bearing joints. However, ankylosing hip is a rare presentation. Various treatment methods have been reported and advocated as efficacious methods for management of heterotopic ossification. We report a case of ankylosing pelvitrochanteric heterotopic ossification treated with surgical excision before full maturation, postoperative radiation therapy and indomethacine without recurrence after 1 year. Treatment options are discussed in this particular case.

Triceps tendon avulsion and associated injuries of the elbow

A rupture or avulsion of the triceps tendon is very rare but concomitant elbow injuries with avulsion of the triceps tendon are even rarer. In this study, an extraordinary and unusual injury combination (radial head and trochlear fracture associated with triceps tendon avulsion), which happened during a fall onto the elbow with outstretched hand, was identified and has been discussed in the literature.

Bilateral congenital absence of flexor pollicis brevis and abductor pollicis brevis muscles with bilateral thenar atrophy: a case report

In this paper, we report a case of a 23-year-old male patient with bilateral absence of the flexor pollicis brevis and abductor pollicis brevis muscles with an intact functioning opponens pollicis and flexor pollicis longus muscles with bilateral thenar atrophy due to its rarity. All physical, neurological, ultrasonographic, direct radiographic, electromyographic and MRI studies were used to confirm and document this congenital anomaly.

Is there a relationship between forefoot alignment and ingrown toenail? A case-control study

Biomechanical imbalance between the hallux and the second toe and external compression of the lateral nail fold are proposed as the main reasons for ingrown toenail. Therefore, any anatomical predisposition facilitating this compression may play a role in the occurrence of ingrown toenail. The purpose of this study is to investigate the relationship between forefoot alignment and ingrown toenail. The authors retrospectively reviewed radiographs of 81 patients with ingrown toenails and compared them with 100 healthy subjects regarding forefoot alignment. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured, and feet were classified according to digital formula as Egyptian, Greek, and square. The mean HVA was 14.5° ± 5.0° in the case group and 13.2° ± 5.9° in the control group. The mean IMA was 9.1° ± 2.5° in the case group and 8.6° ± 3.1° in the control group. The mean IPA was 11.9° ± 4.1° in the case group and 12.0° ± 5.1° in the control group. There was no statistically significant difference between the groups regarding HVA, IMA, or IPA (P = .123, P = .198, and P = .925, respectively). The distribution of foot types between groups was also similar (P = .967). This study has failed to demonstrate any abnormality in forefoot alignment in patients with symptomatic ingrowing toenails, and it is suggested that treatment should not be based on the correction of the anatomy if no abnormality exists.

Aneurysmal bone cyst of the fifth metacarpal

Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor that even more rarely involves the bones of the hand. Various treatment options for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. Due to its rarity in the hand, no evidence-based treatment regimen has been established. A 21-year-old man presented with a history of pain and local swelling over his fifth metacarpal of 5 months' duration. Physical and radiographic examination of the hand was consistent with aneurysmal bone cyst. After biopsy, pathologic examination confirmed the diagnosis of aneurysmal bone cyst. En-block resection of the tumor and autologous bicortical strut graft fixation with Kirschner wires was performed. The hand was immobilized in a short arm cast for 3 weeks after the patient received 3 weeks of physiotherapy. Kirschner wires were removed 6 weeks postoperatively. Excellent clinical and functional results were obtained with no recurrence after 3 years of follow-up with en-block resection and reconstruction with iliac crest graft. Radiographic examination demonstrated the osseous integration of the graft with no signs of recurrence. Although treatment should be planned individually according to lesion site and size and to patient age, we suggest en-block resection to prevent recurrence and secondary surgical interventions particularly in cases with no articular involvement.