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Hyer LC, Shull ER, Fray B, Westberry DE. Growth Charts for Children With Arthrogryposis Multiplex Congenita. Clin Pediatr (Phila) 2024; 63:541-550. [PMID: 37382242 DOI: 10.1177/00099228231182823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Children with arthrogryposis multiplex congenita (AMC) often demonstrate growth differences compared with typically developing (TD) children. However, growth charts have not been developed for this population. The purpose of this study was to create AMC-specific growth charts and to compare these values to those of TD children. A retrospective review of height/length and weight for 206 children with AMC was performed. Growth charts were developed and stratified over seven percentiles; these were then compared with growth charts of TD children. Children with AMC tend to be smaller in stature and weight compared with TD children, particularly in the first 36 months of life. Thereafter, weight values trend toward the 50th percentile of TD children, but height/length values persist around the 5th percentile of TD children. The development of AMC-specific growth charts provides health care providers an objective tool to evaluate growth patterns of patients with AMC.
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Affiliation(s)
- Lauren C Hyer
- Department of Orthopedics, Shriners Children's Greenville, Greenville, SC, USA
| | - Emily R Shull
- Department of Orthopedics, Shriners Children's Greenville, Greenville, SC, USA
| | - Bob Fray
- Furman University, Greenville, SC, USA
| | - David E Westberry
- Department of Orthopedics, Shriners Children's Greenville, Greenville, SC, USA
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Martell-Moran NK. Surgical excision of P3 fragments in 86 declawed cats: case series (2013-2023). J Feline Med Surg 2024; 26:1098612X241240331. [PMID: 38660961 DOI: 10.1177/1098612x241240331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
CASE SERIES SUMMARY This case series describes the clinical findings and surgical intervention of 86 declawed cats; 52 from a shelter or rescue and 34 owned cats. Historical reports from owners and shelter staff included house-soiling, biting behavior, repelling behavior, barbering, lameness, chronic digit infection and nail regrowth. All the cats had fragments of the third phalanx (P3) of varying sizes diagnosed on radiographs. Pathology visible on examination included digital subcutaneous swelling, ecchymosis, malaligned digital pads, ulcerations, exudate, tendon contracture, nail regrowth and callusing. Surgery was pursued in these cases to remove the P3 fragments, relieve tendon contracture and reposition the digital pads with an anchoring suture. Gross findings intraoperatively included fragmented growth of cornified and non-cornified nail tissue, osteophytes on the surface of the second phalanx, deep digital flexor tendon calcification, and both bacterial and sterile exudate. The most common complication 14 days postoperatively was mild (14%) to moderate (1%) lameness. All historical parameters recorded improved in both populations of cats (house-soiling, biting behavior, repelling behavior, barbering, lameness, tendon contracture and chronic digit infection). Postoperatively, 1/47 cats exhibited continued malalignment of two digital pads and there were no reports of long-term postoperative lameness. RELEVANCE AND NOVEL INFORMATION Two methods of declawing cats are detailed in the veterinary literature, including partial amputation of P3 and disarticulation of the entire P3 bone. The novel information in this report includes historical and clinical signs of declawed cats with P3 fragments, intraoperative gross pathology, surgical intervention and the postoperative follow-up results.
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Ergani HM, Yalçın Topçuoğlu E, Yaşar B, Akgün AE, Acicbe O, Akın M, Erkin Ünlü R, Yastı AÇ. Physical Medicine Applications in Hand Burns: Treatment or Rehabilitation. J Burn Care Res 2024; 45:98-103. [PMID: 37638523 DOI: 10.1093/jbcr/irad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 08/29/2023]
Abstract
The aim of this study is to investigate the contribution of concurrent physical therapy to the preservation of hand function in patients with hand burns. This retrospective cohort study included the records of adult patients who presented with hand burns between July 1, 2020, and December 1, 2021. A total of 67 of 1578 burn patients who attended the clinic were included in this study. The patients' age, sex, total BSA with burns, causative agent, depth of burn on the hand, right or left hand, location of the burned area on the hand, treatment applied, healing time of the burn on the hand, limitation of movement, the joint restrictions, contractures, and compliance with physical therapy were assessed and recorded. Among the 67 patients included, 82.1% (n = 55) had no limitation in terms of their joint range of motion, whereas 17.9% (n = 12) had a limitation of movement in their finger joints. When the prevalence of movement limitation was examined by gender, such limitation was found to be more common in females (P = .041). Moreover, contractures were found to occur more frequently in patients with full-thickness burns (P = .032). It was also found that the limitation of movement was more severe in patients with skin grafts (P = .044). In addition, it was observed that the recovery time of the burn area was longer in those patients who had movement limitations (P = .004). In this study, we found that applying early physical therapy to patients after burn injuries facilitated the recovery of hand functions.
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Affiliation(s)
- Hasan Murat Ergani
- Department of Plastic Reconstructive and Aesthetic Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Elif Yalçın Topçuoğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Burak Yaşar
- Department of Plastic Reconstructive and Aesthetic Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ali Emre Akgün
- Department of General Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Okan Acicbe
- Department of Plastic Reconstructive and Aesthetic Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Merve Akın
- Department of General Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ramazan Erkin Ünlü
- Department of Plastic Reconstructive and Aesthetic Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Çınar Yastı
- Department of General Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Ahmad F, Fitch A, Obioha OA, Fernandez JJ, Cohen MS, Simcock X, Wysocki RW. Traction Tenolysis for Flexor Tendon Adhesions: Outcomes in 97 Patients. J Hand Surg Am 2024; 49:65.e1-65.e6. [PMID: 35940997 DOI: 10.1016/j.jhsa.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 03/31/2022] [Accepted: 05/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Traction tenolysis is an alternative, less invasive way of performing flexor tendon tenolysis by winding affected tendons around a surgical instrument. This study assessed outcomes and complications in a cohort of patients who underwent traction tenolysis to determine its effectiveness. METHODS We retrospectively reviewed 97 patients who underwent traction tenolysis performed by 4 fellowship-trained hand surgeons from 2010 to 2019. We collected data on preoperative and postoperative ranges of motion, the number and type of prior ipsilateral hand surgeries, and the duration of therapy and follow-up. Cases of traditional open tenosynovectomy tenolysis were excluded. RESULTS Approximately two-thirds of the patients achieved more than 75% of the normal total active motion, and 80% achieved at least 50% of the normal total active motion. The mean total active flexion increased significantly by 42° and passive flexion by 25°. The differences in active and passive flexion significantly decreased from 28° before the surgery to 9° after the surgery. The active and passive flexion of the distal interphalangeal and proximal interphalangeal joints improved similarly, at approximately 20° and 10°, respectively. The average duration of follow-up was 11 ± 8 weeks. The complication rate was 5%: 1 case of intraoperative flexor digitorum superficialis tendon rupture, 1 case of postoperative infection, and 3 reoperations because of failure to progress. CONCLUSIONS Traction tenolysis is an alternative to traditional open tenolysis surgery in selected patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Farhan Ahmad
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
| | - Ashlyn Fitch
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Obianuju A Obioha
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - John J Fernandez
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Xavier Simcock
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Robert W Wysocki
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Bhagwani RS, Phansopkar P, Jagzape MV, Karanjkar SM, Nandanwar RR. Tailored Physical Therapy in a Case of Tenotomy Post Hip Flexion Deformity With Structural Scoliosis: A Case Report. Cureus 2024; 16:e52276. [PMID: 38357067 PMCID: PMC10864692 DOI: 10.7759/cureus.52276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/13/2024] [Indexed: 02/16/2024] Open
Abstract
Retroperitoneal tumours, mainly classified as malignant and benign, have a rare incidence. It includes major parts of the peritoneum, and surgical excision remains the optimal pathway to remove the tumour. As with any surgery, tumour resection comes with its own complications. These complications would manifest differently depending on patient adaptation or compensation for these drawbacks. Physiotherapy and its positive effects as a need after any surgical procedure become a boon when implemented as and when required. The present study describes the case of a 32-year-old woman who has complained of pain in her right hip for one year, along with forward-bending walking and difficulty sitting. The patient had a history of retroperitoneal tumour excision, after which, to compensate for the pain, she started walking by bending forward, which developed into a hip flexion deformity. The patient was managed by tenotomy and was referred to a physiotherapy outpatient (OPD) for further management. Our aim was to improve overall mobility through gait training and prevent relapses of the contracture.
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Affiliation(s)
- Ritika S Bhagwani
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Medhavi V Jagzape
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samruddhi M Karanjkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshni R Nandanwar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Stiller KR, Dafoe S, Jesudason CS, McDonald TM, Callisto RJ. Passive Movements Do not Appear to Prevent or Reduce Joint Stiffness in Medium to Long-Stay ICU Patients: A Randomized, Controlled, Within-Participant Trial. Crit Care Explor 2023; 5:e1006. [PMID: 38046936 PMCID: PMC10688772 DOI: 10.1097/cce.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVES ICU patients have an increased risk of joint stiffness because of their critical illness and reduced mobility. There is a paucity of evidence evaluating the efficacy of passive movements (PMs). We investigated whether PMs prevent or reduce joint stiffness in ICU patients. DESIGN A randomized, controlled, within-participant, assessor-blinded study. SETTING A 48-bed tertiary care adult ICU. PATIENTS Intubated patients who were expected to be invasively mechanically ventilated for greater than 48 hours with an ICU length of stay greater than or equal to 5 days, and unable to voluntarily move their limbs through full range of motion (ROM). INTERVENTIONS The ankle and elbow on one side of each participant's body received PMs (10 min each joint, morning and afternoon, 5 d/wk). The other side acted as the control. The PMs intervention continued for as long as clinically indicated to a maximum of 4 weeks. MEASUREMENTS The primary outcome was ankle dorsiflexion ROM at cessation of PMs. Plantarflexion, elbow flexion and extension ROM, and participant-reported joint pain and stiffness (verbal analog scale [VAS]) were also measured. Outcomes were recorded at baseline and cessation of PMs. For participants whose PMs intervention ceased early due to recovery, additional post-early-cessation of PMs review measurements were undertaken as near as possible to 4 weeks. MAIN RESULTS We analyzed data from 25 participants with a median (interquartile range) ICU stay of 15.6 days (11.3-25.4). The mean (95% CI) between-side difference for dorsiflexion ROM (with knee extension) at cessation of PMs was 0.4 degrees (-4.4 to 5.2; p = 0.882), favoring the intervention side, indicating there was not a clinically meaningful effect of 5 degrees. No statistically significant differences were found between the intervention and control sides for any ROM or VAS data. CONCLUSIONS PMs, as provided to this sample of medium to long-stay ICU patients, did not prevent or reduce joint stiffness.
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Affiliation(s)
- Kathy R Stiller
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Simone Dafoe
- Physiotherapy, Acute Care and Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christabel S Jesudason
- Physiotherapy, Orthopaedics, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tony M McDonald
- Physiotherapy, Spinal Injuries Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rocky J Callisto
- Physiotherapy, Acute Care and Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Li R, Zheng Y, Fan X, Cao Z, Yue Q, Fan J, Gan C, Jiao H, Liu L. Establishment and validation of a nomogram to predict the neck contracture after skin grafting in burn patients: A multicentre cohort study. Int Wound J 2023; 20:3648-3656. [PMID: 37245866 PMCID: PMC10588345 DOI: 10.1111/iwj.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023] Open
Abstract
Cervical burn contracture is one of the burn contractures with the highest incidence and severity, and there is no effective method to predict the risk of neck contracture. This study aimed to investigate the effect of combined cervicothoracic skin grafting on the risk of neck contracture in burn patients and to develop a nomogram to predict the risk of neck contracture after skin grafting in burn patients. Data from 212 patients with burns who underwent neck skin grafting were collected from three hospitals, and the patients were randomly divided into training and validation sets. Independent predictors were identified through univariate and multivariate logistic regression analyses and incorporated into a prognostic nomogram. Its performance was assessed using the receiver operating characteristic area under the curve, calibration curve, and decision curve analysis. Burn depth, combined cervicothoracic skin grafting, graft thickness, and neck graft size were significantly associated with neck contractures. In the training cohort, the nomogram had an area under the curve of 0.894. The calibration curve and decision curve analysis indicated good clinical applicability of the nomogram. The results were tested using a validation dataset. Combined cervicothoracic skin grafting is an independent risk factor for neck contracture. Our nomogram demonstrated excellent performance in predicting neck contracture risk.
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Affiliation(s)
- Rui Li
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Yangyang Zheng
- Department of General Surgery, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Xijuan Fan
- Department of Plastic SurgeryBeijing Ever Care Medical and Beauty HospitalBeijingChina
| | - Zilong Cao
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Qiang Yue
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Jincai Fan
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Cheng Gan
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Hu Jiao
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Liqiang Liu
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
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Fujimoto A, Mizuno K, Iwata Y, Yajima H, Nishida D, Komaki H, Ishiyama A, Mori-yoshimura M, Tachimori H, Kobayashi Y. Long-term Observation in Patients with Duchenne Muscular Dystrophy with Early Introduction of a Standing Program Using Knee-ankle-foot Orthoses. Prog Rehabil Med 2023; 8:20230038. [PMID: 37901357 PMCID: PMC10602754 DOI: 10.2490/prm.20230038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives This study investigated the outcomes of the early introduction of a standing program for patients with Duchenne muscular dystrophy (DMD). Methods This was a retrospective observational study of 41 outpatients with DMD aged 15-20 years. We introduced the standing program using knee-ankle-foot orthoses (KAFO) to slow the progression of scoliosis when ankle dorsiflexion became less than 0° in the ambulatory period. Results Thirty-two patients with DMD were offered the standing program with KAFO; 12 continued the program until the age of 15 years (complete group) and 20 discontinued the program before the age of 15 years (incomplete group). The non-standing program group included 9 patients. The standing program with KAFO was significantly associated with the Cobb angle at the age of 15 years after adjustment for the duration of corticosteroid use and DMD mutation type (P=0.0004). At the age of 15 years, significant correlations were found between the ankle dorsiflexion range of motion (ROM) and non-ambulatory period (P=0.0010), non-ambulatory period and Cobb angle (P<0.0001), Cobb angle and percent predicted forced vital capacity (P=0.0004), and ankle dorsiflexion ROM and Cobb angle (P=0.0066). In the complete group, the age at ambulation loss (log-rank P=0.0015), scoliosis progression (log-rank P=0.0032), and pulmonary dysfunction (log-rank P=0.0006) were significantly higher than in the non-standing program group. Conclusions The early introduction of a standing program for DMD patients may prolong the ambulation period and slow the progression of scoliosis and pulmonary dysfunction.
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Affiliation(s)
- Akiko Fujimoto
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yasuyuki Iwata
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation, National Hakone Hospital, Odawara, Japan
| | - Hiroyuki Yajima
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Daisuke Nishida
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Akihiko Ishiyama
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Madoka Mori-yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hisateru Tachimori
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Kobayashi
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation, National Hakone Hospital, Odawara, Japan
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Raymond-Pope CJ, Hoffman D, Bloxsom RM, Greising SM, Novacheck TF, Boyer ER. Medial Gastrocnemius Muscle Properties of Children With Cerebral Palsy After Different Tone Treatments: A Pilot Study. Am J Phys Med Rehabil 2023; 102:873-878. [PMID: 36897794 PMCID: PMC10485173 DOI: 10.1097/phm.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Spasticity in children with cerebral palsy can be managed by a spectrum of approaches, from conservative therapy, to temporary botulinum toxin A injections, to permanent transection of sensory nerves with a selective dorsal rhizotomy. This pilot study investigated whether these three tone management approaches are associated with histological and biochemical properties of the medial gastrocnemius. DESIGN A convenience sample of children with cerebral palsy undergoing gastrocnemius lengthening surgery was enrolled. Intraoperative biopsies were obtained from three individuals (one each: minimal tone treatment; frequent gastrocnemius botulinum toxin A injections; previous selective dorsal rhizotomy). All individuals had plantarflexor contractures, weakness, and impaired motor control before the biopsy. RESULTS Differences between participants were observed for muscle fiber cross-sectional area, fiber type, lipid content, satellite cell density, and centrally located nuclei. The most pronounced difference was the abundance of centrally located nuclei in the botulinum toxin A participants (52%) compared with the others (3-5%). Capillary density, collagen area and content, and muscle protein content were similar across participants. CONCLUSIONS Several muscle properties seemed to deviate from reported norms, although age- and muscle-specific references are sparse. Prospective studies are necessary to distinguish cause and effect and to refine the risks and benefits of these treatment options.
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Affiliation(s)
| | - Daniel Hoffman
- School of Kinesiology, University of Minnesota, Minneapolis MN 55455, USA
| | - Rachael M. Bloxsom
- School of Kinesiology, University of Minnesota, Minneapolis MN 55455, USA
| | - Sarah M. Greising
- School of Kinesiology, University of Minnesota, Minneapolis MN 55455, USA
| | - Tom F. Novacheck
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis MN 55455, USA
- Gillette Children’s Specialty Healthcare, St. Paul MN 55101, USA
| | - Elizabeth R. Boyer
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis MN 55455, USA
- Gillette Children’s Specialty Healthcare, St. Paul MN 55101, USA
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Tripathi MK, Tiwari T, Naithani B, Upadhyaya DN, Singh PR, Tripathi I. Clinical utility of i-gel ® and BlockBuster™ supraglottic devices for airway management in postburn injury contracture neck patients under general anesthesia: A randomized controlled trial. Int J Crit Illn Inj Sci 2023; 13:159-164. [PMID: 38292402 PMCID: PMC10824207 DOI: 10.4103/ijciis.ijciis_35_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 02/01/2024] Open
Abstract
Background Post burn injury contracture (PBC) neck patients pose a unique challenge for the anesthesiologists. The use of supraglottic device (SGDs) for managing such patients is being increasingly used. We compared i-gel® and LMA BlockBuster™ in PBC adult patients under general anesthesia (GA). Methods The study included 63 subjects with mild/moderate PBC neck of either sex with American Society of Anesthesiologists Physical Status I and II under GA. Patients with intraoral pathology, mouth opening <2.5 cm, and severe contracture were excluded. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups. The primary objective of the study was the time for successful insertion. First attempt success rate, oropharyngeal leak pressures (OLP), and complications were also assessed. Results Mean insertion time was significantly less in Group I as compared to Group B (17.35 ± 1.43 vs. 21.32 ± 1.10 s; P < 0.001), OLP in Group B was significantly higher as compared to Group I (34.03 ± 1.33 vs. 25.23 ± 3.04 cm of H2O; P < 0.001). Group I was found to be statistically easier to insert as compared to Group B (P = 0.011) with reduced requirement of airway maneuvering to insert the device (P = 0.017). Groups were similar in terms of complications. Conclusion SGDs are attractive option for airway management in mild/moderate degree of PBC neck. i-gel® having shorter insertion time with easier insertion can be favorable at times of emergency while use of LMA BlockBuster™ can be preferred to reduce the risk of aspiration owing to higher OLP.
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Affiliation(s)
- Manish Kumar Tripathi
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bhavya Naithani
- Department of Plastic and Reconstructive Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Divya Narain Upadhyaya
- Department of Plastic and Reconstructive Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Prem Raj Singh
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ila Tripathi
- Department of Ophthalmic Surgery, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
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11
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Chu Kwan W, den Otter-Moore I, Partanen A, Piorkowska K, Waspe AC, Drake JM. Noninvasive magnetic resonance-guided focused ultrasound for tendon disruption: an in vivo Animal study. Int J Hyperthermia 2023; 40:2260129. [PMID: 37743063 DOI: 10.1080/02656736.2023.2260129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE Surgical resection of the tendon is an effective treatment for severe contracture. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is a non-invasive ultrasonic therapy which produces a focal increase in temperature, subsequent tissue ablation and disruption. We evaluated MRgFUS as a clinically translatable treatment modality to non-invasively disrupt in vivo porcine tendons. MATERIAL AND METHODS In vivo Achilles tendons (n = 28) from 15-20kg Yorkshire pigs (n = 16) were randomly assigned to 4 treatment groups of 600, 900, 1200 and 1500 J. Pretreatment range of motion (ROM) of the ankle joint was measured with the animal under general anesthesia. Following MRgFUS treatment, success of tendon rupture, ROM increase, temperature, thermal dosage, skin burn, and histology analyses were performed. RESULTS Rupture success was found to be 29%, 86%, 100% and 100% for treatment energies of 600, 900, 1200 and 1500 J respectfully. ROM difference at 90° flexion showed a statistically significant change in ROM between 900 J and 1200 J from 16° to 27°. There was no statistical significance between other groups, but there was an increase in ROM as more energy was delivered in the treatment. For each of the respective treatment groups, the maximal temperatures were 58.4 °C, 63.3 °C, 67.6 °C, and 69.9 °C. The average areas of thermal dose measured were 24.3mm2, 53.2mm2, 77.8mm2 and 91.6mm2. The average areas of skin necrosis were 5.4mm2, 21.8mm2, 37.2mm2, and 91.4mm2. Histologic analysis confirmed tissue ablation and structural collagen fiber disruption. CONCLUSIONS This study demonstrated that MRgFUS is able to disrupt porcine tendons in vivo without skin incisions.
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Affiliation(s)
| | | | | | | | - Adam C Waspe
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Drake
- The Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Brown E, Kastner T, Harder J, Cox C, MacKay B. Flexor tenotomies for the treatment of bilateral wrist contracture after traumatic brain injury: A case report. Clin Case Rep 2023; 11:e7869. [PMID: 37744617 PMCID: PMC10517200 DOI: 10.1002/ccr3.7869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Traumatic brain injuries have the potential to cause the development of long-term complications. We aim to show that the use of flexor tenotomies in the treatment of flexion contractures following traumatic brain injury is a viable solution.
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Affiliation(s)
| | - Tyler Kastner
- Texas Tech University Health Sciences CenterLubbockTexasUSA
| | - Justin Harder
- Department of Orthopaedic Hand SurgeryTexas Tech University Health Sciences CenterLubbockTexasUSA
| | - Cameron Cox
- Department of Orthopaedic Hand SurgeryTexas Tech University Health Sciences CenterLubbockTexasUSA
| | - Brendan MacKay
- Department of Orthopaedic Hand SurgeryTexas Tech University Health Sciences CenterLubbockTexasUSA
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13
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Qiu B, Hammert W, Wilbur D. External Fixation Prior to Fasciectomy Leads to Substantial Improvement of Advanced Dupuytren's PIP Contractures at Mean Follow-up 15 Months. Hand (N Y) 2023:15589447231175512. [PMID: 37269101 DOI: 10.1177/15589447231175512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The Digit Widget is an external fixation device that can be used to reverse proximal interphalangeal joint (PIPJ) contractures in the hand. Our hypothesis is that usage of the Digit Widget prior to fasciectomy in patients with severe Dupuytren's proximal interphalangeal (PIP) contractures will result in short-term improvement and maintenance of the PIPJ contracture after fasciectomy. METHODS Patients who underwent placement of the Digit Widget soft tissue distractor prior to fasciectomy for Dupuytren's disease were identified between January 2015 and December 2018. Multiple fingers were considered separately. Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), Pain Interference, and Depression scores were collected. Patients treated for contractures from etiologies other than Dupuytren's were not included. Multiple linear regression was used to compare initial PIP contractures, PF scores, and final contractures. RESULTS There were 28 fingers in 24 patients with average age of 56 ± 12 (30.5-69.9) years. Initial mean PIPJ contracture was 81° (50°-120°), which had corrected to 23° at time of removal. Average time between application and fasciectomy was 58 (28-112) days. At final follow-up, average 449 (58-1641) days, the average contracture was 39° (0°-105°). Contracture immediately following fasciectomy was found to be strongly correlated with the contracture at final follow-up. There was no statistical relationship between final PROMIS PF scores and final change in contracture. CONCLUSIONS Digit Widget external fixation is an effective treatment for the correction of advanced PIPJ contractures related to Dupuytren's disease, with an average of 52% improvement in contracture at 15 months.
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Affiliation(s)
- Bowen Qiu
- University of Rochester Medical Center, NY, USA
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14
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Won SH, Kim SH, Lee YK, Chun DI, Lee BR, Kim WJ. A Neglected Extensor Hallucis Longus Tendon Rupture Caused by Arthritic Adhesion. Medicina (Kaunas) 2023; 59:1069. [PMID: 37374273 DOI: 10.3390/medicina59061069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Extensor hallucis longus tendon injury is relatively rare and is principally caused by a laceration when a sharp object is dropped on the instep. Primary suturing is possible if the injury is acute, but if the tear is chronic, tendon contracture causes the space between the edges of the tear to widen, disrupting the end-to-end connection. In particular, a claw toe or checkrein foot deformity may develop over time due to adhesion of the lower leg tendons near the fracture site or scar. We report on a 44-year-old man who visited our outpatient clinic complaining of pain in the right foot and a hindered ability to extend his great toe. He had enjoyed playing soccer during his schooldays; since that time, the extension of that toe had become somewhat difficult. T2-weighted sagittal magnetic resonance imaging revealed that the continuity of the extensor hallucis longus tendon had been lost at the distal phalangeal base attachment site, and that the region of the proximal tendon was retracted to level of the middle shaft of the proximal phalanx. The findings allowed us to diagnose extensor hallucis longus tendon rupture accompanying osteoarthritic changes in the joint and soft tissues. We performed surgical tenorrhaphy and adhesiolysis. This is a rare case of extensor hallucis longus tendon rupture caused by minor trauma. Arthritis that developed at a young age caused the adhesions. If patients with foot and ankle arthritis show tendon adhesion at the arthritic site, tendon rupture can develop even after minor trauma or intense stretching.
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Affiliation(s)
- Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea
| | - Sung Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Gyeonggi-do, Bucheon-si 14584, Republic of Korea
| | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Gyeonggi-do, Bucheon-si 14584, Republic of Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea
| | - Byung-Ryul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Sooncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Woo-Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Sooncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
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15
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Salmons HI, Payne AN, Taunton MJ, Owen AR, Fruth KM, Berry DJ, Abdel MP. Nonsteroidal Anti-Inflammatory Drugs and Oral Corticosteroids Mitigated the Risk of Arthrofibrosis After Total Knee Arthroplasty. J Arthroplasty 2023; 38:S350-S354. [PMID: 37011702 PMCID: PMC10430696 DOI: 10.1016/j.arth.2023.03.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The role of medications to prevent arthrofibrosis following total knee arthroplasty (TKA) remains unclear. We investigated the effect of common oral medications with reported antifibrotic properties on preventing arthrofibrosis and manipulation under anesthesia (MUA) following primary TKA. METHODS Using our total joint registry, 9,771 patients (12,735 knees) who underwent TKA with cemented, posterior-stabilized, and metal-backed tibial components from 2000 to 2016 were identified. Arthrofibrosis, defined as range of motion (ROM) ≤90° for ≥12 weeks postoperatively or as ROM ≤90° requiring MUA, was diagnosed in 454 knees (4%) and matched 1:2 to controls. Mean age was 62 years (range, 19 to 87) and 57% were women. The majority of operative diagnoses were osteoarthritis. Perioperative use of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins), angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), oral corticosteroids, antihistamines, and nonsteroidal anti-inflammatory drugs (NSAIDs) were manually confirmed. Medication effect in preventing arthrofibrosis and MUA was assessed using adjusted multivariable analyses. Mean follow-up was 8 years (range, 2 to 20). RESULTS Reduced risk of arthrofibrosis was associated with perioperative NSAID use (odds ratio (OR) 0.67, P = .045). A similar trend was observed with perioperative corticosteroids (OR 0.52, P = .098). Corticosteroids were associated with reduced risk of MUA (OR 0.26, P = .036), and NSAIDs trended towards reducing MUA (OR 0.69, P = .11). CONCLUSION This investigation determined that perioperative NSAID use was associated with reduced risk of arthrofibrosis and trended towards reduced risk of subsequent MUA. Similarly, oral corticosteroids were associated with reduced risk of MUA and trended towards reduced risk of arthrofibrosis.
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Affiliation(s)
- Harold I. Salmons
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Ashley N. Payne
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Michael J. Taunton
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Aaron R. Owen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Kristin M. Fruth
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234
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16
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Atwan Y, Abdulla I, Grewal R, Faber KJ, King GJW, Athwal GS. Indomethacin for Heterotopic Ossification Prophylaxis Following Surgical Treatment of Elbow Trauma: A Randomized Controlled Trial. J Shoulder Elbow Surg 2023; 32:1242-1248. [PMID: 36907317 DOI: 10.1016/j.jse.2023.02.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/15/2023] [Accepted: 02/04/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Heterotopic ossification is a frequent complication following surgical treatment of elbow trauma. The use of indomethacin to prevent heterotopic ossification is reported in the literature, however, its effectiveness is controversial. The purpose of this randomized, double blind, placebo-controlled study was to determine if indomethacin is effective in reducing the incidence and severity of heterotopic ossification after surgical management of elbow trauma. METHODS Between February 2013 and April 2018, 164 eligible patients were randomized to receive postoperative indomethacin or placebo medications. The primary outcome was to determine the incidence of heterotopic ossification on elbow radiographs at one year follow-up. Secondary outcomes included the Patient Rated Elbow Evaluation (PREE), the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder and Hand (DASH). Range of motion, complications and non-union rates were also obtained. RESULTS At one year follow-up, there was no significant difference in the incidence of heterotopic ossification in the indomethacin group (49%) compared to the control (55%) group (relative risk = 0.89; p = 0.52). There were no significant differences in postoperative PREE, MEPI, DASH scores or range of motion (p = 0.16). There was a 17% complication rate in both the treatment and control groups (p = 1). There were no non-unions in either group. CONCLUSION This level 1 study demonstrated that indomethacin prophylaxis against heterotopic ossification in surgically treated elbow trauma was not significantly different than placebo.
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Affiliation(s)
- Yousif Atwan
- Roth|MacFarlane Hand and Upper Limb Centre, London, ON, Canada; Division of Orthopaedic Surgery, Western University, London, ON, Canada; Western University (LHSC), 339 Windermere Road, Room B9-123, London, ON, Canada N6A 5A5.
| | - Irfan Abdulla
- Fraser Orthopaedic Institute, New Westminster, BC, Canada
| | - Ruby Grewal
- Roth|MacFarlane Hand and Upper Limb Centre, London, ON, Canada; Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Kenneth J Faber
- Roth|MacFarlane Hand and Upper Limb Centre, London, ON, Canada; Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Graham J W King
- Roth|MacFarlane Hand and Upper Limb Centre, London, ON, Canada; Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - George S Athwal
- Roth|MacFarlane Hand and Upper Limb Centre, London, ON, Canada; Division of Orthopaedic Surgery, Western University, London, ON, Canada
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17
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Ge X, Sun Y, Tang Y, Zhou F, Yao G, Su X. Flexible application of scar tissue flaps in scar contracture release surgery: A retrospective study. J Cosmet Dermatol 2023; 22:907-912. [PMID: 36374624 DOI: 10.1111/jocd.15505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/03/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Complete release of scar contracture often relies on surgery, but if the surgery injures normal skin tissue triggers new wounds and scarring, which adds insult to injury for the patient. OBJECTIVE To explore a method that uses scar tissue to repair the defect after the release of scars and try to avoid damage to normal skin tissue. MATERIALS AND METHODS Forty-eight scar contracture patients admitted to our hospital from October 2014 to October 2019 were treated with scar tissue flaps (including Subcutaneous pedicle rhomboid flap, Z-plasty flap, 5-flap, and their combination model) and minor defects in combination with little scattered skin grafts. Medical and demographic data were collected on each patient. Assessed the joint range of motion (ROM) preoperatively and postoperatively, and complication was recorded. The rate of scar contracture recurrence was recorded at a follow-up of 6-24 months. RESULTS Twenty-eight cases of scar contracture located in the joint sites, 20 in the trunk. All the surgical outcomes were satisfied, with significant improvement in contracture scarring and joint status. Postoperative joint range of motion (ROM) showed a significant improvement in comparison with preoperative mobility, whereas the difference was statistically significant (p < 0.05). After 24 months of follow-up, five joints showed recontraction, with a recurrence rate of 10.42%. CONCLUSION Scar contracture could be efficiently treated by properly designing incisions and making the most of the scar tissue flap, to minimize and avoid damage to the normal skin.
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Affiliation(s)
- Xiaojing Ge
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yute Sun
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Youzhi Tang
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fang Zhou
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yao
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Su
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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18
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Lage MHH, Pozavski JAR, Lamounier AR, de Melo EG. Bilateral patellar agenesis in dog: A case report. Anat Histol Embryol 2023; 52:197-203. [PMID: 36197313 DOI: 10.1111/ahe.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022]
Abstract
A bilateral patellar agenesis is an extremely rare congenital condition in which the patient does not develop both patellas and can present secondary alterations as bone, muscle and postural changes. There are some hypotheses that it has a genetic background presenting dominant characteristic. It is not yet standardized a gold treatment for this affection, but according to rare reports, clinical and surgical treatments are possible. This is a case report based on imagining exams of a mix breed male puppy that was born with bilateral patellar agenesis, an affection not yet reported in canine species.
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Affiliation(s)
- Maíra Harumi Higa Lage
- Department of Veterinary Clinical Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Júlia Augusta Rocha Pozavski
- Department of Veterinary Clinical Sciences, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil
| | - Alysson Rodrigo Lamounier
- Department of Veterinary Clinical Sciences, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil
| | - Eliane Gonçalves de Melo
- Department of Veterinary Clinical Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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19
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Gus E, Zhu J, Brooks SG. Postburn breast reconstruction: a scoping review. Scars Burn Heal 2023; 9:20595131231202100. [PMID: 37743873 PMCID: PMC10512695 DOI: 10.1177/20595131231202100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Introduction Postburn breast deformities pose functional and aesthetic concerns for burn patients, particularly when injury occurs before puberty, as normal breast development may be hindered. Postburn breast reconstruction aims at restoration of native anatomic features, as well as re-establishment of symmetry. The objectives of this scoping review are to map the literature on scar management and breast reconstruction, highlighting strategies that are particular to postburn deformities, as well as to establish optimal timing principles. Methods A comprehensive search of the English literature across MEDLINE and EMBASE databases, including the grey literature, was conducted. Literature of all study designs were eligible, provided it discussed the treatment of postburn breast deformities. Results A total of 64 studies were included. The most common study design was case series (58%) followed by retrospective cohorts (28%). Scar contracture release with split thickness skin grafts (26%) and various techniques for nipple-areola reconstruction (22%) were the most common reconstructive procedures. Discussion Scar contracture releases predominate when there is normal breast development under a contracted skin envelope, and should be performed as soon as breast mound development is restricted. Surgical techniques widely used for postmastectomy reconstruction are required for patients with amastia or hypoplastic breasts. Conclusion Given the heterogeneity of defects, availability of donor sites, and patient preference, no standardized guideline is available. Surgeons should combine basic scar management principles with postmastectomy techniques, adapting the surgical approach to features that are particular to thermally injured patients, as well as taking into account ideal timing considerations. Lay Summary Breast deformities secondary to burn scars pose functional and aesthetic concerns for burn patients, particularly when injury occurs before puberty, as normal breast development may be hindered. Postburn breast reconstruction aims at restoration of native anatomic features, as well as re-establishment of symmetry. This literature review aimed at summarizing the available techniques to treat postburn breast deformities, as well as establishing optimal timing guidelines, given these issues may occur at any phase of breast development. When there is breast development under a scarred skin envelope, treatment entails scar contracture release and should be recommended as soon as the diagnosis is established, in order to allow the breast to further develop in an unrestricted manner. When there is absence of breast tissue, surgical techniques widely utilized for breast cancer reconstruction are warranted, and should be delayed until no further breast development is expected. Given the heterogeneity of deformities, availability of donor sites, and patience preference, no standardized guideline is available. Treatment options include several surgical techniques, in addition to non-surgical scar management, and timing considerations must take into account the patient's developmental phase and psychosocial wellness.
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Affiliation(s)
- Eduardo Gus
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jane Zhu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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McNamara CT, Iorio ML, Greyson M. Concepts in soft-tissue reconstruction of the contracted hand and upper extremity after burn injury. Front Surg 2023; 10:1118810. [PMID: 37206342 PMCID: PMC10188946 DOI: 10.3389/fsurg.2023.1118810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Burns and their subsequent contracture result in devastating functional and aesthetic consequences which disproportionally affect the upper extremity. By focusing on reconstruction with analogous tissue and utilizing the reconstructive elevator, function can be restored concomitantly with form and aesthetic appearance. General concepts for soft-tissue reconstruction after burn contracture are presented for different sub-units and joints.
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21
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Iwahira Y, Nakagami G, Sanada H. Risk factors for capsular contracture after breast reconstruction with tissue expanders and silicone implants in nonirradiated patients: A retrospective observational cohort study. Medicine (Baltimore) 2022; 101:e31837. [PMID: 36482544 PMCID: PMC9726329 DOI: 10.1097/md.0000000000031837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Breast reconstruction surgery with tissue expanders and silicone implants is widely performed; however, risk factors for late complications such as capsular contracture have not been fully investigated despite their high prevalence. We investigated the association between expander and implant positions and the development of capsular contracture in patients who underwent breast reconstruction surgery over 10 years previously. In this retrospective observational study, we analyzed 239 patients, among whom 69 (28.9%) had developed capsular contracture of Baker Classification grade II or higher. The position of the expander was classified into six categories based on the inferior margin of the healthy breast. The position of the implant was defined as an upward movement from the position of the expander and was classified into three categories based on the inferior margin of the breast at the time of expander insertion. Using multivariate logistic regression analysis, we assessed whether the misalignment of the expander and silicone implant positions affected capsular contracture development. Both expander and implant positions were significantly different between the groups. The odds ratios, adjusted for confounding variables, were 3.4 and 5.2 for an expander position of 1 and 2 lateral fingers upward, respectively, and 4.8 and 45.4 for a silicone implant position of 2 and 3 lateral fingers upward, respectively. We identified malposition of expanders and silicone implants as risk factors for developing capsular contracture. Correct insertion and adequate dilatation of the expander in the correct position could reduce the risk for capsular contracture.
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Affiliation(s)
- Yoshiko Iwahira
- Breast Surgery Clinic, Tokyo, Japan
- * Correspondence: Yoshiko Iwahira, YCC Takanawa Bldg., 2, 3F, 2-21-43, Takanawa, Minato-ku, Tokyo 108-0074, Japan (e-mail: )
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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22
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Hems T. Natural history of elbow flexion and forearm rotation contractures in obstetric brachial plexus injury. J Hand Surg Eur Vol 2022; 47:1121-1127. [PMID: 36050833 DOI: 10.1177/17531934221121912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A prospective database study was undertaken to investigate the severity and progression of elbow and forearm contractures in patients with obstetric brachial plexus injury. One-hundred and fifty-nine patients, who had not undergone nerve repair (mean age 12 years at last follow-up) (56 Narakas Group 1, 66 Group 2, 27 Group 3, 10 Group 4) were studied. Mean fixed flexion of the elbow at last follow-up was 13° for Group 1, 15° for Group 2, 19° for Group 3 and 24° for Group 4. Severe contracture of 30° or more developed in 31 children (mean age 118 months), with poorer active shoulder abduction being a significant risk factor. Onset of contracture was before the age of 5 years but did not increase substantially beyond 12 years. Active and passive pronation and supination tended to decrease with increasing injury severity. Seventeen children developed severe restriction of passive pronation (supination contracture) (mean age 69 months), and 12 developed severe restriction of passive supination at a mean of 137 months.Level of evidence: III.
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Affiliation(s)
- Tim Hems
- Scottish National Brachial Plexus Injury Service, Queen Elizabeth University Hospital and Royal Hospital for Children, Glasgow, UK
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Moore LK, Lee CS, Agha O, Liu M, Zhang H, Dang ABC, Dang A, Liu X, Feeley BT. A novel mouse model of hindlimb joint contracture with 3D-printed casts. J Orthop Res 2022; 40:2865-2872. [PMID: 35266583 DOI: 10.1002/jor.25313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/21/2021] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Stiff joints formed after trauma, surgery or immobilization are frustrating for surgeons, therapists and patients alike. Unfortunately, the study of contracture is limited by available animal model systems, which focus on the utilization of larger mammals and joint trauma. Here we describe a novel mouse-based model system for the generation of joint contracture using 3D-printed clamshell casts. With this model system we are able to generate both reversible and irreversible contractures of the knee and ankle. Four- or 8-month-old female mice were casted for either 2 or 3 weeks before liberation. All groups formed measurable contractures of the knee and ankle. Younger mice immobilized for less time formed reversible contractures of the knee and ankle. We were able to generate irreversible contracture with either longer immobilization time or the utilization of older mice. The contracture formation translated into differences in gait, which were detectable using the DigiGait® analysis system. This novel model system provides a higher throughput, lower cost and more powerful tool in studying the molecular and cellular mechanisms considering the large existing pool of transgenic/knockout murine strains.
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Affiliation(s)
- Laura K Moore
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Carlin S Lee
- Department of Orthopedic Surgery, San Francisco VA Medical Center, San Francisco, California, USA
| | - Obiajulu Agha
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Mengyao Liu
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA.,Department of Orthopedic Surgery, San Francisco VA Medical Center, San Francisco, California, USA
| | - He Zhang
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA.,Department of Orthopedic Surgery, San Francisco VA Medical Center, San Francisco, California, USA.,Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Alan B C Dang
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA.,Department of Orthopedic Surgery, San Francisco VA Medical Center, San Francisco, California, USA
| | - Alexis Dang
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA.,Department of Orthopedic Surgery, San Francisco VA Medical Center, San Francisco, California, USA
| | - Xuhui Liu
- Department of Orthopedic Surgery, San Francisco VA Medical Center, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA.,Department of Orthopedic Surgery, San Francisco VA Medical Center, San Francisco, California, USA
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24
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Abstract
AIMS The conventionally described mechanism of distal biceps tendon rupture (DBTR) is of a 'considerable extension force suddenly applied to a resisting, actively flexed forearm'. This has been commonly paraphrased as an 'eccentric contracture to a flexed elbow'. Both definitions have been frequently used in the literature with little objective analysis or citation. The aim of the present study was to use video footage of real time distal biceps ruptures to revisit and objectively define the mechanism of injury. METHODS An online search identified 61 videos reporting a DBTR. Videos were independently reviewed by three surgeons to assess forearm rotation, elbow flexion, shoulder position, and type of muscle contraction being exerted at the time of rupture. Prospective data on mechanism of injury and arm position was also collected concurrently for 22 consecutive patients diagnosed with an acute DBTR in order to corroborate the video analysis. RESULTS Four videos were excluded, leaving 57 for final analysis. Mechanisms of injury included deadlift, bicep curls, calisthenics, arm wrestling, heavy lifting, and boxing. In all, 98% of ruptures occurred with the arm in supination and 89% occurred at 0° to 10° of elbow flexion. Regarding muscle activity, 88% occurred during isometric contraction, 7% during eccentric contraction, and 5% during concentric contraction. Interobserver correlation scores were calculated as 0.66 to 0.89 using the free-marginal Fleiss Kappa tool. The prospectively collected patient data was consistent with the video analysis, with 82% of injuries occurring in supination and 95% in relative elbow extension. CONCLUSION Contrary to the classically described injury mechanism, in this study the usual arm position during DBTR was forearm supination and elbow extension, and the muscle contraction was typically isometric. This was demonstrated for both video analysis and 'real' patients across a range of activities leading to rupture.Cite this article: Bone Jt Open 2022;3(10):826-831.
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Affiliation(s)
- Christopher Jukes
- University Hospitals Sussex, Brighton, UK,Correspondence should be sent to Christopher Jukes. E-mail:
| | | | | | | | - Joideep Phadnis
- University Hospitals Sussex, Brighton, UK,Brighton & Sussex Medical School, Brighton, UK
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25
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Muacevic A, Adler JR. Difficult Airway Management in a Patient With Post-burn Contracture Neck. Cureus 2022; 14:e30011. [PMID: 36348892 PMCID: PMC9637244 DOI: 10.7759/cureus.30011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
During reconstructive interventions in patients presenting with severe post-burn mento-sternal scar contracture, securing the airway forms a critical part of management. Extreme contracture is more likely to develop in patients who have had thoracic burns with ascending involvement of the neck and mandibular region. When cervical hyperextension and elevation of the mandible are impeded, post-burn contracture of the neck might render endotracheal intubation difficult. The development of rigid scar tissue that distorts the laryngeal and mandibular anatomy, or the development of microstomia following scar tissue retraction in facial burns, may make alternative approaches to direct laryngoscopy challenging. In patients with healed neck burns, intubation difficulties should be anticipated, and equipment for aiding intubation should be kept ready. Furthermore, a surgeon must be present throughout anesthesia induction in case an emergency neck release is required. Although the role of awake fiberoptic intubation has been well established in the general population, it is yet to be assessed in patients with burns. In this report, we present a case of successfully managed post-burn contracture that was planned for awake fiberoptic intubation.
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26
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Abstract
This systematic review investigates complications and recurrence of Dupuytren's contracture in metacarpophalangeal joints (MCPJs) and/or proximal interphalangeal joints (PIPJs) of fingers treated with collagenase clostridium histolyticum (CCH). A review of the literature on Dupuytren's disease was performed using PRISMA guidelines. Included publications described complications and/or recurrences for contractures ≥20° in MCPJs and/or PIPJs treated with CCH. Successful treatments reduced contractures to ≤5° immediately. Treatment-related adverse events (AEs) were classified as minor, major surgical, and major nonsurgical. Contracture recurrence involved return of fixed-flexion contracture ≥20° in a successfully treated finger in patients with ≥12 months of follow-up. Of 2675 patients (3753 joints), 94% experienced ≥1 treatment-related AE, most commonly peripheral edema (64%), pain in extremity (53%), and contusion (51%). Major surgical complications occurred in 9 patients (1.0%). Major nonsurgical complications occurred in 2 patients, specifically nonrupture tendon injury and anaphylaxis. Of 1488 patients (2069 joints), recurrences were reported in 23% of successfully treated joints (n = 466; 20% MCPJs, 28% PIPJs), on average 12 to 24 months after treatment. MCPJs achieved greater success than PIPJs in initial contracture reduction (77% versus 36%). CCH is a safe, effective treatment to improve hand function in Dupuytren's contracture. Most AEs are minor and self-resolving, although the risk of major AEs still exists. Following treatment, 23% of successfully treated joints experience recurrence, typically within 12 to 24 months but sometimes as early as 6 months. Surgeons are encouraged to discuss these risks with patients for shared decision-making regarding optimal treatment modalities.
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Affiliation(s)
| | | | | | | | | | - Leon Nesti
- Uniformed Services University of the
Health Sciences, Bethesda, MD, USA
| | - John C. Dunn
- William Beaumont Army Medical Center, El
Paso, TX, USA
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27
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Özden E, Mert M, Özçelik İB. Soft Tissue Management and Tibialis Posterior Tendon Transfer in Acute Correction for Neglected Drop Foot Deformity. J Foot Ankle Surg 2022; 61:615-620. [PMID: 35248446 DOI: 10.1053/j.jfas.2021.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/22/2021] [Accepted: 10/13/2021] [Indexed: 02/03/2023]
Abstract
Acute correction of rigid drop foot deformity can be problematic due to the skin defect that may occur in the medial part of the ankle. The purpose of this study is to present an innovative solution for this problem. We hypothesized that acute correction for rigid ankle contractures without arthrosis might be possible if the medial skin defect could be closed. Therefore, we described a surgical technique for acute functional correction of rigid drop foot deformities. The closure of the medial defect was performed by applying a flap and partial-thickness skin graft. We have retrospectively evaluated the results of 18 patients who were treated between 2010 and 2016 with this technique. The mean age of the patients was 37 ± 9.5 (22-56) years. Foot drop etiology was firearm-related nerve injury. Corrections were performed after 14.6 ± 7.9 (8-38) months following the injury. At the end of an average follow-up period of 44.4 ± 6.2 (37-60) months, 14 of 18 patients (78%) recovered without complications, 3 patients experienced partial loss in the medial skin graft region, and 1 patient developed a superficial infection. None of the patients have developed pes planus. We observed that the ankle flexion contracture, which was 34° ± 9.2° (20°-50°) preoperatively, could reach an average of 2.2° ± 2.5° (0°-6°) dorsiflexion after surgery. We suggest that acute correction and tibialis posterior tendon transfer in the treatment of rigid foot drop deformity can be performed with an effective skin closure with low soft tissue complications.
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Affiliation(s)
- Erdem Özden
- Surgeon, Department of Orthopedic Surgery and Traumatology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, İstanbul, Türkiye.
| | - Murat Mert
- Surgeon, Associate Professor, Department of Orthopedic Surgery and Traumatology, Yeniyyüzyıl University Gaziosmanpaşa Hospital, İstanbul, Türkiye
| | - İsmail Bülent Özçelik
- Surgeon, Professor, Department of Hand and Reconstructive Microsurgery, Yeniyyüzyıl University Gaziosmanpaşa Hospital, İstanbul, Türkiye
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28
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Iyer C, Soletti AB. Lived Experiences of Adult Burn Survivors with Post-Burn Contractures. Soc Work Public Health 2022; 37:209-223. [PMID: 34797206 DOI: 10.1080/19371918.2021.1997862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The article documents the life changes and challenges that are experienced by individuals who suffer from burns with long-lasting injury, and what are the available support mechanisms for these individuals. The experiences are drawn from a qualitative phenomenological inquiry conducted at a leading facility for burns treatment in Navi Mumbai, where people from across the country can access free non-cosmetic corrective surgery for burn-related contracture. In-depth interviews have been conducted with nine participants and three key informants. Burns are commonly experienced as a disabling phenomenon, with the repercussions being experienced in the activities of daily living, finances, social roles, and social participation. We have noted, not only the changes in physical and emotional self but also the difficulty in accepting the changed self. Traversing and negotiating the fragmented healthcare system has been a baffling experience that is riddled with expensive, complex, and protracted treatment procedures. The uncertainty around the prognosis and treatment are sources of distress for the participants and their families. The paper concludes by indicating the need and scope for social work interventions in the lived experiences of adult burn survivors.
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Affiliation(s)
- Chetana Iyer
- Center for Health and Mental Health, School of Social Work, Tata Institute of Social Sciences, Mumbai, India
| | - Asha Banu Soletti
- Center for Health and Mental Health, School of Social Work, Tata Institute of Social Sciences, Mumbai, India
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29
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Wang ML, Rajpar I, Ruggiero NA, Fertala J, Steplewski A, Beredjiklian PK, Rivlin MR, Chen Y, Feldman GJ, Fertala A, Tomlinson RE. Circulating inflammatory cytokines alter transcriptional activity within fibrotic tissue of Dupuytren's disease patients. J Orthop Res 2022; 40:738-749. [PMID: 33913534 DOI: 10.1002/jor.25059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
Dupuytren's disease is a benign fibroproliferative disorder of the hand that results in disabling digital contractures that impair function and diminish the quality of life. The incidence of this disease has been correlated with chronic inflammatory states, but any direct association between inflammatory cytokines and Dupuytren's disease is not known. We hypothesized that advanced fibroproliferation is associated with increased levels of circulating inflammatory cytokines. Blood and fibrotic cord tissue were collected preoperatively from patients with severe contracture and control patients. Blood plasma concentrations of known inflammatory cytokines were evaluated using a multiplex immunoassay. Proteins from the cord tissue were analyzed by RNA sequencing and immunohistochemistry. Moreover, collagen-rich cords were analyzed using Fourier-transform infrared spectroscopy. The results indicate that patients exhibited significantly elevated circulating inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin (IL)-2, and IL-12p70, as compared with controls. Similarly, IL-4 and IL-13 were detected significantly more frequently in Dupuytren's disease as compared with control. RNA sequencing revealed 5311 differentially expressed genes and distinct clustering between diseased and control samples. In addition to increased expression of genes associated with fibroproliferation, we also observed upregulation of transcripts activated by inflammatory cytokines, including prolactin inducible protein and keratin intermediate filaments. IL-2, but not TNF-α, was detected in fibrotic cord tissue by immunohistochemistry. Finally, spectroscopic assays revealed a significant reduction of the collagen content and alterations of collagen cross-linking within the Dupuytren's disease tissues. In total, our results illustrate that patients with severe Dupuytren's disease exhibit substantially elevated circulating inflammatory cytokines that may drive fibroproliferation. Clinical Significance: The results from this study establish the basis for a specific cytokine profile that may be useful for diagnostic testing and therapeutic intervention in Dupuytren's disease.
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Affiliation(s)
- Mark L Wang
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Ibtesam Rajpar
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas A Ruggiero
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jolanta Fertala
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrzej Steplewski
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pedro K Beredjiklian
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Michael R Rivlin
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Yong Chen
- Department of Molecular and Cellular Biosciences, Rowan University, Glassboro, New Jersey, USA
| | - George J Feldman
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrzej Fertala
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan E Tomlinson
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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30
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Owen AR, Dagneaux L, Limberg AK, Bettencourt JW, Bayram B, Bolon B, Berry DJ, Morrey ME, Sanchez-Sotelo J, van Wijnen AJ, Abdel MP. Biomechanical, histological, and molecular characterization of a new posttraumatic model of arthrofibrosis in rats. J Orthop Res 2022; 40:323-337. [PMID: 33871082 PMCID: PMC8523596 DOI: 10.1002/jor.25054] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
Experimental analyses of posttraumatic knee arthrofibrosis utilize a rabbit model as a gold standard. However, a rodent model of arthrofibrosis offers many advantages including reduced cost and comparison with other models of organ fibrosis. This study aimed to characterize the biomechanical, histological, and molecular features of a novel posttraumatic model of arthrofibrosis in rats. Forty eight rats were divided into two equal groups. An immobilization procedure was performed on the right hind limbs of experimental rats. One group was immobilized for 4 weeks and the other for 8 weeks. Both groups were remobilized for 4 weeks. Limbs were studied biomechanically via assessment of torque versus degree of extension, histologically via whole knee specimen, and molecularly via gene expression of posterior capsular tissues. Significant differences were observed between experimental and control limbs at 4 N-cm of torque in the 4-week (knee extension: 115° ± 8° vs. 169° ± 17°, respectively; p = 0.007) and 8-week immobilization groups (knee extension: 99° ± 12° vs. 174° ± 9°, respectively; p = 0.008). Histologically, in each group experimental limbs demonstrated increased posterior capsular thickness and total area of tissue when compared to control limbs (p < 0.05). Gene expression values evaluated in each group were comparable. This study presents a novel rat model of arthrofibrosis with severe and persistent knee contractures demonstrated biomechanically and histologically. Statement of clinical significance: Arthrofibrosis is a common complication following contemporary total knee arthroplasties. The proposed model is reproducible, cost-effective, and can be employed for translational investigations studying the pathogenesis of arthrofibrosis and efficacy of neoadjuvant pharmacologic agents.
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Affiliation(s)
- Aaron R. Owen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Louis Dagneaux
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Banu Bayram
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark E. Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,Corresponding author and requests for reprints author (Matthew P. Abdel, M.D.),
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31
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Averin AS, Nenov MN, Starkov VG, Tsetlin VI, Utkin YN. Effects of Cardiotoxins from Naja oxiana Cobra Venom on Rat Heart Muscle and Aorta: A Comparative Study of Toxin-Induced Contraction Mechanisms. Toxins (Basel) 2022; 14:88. [PMID: 35202116 PMCID: PMC8878657 DOI: 10.3390/toxins14020088] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
Cardiotoxins (CaTxs) are a group of snake toxins that affect the cardiovascular system (CVS). Two types (S and P) of CaTxs are known, but the exact differences in the effects of these types on CVS have not been thoroughly studied. We investigated cellular mechanisms of action on CVS for Naja oxiana cobra CaTxs CTX-1 (S-type) and CTX-2 (P-type) focusing on the papillary muscle (PM) contractility and contraction of aortic rings (AR) supplemented by pharmacological analysis. It was found that CTX-1 and CTX-2 exerted dose-dependent effects manifested in PM contracture and AR contraction. CTX-2 impaired functions of PM and AR more strongly than CTX-1. Effects of CaTxs on PM were significantly reduced by nifedipine, an L-type Ca2+ channel blocker, and by KB-R7943, an inhibitor of reverse-mode Na+/Ca2+ exchange. Furthermore, 2-aminoethoxydiphenyl borate, an inhibitor of store-operated calcium entry, partially restored PM contractility damaged by CaTxs. The CaTx influence on AR contracture was significantly reduced by nifedipine and KB-R7943. The involvement of reverse-mode Na+/Ca2+ exchange in the effect of CaTxs on the rat aorta was shown for the first time. The results obtained indicate that CaTx effects on CVS are mainly associated with disturbance of transporting systems responsible for the Ca2+ influx.
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Affiliation(s)
- Alexey S. Averin
- Institute of Cell Biophysics of the Russian Academy of Sciences, Federal Research Center “Pushchino Scientific Center of Biological Research of the Russian Academy of Sciences”, 142290 Pushchino, Russia;
| | - Miroslav N. Nenov
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, 142290 Pushchino, Russia;
| | - Vladislav G. Starkov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997 Moscow, Russia; (V.G.S.); (V.I.T.)
| | - Victor I. Tsetlin
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997 Moscow, Russia; (V.G.S.); (V.I.T.)
| | - Yuri N. Utkin
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997 Moscow, Russia; (V.G.S.); (V.I.T.)
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32
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Ours CA, Biesecker LG, Darling TN. Progression of skin lesions in Warburg-Cinotti syndrome. JAAD Case Rep 2022; 20:47-49. [PMID: 35036505 PMCID: PMC8749210 DOI: 10.1016/j.jdcr.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Christopher A Ours
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Leslie G Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Thomas N Darling
- Department of Dermatology, Uniformed Services University, Bethesda, Maryland
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33
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Duong T, Canbek J, Fernandez-Fernandez A, Henricson E, Birkmeier M, Siener C, Rocha CT, McDonald C, Gordish-Dressman H. Knee Strength and Ankle Range of Motion Impacts on Timed Function Tests in Duchenne Muscular Dystrophy: In the Era of Glucocorticoids. J Neuromuscul Dis 2021; 9:147-159. [PMID: 34719507 DOI: 10.3233/jnd-210724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Duchenne Muscular Dystrophy (DMD) is a neuromuscular disorder that presents in childhood and is characterized by slowly progressive proximal weakness and lower extremity contractures that limit ambulatory ability [1, 2]. Contractures develop in the ankles, knees, and hips due to muscle imbalances, fibrotic changes, loss of strength, and static positioning [2, 5]. Currently, standards of care guidelines emphasize the importance of maintaining good musculoskeletal alignment through stretching, bracing, and glucocorticoid (GC) therapy to preserve strength and function. METHODS This is a retrospective analysis of prospectively collected data through the CINRG Duchenne Natural history study (DNHS). The objectives of this analysis are to understand the progression of ankle contractures for individuals with DMD and to investigate the relationship between progressive lower limb contractures, knee strength, and Timed Function Tests.A collection of TFTs including supine to stand (STS), 10 meter walk test (10MWT), and timed stair climbing (4SC) have been used to monitor disease progression and are predictive of loss of ambulation in these patients [4]. Multiple factors contribute to loss of ambulation, including progressive loss of strength and contracture development that leads to changing biomechanical demands for ambulation. A better understanding of the changes in strength and range of motion (ROM) that contribute to loss of function is important in a more individualized rehabilitation management plan. In this longitudinal study, we measured strength using quantitative muscle testing (QMT) with the CINRG Quantitative Measurement System (CQMS)), ROM was measuresed with a goniometer and TFTs were measured using a standard stopwatch and methodology. RESULTS We enrolled 440 participants; mean baseline age was 8.9 (2.1, 28.0) years with 1321 observations used for analysis. GC use was stratified based on duration on drug with 18.7%at < 6 months or naïve; 4.3%<1 year; 58.0%1 < 10 years; and 19.3%between 10-25 years of GC use. Ankle ROM was better for those on GC compared to GC naive but did not significantly influence long-term progression rates. QMT, ROM, age and GCs contribute to speed of TFTs. Knee extension (KE) strength and Dorsiflexion (DF) ROM are significant predictors of speed for all TFTs (p < 0.001). Of the variables used in this analysis, KE strength is the primary predictor of walking speed, estimating that every pound increase in KE results in a 0.042 m/s improvement in 10MWT, and a smaller similar increase of 0.009 m/s with every degree of ankle DF ROM. CONCLUSION GC use provides an improvement in strength and ROM but does not affect rate of change. Knee strength has a greater influence on speed of TFTs than DF ROM, although both are statistically significant predictors of speed. Results show that retaining knee strength [1, 2], along with joint flexibility, may be important factors in the ability to perform walking, climbing and supine to stand activities.
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Affiliation(s)
- Tina Duong
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Rehabilitation, Stanford Healthcare, Stanford, CA, USA
| | - Jennifer Canbek
- Physical Therapy Department, Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - Erik Henricson
- University of California, Davis, Department of Neurology, Sacramento, CA USA
| | - Marisa Birkmeier
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Catherine Siener
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Carolina Tesi Rocha
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Craig McDonald
- University of California, Davis, Department of Neurology, Sacramento, CA USA
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34
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ŞENAYLI A, ÇANKAYA G, ÖZTORUN Cİ, OFLAZ H, ŞENEL E. Clinical trials of 3D printing splints to avoid contracture development in burned children. Turk J Med Sci 2021; 51:2543-2553. [PMID: 34174795 PMCID: PMC8742488 DOI: 10.3906/sag-2104-170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background/aim We evaluated the feasibility of producing splints with 3D printer technology to prevent contractures in burned children in our clinical prospective study. Materials and methods After approvals, children with burns greater than 2nd degree were included in the study. Age, sex, burn percentages, printing time, filament types, number of filament trials, splint suitability, patient and doctor comments, preclinical trials’ significances and financial impact were evaluated statistically. Results Seventy-six trials were conducted on 18 patients. Fourteen of the patients were male and 4 are female. Average ages of boys and girls were 5 and 3, respectively. Burn percentage was 36.9 ± 13. Polylactic acid (PLAFlex), polyurethane (PolyFlex), semiflexible copolyester (nGenFlex), and thermoplastic polyurethane (TPU) were the main filaments that were used in the study. Printing time differed from 4 to 29 h according to body regions. Splints were suitable for 81.25% in upper extremity, for 66.7% in lower extremity, and for 100% in mouth. Burn percentage was significantly correlated with total number of filament (p = 0.049). Other statistical evaluations were insignificant. Conclusion The 3D printer seems to be useful in children with burns. However, difficulties caused by some reasons like production must be overcome. By increasing clinical experience, this emerging custom-made technology may become standard, and documented problems can be solved.
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Affiliation(s)
- Atilla ŞENAYLI
- Department of Pediatric Surgery, Faculty of Medicine, Yıldırım Beyazıt University, AnkaraTurkey
| | - Güven ÇANKAYA
- Department of Material Engineering, Faculty of Engineering, Yıldırım Beyazıt University, AnkaraTurkey
| | - Can İhsan ÖZTORUN
- Department of Pediatric Surgery, Faculty of Medicine, Yıldırım Beyazıt University, AnkaraTurkey
| | - Hakan OFLAZ
- Department of Bioengineering, Faculty of Engineering, Gebze Technical University, KocaeliTurkey
| | - Emrah ŞENEL
- Department of Pediatric Surgery, Faculty of Medicine, Yıldırım Beyazıt University, AnkaraTurkey
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Goh GS, Zeng GJ, Chen JY, Lo NN, Yeo SJ, Liow MHL. Preoperative Flexion Contracture Does Not Compromise the Outcomes and Survivorship of Medial Fixed Bearing Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:3406-3412. [PMID: 34090691 DOI: 10.1016/j.arth.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the expanding indications for unicompartmental knee arthroplasty (UKA), the classic indication that limits flexion contracture to <5° in fixed bearing UKA excludes most patients with arthritic knees and has not been challenged in modern literature. This study compared the clinical outcomes between patients with severe flexion contracture and controls undergoing UKA. METHODS Eighty seven medial fixed bearing UKAs performed in patients with severe (≥15°) flexion contracture were matched 1:1 with 87 controls without flexion or recurvatum deformity (-5°<extension<5°) using propensity scores to control for age, sex, BMI, Charlson comorbidity index, ASA class, and baseline patient-reported outcome measures (PROMs). Perioperative outcomes were recorded. Range of motion, Knee Society Score, Oxford Knee Score, SF-36, and patient satisfaction were assessed at 6 months and 2 years. Survivorship was recorded at mean 11.5 ± 3.2 years. RESULTS Preoperative knee extension in the control and contracture groups was 0.9° ± 1.9° and 18.0° ± 3.5° (P < .001), respectively, whereas flexion was 122.8° ± 27.9° and 120.6° ± 13.6° (P = .502). The contracture group had poorer Knee Society functional (P = .023) and SF-36 physical score (P = .010) at 6 months. However, there was no difference in PROMs at 2 years. A similar proportion achieved the minimal clinically important difference for each PROM and was satisfied with surgery. Range of motion remained poorer in the contracture group and a higher percentage had residual contractures (P < .001). Ten-year survivorship was 94% and 97% in the control and contracture groups, respectively (P = .145). CONCLUSION Although patients with severe flexion contractures had a poorer range of motion and postoperatively, these patients attained comparable PROMs, satisfaction rates, and mid-term survivorship after UKA. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Gerald J Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Jerry Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital
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36
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Nevin JL, King GJW. Synovial sarcoma of the elbow presenting with painful stiffness: a case report. Shoulder Elbow 2021; 13:677-682. [PMID: 34804217 PMCID: PMC8600674 DOI: 10.1177/1758573220972074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022]
Abstract
Elbow stiffness is a challenging problem for the upper extremity surgeon to treat. It can significantly impact the patient's function in activities of daily living. While the most common etiologies are post-traumatic or secondary to arthritis, a large variety of etiologies should be considered with atypical presentations. It is important that the upper-extremity surgeon have a systematic approach to the diagnosis and management of elbow contracture in order to ensure malignant processes are considered. We present an unusual case of a young patient with atraumatic, non-arthritic elbow stiffness whose underlying diagnosis was a synovial sarcoma, as well as a review of the literature and differential for elbow stiffness. Level of evidence: IV.
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Affiliation(s)
| | - Graham JW King
- Graham JW King, Roth McFarlane Hand and
Upper Limb Centre, St. Joseph’s Health Centre, D0-213 - 268 Grosvenor St,
London, ON, Canada N6A 4V2.
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37
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Dutta G, Dey S, Singh S, Rai A, Bhattacharya R. Versatility Of Square Flaps In Post-Burn Contractures Involving Upper Limb. Ann Burns Fire Disasters 2021; 34:259-263. [PMID: 34744542 PMCID: PMC8534307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 06/13/2023]
Abstract
Post-burn contractures are a common problem and functionally limiting for upper limbs. Many different techniques have been described in the literature for their treatment. Z-plasty and release with SSG cover are the commonest procedures done for post-burn contractures. In this study we assess the use of the square flap technique in post-burn contractures of upper limb. Eleven patients with a total number of twelve upper limb contractures (mild to moderate) involving axilla, elbow and finger underwent release by standard square flap technique. All cases were followed up for at least 6 months and analyzed for range of motion and aesthetic outcome. Patient and surgeon satisfaction was recorded. All operated cases achieved a satisfactory range of movement post-operatively without any recurrence. The number of patients who were satisfied with the surgery were 7 out of 11, and 4 patients were somewhat satisfied with the results obtained. In contrast, the surgeons were satisfied in all cases. Square flap is shown to be an easy and reliable flap for mild to moderate contractures of the anterior or posterior axillary folds, elbow contractures and finger contractures with low recurrence rate.
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Affiliation(s)
- G. Dutta
- 1RG Kar Medical College and Hospital, Kolkata, India
| | - S. Dey
- 2NRS Medical College and Hospital, Kolkata, India
| | - S. Singh
- 3Mayo Institute of Medical Sciences, Barabanki, India
| | - A. Rai
- 1RG Kar Medical College and Hospital, Kolkata, India
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Hirase T, Suresh R, Cotton MO, Han A, Burn MB, Harris JD, Liberman SR. Percutaneous Needle Fasciotomy versus Collagenase Injection for Dupuytren's Contracture: A Systematic Review of Comparative Studies. J Hand Microsurg 2021; 13:150-156. [PMID: 34511831 DOI: 10.1055/s-0040-1721876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction The purpose of this study was to review and compare clinical outcomes between percutaneous needle fasciotomy (PNF) and collagenase Clostridium histolyticum (CCH) injection for the treatment of Dupuytren's contracture. Materials and Methods A systematic review was performed including all level I-III evidence studies investigating the clinical outcomes of PNF and CCH injection in the treatment of Dupuytren's contracture. Results Five studies (278 CCH patients, 225 PNF patients; 285 CCH fingers, 246 PNF fingers, 405 males, and 98 females) were analyzed. Two randomized studies were level I evidence, one randomized study was level II, and two nonrandomized studies were level III. Two studies analyzed a total of 205 patients, each demonstrating statistically superior outcomes in one outcome measure (contracture improvement and Michigan Hand Questionnaire (MHQ) satisfaction subscore) with PNF, while the remaining three studies demonstrated no significant differences in outcomes between the two techniques. Three studies reported a statistically higher rate of minor complications (local pain, edema, ecchymosis, lymphadenopathy, pruritis) with CCH, while the remaining two studies demonstrated no significant difference in complication rates. Conclusion For the treatment of Dupuytren's contracture, there is some evidence that suggests superior clinical outcomes of PNF compared with CCH and a higher minor complication rate with CCH.
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Affiliation(s)
- Takashi Hirase
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Rishi Suresh
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Michael O Cotton
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Alex Han
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Matthew B Burn
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Shari R Liberman
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
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Owen AR, Tibbo ME, van Wijnen AJ, Pagnano MW, Berry DJ, Abdel MP. Acquired Idiopathic Stiffness After Contemporary Total Knee Arthroplasty: Incidence, Risk Factors, and Results Over 25 Years. J Arthroplasty 2021; 36:2980-2985. [PMID: 33879331 PMCID: PMC8292170 DOI: 10.1016/j.arth.2021.03.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Acquired idiopathic stiffness (AIS) remains a common failure mode of contemporary total knee arthroplasties (TKAs). The present study investigated the incidence of AIS and manipulation under anesthesia (MUA) at a single institution over time, determined outcomes of MUAs, and identified risk factors associated with AIS and MUA. METHODS We identified 9771 patients (12,735 knees) who underwent primary TKAs with cemented, modular metal-backed, posterior-stabilized implants from 2000 to 2016 using our institutional total joint registry. Mean age was 68 years, 57% were female, and mean body mass index was 33 kg/m2. Demographic, surgical, and comorbidity data were investigated via univariate Cox proportional hazard models and fit to an adjusted multivariate model to access risk for AIS and MUA. Mean follow-up was 7 years. RESULTS During the study period, 456 knees (3.6%) developed AIS and 336 knees (2.6%) underwent MUA. Range of motion (ROM) increased a mean of 34° after the MUA; however, ROM for patients treated with MUA was inferior to patients without AIS at final follow-up (102° vs 116°, P < .0001). Significant risk factors included younger age (HR 2.3, P < .001), increased tourniquet time (HR 1.01, P < .001), general anesthesia (HR 1.3, P = .007), and diabetes (HR 1.5, P = .001). CONCLUSION Acquired idiopathic stiffness has continued to have an important adverse impact on the outcomes of a subset of patients undergoing primary TKAs. When utilized, MUA improved mean ROM by 34°, but patients treated with MUA still had decreased ROM compared to patients without AIS. Importantly, we identified several significant risk factors associated with AIS and subsequent MUA. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Aaron R. Owen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Meagan E. Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905,Department of Biochemistry and Molecular Biology, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Mark W. Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905,Corresponding author and requests for reprints author (Matthew P. Abdel, M.D.):
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Houwen-van Opstal SLS, van den Elzen YMEM, Jansen M, Willemsen MAAP, Cup EHC, De Groot IJM. Facilitators and Barriers to Wearing Hand Orthoses by Adults with Duchenne Muscular Dystrophy: A Mixed Methods Study Design. J Neuromuscul Dis 2021; 7:467-475. [PMID: 32568104 PMCID: PMC7592678 DOI: 10.3233/jnd-200506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: To retard shortening of finger flexors in patients with Duchenne muscular dystrophy (DMD), hand orthoses are prescribed. However, many patients do not wear the orthoses regularly. To optimize orthotic interventions, we need insight into the factors influencing compliance. Objective: To evaluate the compliance regarding hand orthoses in an adult DMD population and to explore experiences and perceptions of DMD patients wearing orthoses, and of their caregivers. Methods: Mixed methods observational study, combining quantitative and qualitative data from medical charts combined with qualitative semi-structured interviews using a constant comparative method and a short validated questionnaire (D-QUEST). Results: 65 medical charts were analyzed. 48 patients were assessed as needing hand orthoses, of whom 37.5 % were compliant. Qualitative data analyses revealed (1) motivation: preservation of hand function; (2) barriers: discomfort and impediments; (3) facilitators: good fit and personalized wearing schedule; (4) fitting process: satisfactory, but patients do not readily seek help when barriers appear. Conclusions: Patients are motivated to wear hand orthoses, but often discontinue use because of orthosis-and disease-specific barriers. The identification of these barriers leads to practical and feasible recommendations concerning the orthoses and the fitting process, such as less rigid material, preservation of some function while wearing the orthoses, and fixed evaluation points. The findings were confirmed by the D-QUEST.
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Affiliation(s)
- S L S Houwen-van Opstal
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Y M E M van den Elzen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Jansen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M A A P Willemsen
- Amalia Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E H C Cup
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I J M De Groot
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
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Noskovicova N, Hinz B, Pakshir P. Implant Fibrosis and the Underappreciated Role of Myofibroblasts in the Foreign Body Reaction. Cells 2021; 10:1794. [PMID: 34359963 DOI: 10.3390/cells10071794] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
Body implants and implantable medical devices have dramatically improved and prolonged the life of countless patients. However, our body repair mechanisms have evolved to isolate, reject, or destroy any object that is recognized as foreign to the organism and inevitably mounts a foreign body reaction (FBR). Depending on its severity and chronicity, the FBR can impair implant performance or create severe clinical complications that will require surgical removal and/or replacement of the faulty device. The number of review articles discussing the FBR seems to be proportional to the number of different implant materials and clinical applications and one wonders, what else is there to tell? We will here take the position of a fibrosis researcher (which, coincidentally, we are) to elaborate similarities and differences between the FBR, normal wound healing, and chronic healing conditions that result in the development of peri-implant fibrosis. After giving credit to macrophages in the inflammatory phase of the FBR, we will mainly focus on the activation of fibroblastic cells into matrix-producing and highly contractile myofibroblasts. While fibrosis has been discussed to be a consequence of the disturbed and chronic inflammatory milieu in the FBR, direct activation of myofibroblasts at the implant surface is less commonly considered. Thus, we will provide a perspective how physical properties of the implant surface control myofibroblast actions and accumulation of stiff scar tissue. Because formation of scar tissue at the surface and around implant materials is a major reason for device failure and extraction surgeries, providing implant surfaces with myofibroblast-suppressing features is a first step to enhance implant acceptance and functional lifetime. Alternative therapeutic targets are elements of the myofibroblast mechanotransduction and contractile machinery and we will end with a brief overview on such targets that are considered for the treatment of other organ fibroses.
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Abstract
Background: In spastic paresis, the respective contributions to active function of antagonist hypoextensibility, spasticity, and impaired descending command remain unknown. Objectives: We explored correlations between ambulation speed and coefficients of shortening, spasticity and, weakness for three lower limb extensors.Methods: This retrospective study identified 140 subjects with chronic hemiparesis (>6 months since injury) assessed during a single visit with barefoot 10-meter ambulation at comfortable and fast speed, and measurements of passive range of motion (XV1), angle of catch at fast stretch (XV3) and active range of motion (XA) against the resistance of gastrocnemius, rectus femoris, and gluteus maximus. Coefficients of shortening (CSH=[XN-XV1]/XN; XN, normal expected amplitude based on anatomical values), spasticity (CSP=[XV1-XV3]/XV1), and weakness (CWK=[XV1-XA]/XV1) were derived. For each muscle, multivariable analysis explored CSH, CSP, and CWK as potential predictors of ambulation speed.Results: Ambulation speed was 0.62±0.28m/s (mean±SD, comfortable) and 0.84±0.38m/s (fast) and was correlated with CSH and CWK against gastrocnemius (CSH, comfortable, ns; fast, β=-0.20, p=.03; CWK, comfortable, β=-0.21, p=.010; fast, β=-0.21, p =.012), rectus femoris (CSH, comfortable, β=-0.41, p=6E-7; fast, β=-0.43, p=5E-7; CWK, comfortable, β=-0.36, p=5E-5; fast, β=-0.33, p=.0003) and gluteus maximus (CSH, comfortable, β=-0.19, p=.02; fast, β=-0.26, p=.002; CWK, comfortable, β=-0.26, p=.002; fast, β=-0.22, p=.010). Ambulation speed was not correlated with CSP.Conclusions: In chronic hemiparesis, ambulation speed correlates with coefficients of shortening and of weakness in lower limb extensors, but not with their spasticity level. This may encourage therapists to focus treatment primarily on muscle shortening by stretching programs and on impaired descending command by active training.
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Affiliation(s)
- Mouna Ghédira
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP).,EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Maud Pradines
- EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Valentina Mardale
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP)
| | - Jean-Michel Gracies
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP).,EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Nicolas Bayle
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP).,EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Emilie Hutin
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP).,EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
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Terziqi H, Sopjani I, Gjikolli B, Muqaj G, Mustafa M. Algorithms For Management Of Post-Burn Contracture In Upper Extremity In Children. Ann Burns Fire Disasters 2021; 34:192-198. [PMID: 34584510 PMCID: PMC8396151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 06/13/2023]
Abstract
The aim of this study is to describe the management and outcome of surgical treatment for post burn contractures in different parts of the upper extremities in children, and provide a final decision algorithm that can be a useful guide for the Resident regarding surgical approach to contracture management. This was a retrospective study conducted in the Clinic of Plastic and Reconstructive Surgery, Pristina-Kosovo, between 2014-2016. All cases continued check ups in the Gentiana-Grelor private clinic in Pristina until 2019. Followups were conducted for no less than 6 months with respect to the viability and healing of the repaired area. Patients of both genders, aged from 0 months to 18 years with post-burn contracture in upper extremity, were included in the study. For the sake of presentation, we divided them anatomically into four main areas: axilla, elbow, wrist and hand. We start with a reconstructive ladder using skin grafts (STSG, FTSG), and local flaps such as advancement flaps, Z-plasties, V-Y or Y-V advancement flap, abdonimal/groin pedicled flap, cross finger flap, radial forearm flap were used. Patients were called for follow-up lasting a minimum of one to up to three years. The study included 144 patients. Their age ranged from 9 months to 18 years, the mean age being 12 years. Ordering them by location, post-burn contracture percentage in upper extremity in children was 68% on the hands, 18% on the elbows, 8% on the axilla and 6% on the wrist. A classification and treatment algorithm aids in achieving significant improvements in both joint motions and aesthetic deformities.
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Affiliation(s)
- H Terziqi
- Clinic of Plastic Surgery, University Clinic Centre Pristina, Kosovo
- Clinic of Gentiana-Grelor, Pristina, Kosovo
- AAB College, Pristina, Kosovo
| | | | - B Gjikolli
- AAB College, Pristina, Kosovo
- Radiology Clinic, University Clinic Centre Pristina, Kosovo
| | - G Muqaj
- Clinic of Gentiana-Grelor, Pristina, Kosovo
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Nishizawa H, Nakamura A. Changes in motor function in Duchenne muscular dystrophy patients after travel restrictions due to COVID-19. Muscle Nerve 2021; 64:357-361. [PMID: 34105182 PMCID: PMC8242363 DOI: 10.1002/mus.27348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 11/20/2022]
Abstract
Introduction/Aim This retrospective study aimed to quantify the changes in motor function in patients with Duchenne muscular dystrophy (DMD) due to the government‐imposed travel restrictions associated with the coronavirus disease 2019 (COVID‐19) pandemic. Methods Twelve DMD patients were enrolled in this investigation (mean ± SD age: 9.8 ± 3.6 y). Their physical characteristics and motor function were evaluated approximately 3 mo before, immediately before, and approximately 3 mo after the travel restrictions were decreed. Statistical comparisons were performed of the changes in motor function before and after the travel restrictions. Results The change in range of motion (ROM) of ankle dorsiflexion was significantly decreased after the travel restrictions. Changes in body mass index and other motor function parameters were not significant. Discussion An apparent decrease in the amount of physical activity due to travel restrictions in response to COVID‐19 negatively affected ankle dorsiflexion ROM but not other motor functions. A more sedentary lifestyle and lack of regular physical therapy services most likely contributed to this reduction. The use of remote rehabilitation tools with the involvement of physiotherapists may help mitigate such changes and prevent more severe physical decline.
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Affiliation(s)
- Hitomi Nishizawa
- Faculty of Health Sciences, Department of Medicine, Shinshu University, Matsumoto, Japan
| | - Akinori Nakamura
- Department of Neurology, National Hospital Organization Matsumoto Medical Center, Matsumoto, Japan.,Third Department of Internal Medicine, School of Medicine, Shinshu University, Matsumoto, Japan
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Lim J, Lietman C, Grol MW, Castellon A, Dawson B, Adeyeye M, Rai J, Weis M, Keene DR, Schweitzer R, Park D, Eyre DR, Krakow D, Lee BH. Localized chondro-ossification underlies joint dysfunction and motor deficits in the Fkbp10 mouse model of osteogenesis imperfecta. Proc Natl Acad Sci U S A 2021; 118:e2100690118. [PMID: 34161280 PMCID: PMC8237619 DOI: 10.1073/pnas.2100690118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a genetic disorder that features wide-ranging defects in both skeletal and nonskeletal tissues. Previously, we and others reported that loss-of-function mutations in FK506 Binding Protein 10 (FKBP10) lead to skeletal deformities in conjunction with joint contractures. However, the pathogenic mechanisms underlying joint dysfunction in OI are poorly understood. In this study, we have generated a mouse model in which Fkbp10 is conditionally deleted in tendons and ligaments. Fkbp10 removal substantially reduced telopeptide lysyl hydroxylation of type I procollagen and collagen cross-linking in tendons. These biochemical alterations resulting from Fkbp10 ablation were associated with a site-specific induction of fibrosis, inflammation, and ectopic chondrogenesis followed by joint deformities in postnatal mice. We found that the ectopic chondrogenesis coincided with enhanced Gli1 expression, indicating dysregulated Hedgehog (Hh) signaling. Importantly, genetic inhibition of the Hh pathway attenuated ectopic chondrogenesis and joint deformities in Fkbp10 mutants. Furthermore, Hh inhibition restored alterations in gait parameters caused by Fkbp10 loss. Taken together, we identified a previously unappreciated role of Fkbp10 in tendons and ligaments and pathogenic mechanisms driving OI joint dysfunction.
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Affiliation(s)
- Joohyun Lim
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
| | - Caressa Lietman
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
| | - Matthew W Grol
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
| | - Alexis Castellon
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
| | - Brian Dawson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
| | - Mary Adeyeye
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
| | - Jyoti Rai
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195
| | - MaryAnn Weis
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195
| | - Douglas R Keene
- Research Division, Shriners Hospital for Children, Portland, OR 97239
| | - Ronen Schweitzer
- Research Division, Shriners Hospital for Children, Portland, OR 97239
| | - Dongsu Park
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
| | - David R Eyre
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195
| | - Deborah Krakow
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095
| | - Brendan H Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030;
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Whittle J, Johnson A, Dobbs MB, Gurnett CA. Models of Distal Arthrogryposis and Lethal Congenital Contracture Syndrome. Genes (Basel) 2021; 12:genes12060943. [PMID: 34203046 PMCID: PMC8234565 DOI: 10.3390/genes12060943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/10/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022] Open
Abstract
Distal arthrogryposis and lethal congenital contracture syndromes describe a broad group of disorders that share congenital limb contractures in common. While skeletal muscle sarcomeric genes comprise many of the first genes identified for Distal Arthrogyposis, other mechanisms of disease have been demonstrated, including key effects on peripheral nerve function. While Distal Arthrogryposis and Lethal Congenital Contracture Syndromes display superficial similarities in phenotype, the underlying mechanisms for these conditions are diverse but overlapping. In this review, we discuss the important insights gained into these human genetic diseases resulting from in vitro molecular studies and in vivo models in fruit fly, zebrafish, and mice.
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Affiliation(s)
- Julia Whittle
- Department of Neurology, Washington University in St Louis, St Louis, MO 63130, USA;
| | - Aaron Johnson
- Department of Developmental Biology, Washington University in St Louis, St Louis, MO 63130, USA;
| | - Matthew B. Dobbs
- Paley Orthopaedic and Spine Institute, West Palm Beach, FL 33407, USA;
| | - Christina A. Gurnett
- Department of Neurology, Washington University in St Louis, St Louis, MO 63130, USA;
- Correspondence:
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Ammerman BM, Updegrove G, Ponnuru P, Armstrong A. Analysis of Long-Term Outcomes Following Surgical Contracture Release of the Elbow: A Case Series. Cureus 2021; 13:e14691. [PMID: 34055535 PMCID: PMC8152451 DOI: 10.7759/cureus.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Elbow contracture is a debilitating condition with an incidence ranging from as low as almost 1% to as high as 20% and results in significant limiting consequences on a patient’s activities of daily living (ADLs). Postoperative rehabilitation is important in maintaining the range of motion and sustaining an improved range of motion. The purpose of this study was to evaluate the long-term results of elbow contracture release surgery and the effect of an occupational therapy/physical therapy (OT/PT)-guided, self-directed rehabilitation program following surgery, without the use of continuous passive motion (CPM) devices. Methods We enrolled patients who had undergone elbow contracture release surgery from 2005 to 2016 at a single institution under the senior author. The evaluation included objective measurements of range-of-motion, strength, and neurological sensory testing. Provocative testing of the elbow and hand was performed. American Shoulder and Elbow Surgeons-elbow (ASES-e), Simple Shoulder Test-elbow (SST-e), Disabilities of the Arm and Shoulder (DASH), Mayo Elbow Performance Index (MEPI), Short Form-36 (SF-36), and an investigator questionnaire were completed. Results We enrolled 19 patients, six female and 13 male, with an average follow-up of 58.9 months (SD± 39.8, Range 22-117). We showed improvement and sustained motion between preoperative and postoperative research visit flexion (p<0.001) and flexion extension-arc (p<0.01). The mean increase in flexion was 98° to 131° and the flexion-extension arc was 36°. Patients were satisfied with the decision to undergo surgery and had sustained ability to complete ADLs. Discussion This patient cohort demonstrated a statistically significant increase, as well as long-term maintenance in the flexion and flexion-extension arc. A self-directed, OT/PT-guided, therapy program without CPM was effective. Patients showed good outcomes and were satisfied with their ability to perform ADLs, decreased pain, and the decision to undergo surgery.
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Affiliation(s)
- Brittany M Ammerman
- Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Gary Updegrove
- Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Padmavathi Ponnuru
- Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - April Armstrong
- Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Graham HK, Thomason P, Willoughby K, Hastings-Ison T, Stralen RV, Dala-Ali B, Wong P, Rutz E. Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study. Children (Basel) 2021; 8:252. [PMID: 33807084 PMCID: PMC8004848 DOI: 10.3390/children8030252] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 02/01/2023]
Abstract
This article presents a classification of lower limb musculoskeletal pathology (MSP) for ambulant children with cerebral palsy (CP) to identify key features from infancy to adulthood. The classification aims to improve communication, and to guide referral for interventions, which if timed appropriately, may optimise long-term musculoskeletal health and function. Consensus was achieved by discussion between staff in a Motion Analysis Laboratory (MAL). A four-stage classification system was developed: Stage 1: Hypertonia: Abnormal postures are dynamic. Stage 2: Contracture: Fixed shortening of one or more muscle-tendon units. Stage 3: Bone and joint deformity: Torsional deformities and/or joint instability (e.g., hip displacement or pes valgus), usually accompanied by contractures. Stage 4: Decompensation: Severe pathology where restoration of optimal joint and muscle-tendon function is not possible. Reliability of the classification was tested using the presentation of 16 clinical cases to a group of experienced observers, on two occasions, two weeks apart. Reliability was found to be very good to excellent, with mean Fleiss' kappa ranging from 0.72 to 0.84. Four-stages are proposed to classify lower limb MSP in children with CP. The classification was reliable in a group of clinicians who work together. We emphasise the features of decompensated MSP in the lower limb, which may not always benefit from reconstructive surgery and which can be avoided by timely intervention.
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Affiliation(s)
- H. Kerr Graham
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia;
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Pam Thomason
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
| | - Kate Willoughby
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Tandy Hastings-Ison
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
| | - Renee Van Stralen
- Department of Orthopedic Surgery, Sophia Children’s Hospital, Erasmus MC, 3015GD Rotterdam, The Netherlands;
| | - Benan Dala-Ali
- Orthopaedic Department, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK;
| | - Peter Wong
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Erich Rutz
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia;
- Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (P.T.); (T.H.-I.); (P.W.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
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Inoue S, Moriyama H, Wakimoto Y, Li C, Hatakeyama J, Wakigawa T, Sakai Y, Akisue T. Transcutaneous application of carbon dioxide improves contractures after immobilization of rat knee joint. Phys Ther Res 2021; 23:113-122. [PMID: 33489648 DOI: 10.1298/ptr.e10023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/13/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Joint contractures are a major complication following joint immobilization. However, no fully effective treatment has yet been found. Recently, carbon dioxide (CO2) therapy was developed and verified this therapeutic application in various disorders. We aimed to verify the efficacy of transcutaneous CO2 therapy for immobilization-induced joint contracture. METHOD Twenty-two Wistar rats were randomly assigned to three groups: caged control, those untreated after joint immobilization, and those treated after joint immobilization. The rats were treated with CO2 for 20 min once a daily either during immobilization, (prevention) or during remobilization after immobilization (treatment). Knee extension motion was measured with a goniometer, and the muscular and articular factors responsible for contractures were calculated. We evaluated muscle fibrosis, fibrosis-related genes (collagen Type 1α1 and TGF-β1) in muscles, synovial intima's length, and fibrosis-related proteins (Type I collagen and TGF-β1) in the joint capsules. RESULTS CO2 therapy for prevention and treatment improved the knee extension motion. Muscular and articular factors decreased in rats of the treatment group. The muscular fibrosis of treated rats decreased in the treatment group. Although CO2 therapy did not repress the increased expression of collagen Type 1α1, the therapy decreased the expression of TGF-β1 in the treatment group. CO2 therapy for treatment improved the shortening of the synovial membrane after immobilization and decreased the immunolabeling of TGF-β1 in the joint capsules. CONCLUSIONS CO2 therapy may prevent and treat contractures after joint immobilization, and appears to be more effective as a treatment strategy for the deterioration of contractures during remobilization.
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Affiliation(s)
- Shota Inoue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University
| | - Yoshio Wakimoto
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Changxin Li
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Junpei Hatakeyama
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Taisei Wakigawa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine
| | - Toshihiro Akisue
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University
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de Morais Filho MC, Fujino MH, Blumetti FC, Dos Santos CA, Kawamura CM, Ramos BCA, Lopes JAF. Comparison between semitendinosus transfer to distal femur and medial hamstrings surgical lengthening for treatment of flexed knee gait in cerebral palsy. J Orthop Surg (Hong Kong) 2020; 28:2309499020910978. [PMID: 32167417 DOI: 10.1177/2309499020910978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Hamstrings surgical lengthening (HSL) has been frequently used for the treatment of flexed knee gait in cerebral palsy; however, recurrence of knee flexion deformity (KFD) and increase of anterior pelvic tilt (APT) were reported in a long-term follow-up. RESEARCH QUESTION The aim of this study was to compare semitendinosus transfer to distal femur (STTX) and semitendinosus surgical lengthening (STL) regarding the reduction of KFD and the increase of APT after flexed knee gait treatment. METHODS One hundred and eleven patients were evaluated and they were divided into two groups according to surgical procedures at knees: group A (65 patients/130 knees), including patients who received medial HSL as part of multilevel approach; group B (46 patients/92 knees), represented by patients who underwent orthopedic surgery including an STTX instead of STL. RESULTS Fixed knee flexion deformity (FKFD) decreased only in group B (from 6.79° to 2.96°, p < 0.001) after intervention. In kinematics, APT increased from 16.38° to 19.03° in group A (p = 0.003), while group B also increased from 15.26° to 20.59° (p < 0.001). The minimum knee flexion in stance phase (MKFS) reduced from 25.34° to 21.65° (p = 0.016) in group A and from 31° to 19.57° (p < 0.001) in group B. In the comparison between groups A and B, the increase of APT (p = 0.028) and reduction of FKFD (p < 0.001), popliteal angle (p = 0.001), bilateral popliteal angle (p = 0.003) and MKFS (p = 0.006) were higher after STTX than STL. CONCLUSION In the present study, patients who received STTX exhibited more improvement of knee extension at clinical examination and during gait than those who underwent to STL; however, STTX was not effective to prevent the increase of APT after flexed knee gait treatment.
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Affiliation(s)
- Mauro César de Morais Filho
- Division of Pediatric Orthopedic Surgery, Gait Laboratory and Cerebral Palsy Clinic, Association for the Care of Disabled Children, São Paulo, Brazil
| | - Marcelo Hideki Fujino
- Division of Pediatric Orthopedic Surgery, Gait Laboratory and Cerebral Palsy Clinic, Association for the Care of Disabled Children, São Paulo, Brazil
| | - Francesco Camara Blumetti
- Division of Pediatric Orthopedic Surgery, Gait Laboratory and Cerebral Palsy Clinic, Association for the Care of Disabled Children, São Paulo, Brazil
| | - Carlos Alberto Dos Santos
- Division of Pediatric Orthopedic Surgery, Cerebral Palsy Group, Institute of Orthopedics and Traumatology of Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Cátia Miyuki Kawamura
- Division of Physical Therapy, Gait Laboratory, Association for the Care of Disabled Children, São Paulo, Brazil
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