Acta Orthopaedica Et Traumatologica Hellenica

Closed Reduction and Casting Versus K-wire Fixation of Gartland Type II Supracondylar Fracture Humerus in Children: Radiographic Outcome and Complications

2024-03-11T12:35:31+00:00

Background: Supracondylar fracture is the most common elbow fracture in children. There is substantial agreement on managing Gartland type I (conservative) and type III (operative) fractures. The treatment of type II fractures is still debatable. This study aimed to review the radiographic outcome and complications of type II supracondylar fractures in children treated by closed reduction & casting and closed reduction & K-wire fixation, respectively.
Methods: We retrospectively reviewed 61 children with type II fractures treated with closed reduction and casting (Group 1;32) and closed reduction K-wire fixation (Group 2;29). Radiographic outcomes and complications were analysed and compared between the two groups.
Results: Overall higher radiographic loss of reduction (LOR) was noted in group 1 compared to group 2 (40.62% vs 13.79%, p=0.0405). Higher LOR was observed in both IIA and IIB fractures in group 1, managed with closed reduction and casting (p=0.1257, p=0.0437).
We found higher LOR in group 1 with IIA fractures, where the anterior humeral line (AHL) was not intersected the capitellum (p=0.0224). We noted more complications in group 1 patients compared to group 2 (28.12% vs 17.24%, p=0.316), and most of these complications were due to reoperation following the loss of reduction.

Conclusion: Higher LOR and complications were noted in type II fractures managed by closed reduction and casting (Group 1) alone. Our study supports K-wire fixation in some cases of type IIA fracture, where the AHL is not intersecting the capitellum and in all cases of type IIB fractures.

Τhe role of the gastrocnemius muscle flap in the treatment of failed Total Knee Arthroplasty.

2024-03-11T12:39:54+00:00

ntroduction: Total knee arthroplasty (TKA), although generally a safe operation, fails in a small number of patients with substantial morbidity. Muscle flaps and especially the medial gastrocnemius offer a viable treatment option for limb salvage. The surgical technique is described and the senior author’s personal experience is reviewed.
Patients and methods: A retrospective study of patients treated with a medial gastrocnemius flap for failed TKA was conducted. Five patients were found, 4 female and one male. Mean age was 63.8 years (range, 38 – 85 years). Four patients were operated at the Middlesex and UCH Hospitals, London and one at Metropolitan General Hospital, Athens. All patients had a preexisting skin defect of the knee area with exposed tendon, bone and/or implant. The surgical technique used is briefly described. Postoperative antibiotics were administered to all patients for a minimum of 6 weeks.
Results: There were no flap or donor site complications. All flaps and skin grafts survived. One patient died at home five weeks postoperatively of unrelated causes. One patient presented with a wound breakdown three weeks after the flap operation. The defect was covered with a lateral tibial fasciocutaneous flap. The Oxford Knee Score improved in all patients.
Conclusion: The medial gastrocnemius muscle flap remains the first line of treatment of failed total knee arthroplasties. Early use of the flap is recommended in order to achieve the best possible outcome.

The Constraints-led Approach Framework in Training and Coaching.

2024-03-11T12:44:51+00:00

Movement “constraint” is defined as a variable that defines the way a movement can be organized and controlled. The “constraint model” emphasises the important interactions of individual constraints, environmental constraints, and those of skill - in a balanced perspective - and suggests that constraints can shape the manifestation of movement patterns, cognitive processes, and decision-making processes. According to the Constraints Model, any learning / teaching environment should be arranged in such a manner as to provide any learner with capability or protentional into movement. Therefore, in this way, each youngster will feel that they have accomplishing something, improving their perception of their abilities and, thus, their self-confidence. The application of the Constraint Model within PE can help to ‘shape’ young people who will progress in life with fluency and skill, will be creative and confident, and have acquired a deep understanding and knowledge of how they interact within a dynamic and ever constantly changing environment.

Surgical versus non-surgical treatment of degenerative lumbar spondylolisthesis: systematic review of randomized control trials.

2024-03-11T12:48:17+00:00

Background: The best management for degenerative spondylolisthesis patients is still controversial. Low-grade spondylolisthesis without neurologic deficits used to be treated non-surgically as a first-line. Many studies stated that in patients with degenerative spondylolisthesis with or without spinal stenosis, surgery had superior outcomes. The aim of this systematic review was to describe the effectiveness of surgery versus conservative treatment for lumbar degenerative spondylolisthesis.
Methods: A comprehensive literature search was performed for relevant studies in Medline, EMBASE, CINAHL, Scopus, Centre for Review and Dissemination databases and Cochrane databases were searched. The search included English studies, and all conservative and surgical interventions were included.
Results: Two studies met the inclusion criteria. The number of patients was 650 (355 treated with surgical intervention and 295 treated conservatively). Surgery was found to be more effective than conservative care in the two studies.
Conclusion: Patients with lumbar degenerative spondylolisthesis treated with surgery had significantly better results in pain and function compared with patients treated with nonoperative treatment.
The study is retrospectively registered.
Level of evidence: II

Platelet Rich Plasma for the management of knee osteoarthritis: a review of biological role and potential mechanism of action

2024-03-11T12:26:22+00:00

Knee osteoarthritis (KOA) is a progressive degenerative disease characterised by joint cartilage damage, interindividual variation in clinical manifestations and severe end-stage clinical symptoms. It is one of the most common arthritis types, with increasing prevalence as life expectancy and obesity rise. It is quite a significant public health issue as it reduces physical function, causes chronic pain, and severely impacts the quality of life. The early and middle KOA stages are usually managed conservatively, and the end-stage KOA with knee arthroplasty. Emerging evidence suggests that platelet-rich plasma (PRP) has a potentially regenerative effect on various tissues. Intraarticular PRP has been shown to provide symptomatic relief in early KOA, at least as effective as hyaluronic acid and steroid injections. The combined effects of PRP positively impact inflammation, angiogenesis, cell migration and metabolism of many degenerative joints. However, the PRP’s biological activity and mechanism of action are not yet fully understood. This article aims to resume the critical evidence highlighting all reported biological, biochemical and cellular PRP actions in KOA to help physicians better understand this molecular treatment type.

Bilateral simultaneous bony skier’s thumb. A case report.

2024-03-11T12:51:41+00:00

Injuries of the thumb during winter sport activities usually occur amongst skiers, followed by snowboarders. Rupture of the ulnar collateral ligament (UCL) is most common injury, as a result of fall or an entrapment of the hand in a ski pole. We present a simultaneous bilateral bony rupture of the thumb UCL in a female recreational snowboarder, sustained after a simple fall during a snow ride. Surgical intervention with open reduction and stabilization with 1 mm Kirschner wires was performed at one time on both hands by the same orthopedic surgeon. A thumb plaster cast was applied for protection on either thumb. K-wires and the thumb cast were retained for a period of 4 weeks. The patient regained full function of her thumbs at 6 months postoperatively.

The echo of Silence

2024-03-11T12:19:40+00:00

We perceive the world around us through synapses, neurons, and cells. Nevertheless, some of us fall to the temptation of doubting their own senses, seeking comfort in technology and the “infallible” artificial intelligence. Others have reconciled the idea that they see the world through a peephole. Others do not even bother and instead they leave it all to the experts. Questions remain unanswered, creating the root of the question of the current paper: How do we define silence? How do we capture in words and shapes the complete absence of sound? Our senses fail to detect silence. However, they do prove able to describe the world that surrounds them. This is because, around the (apparent) absence of sounds, we witness events that require our attention and stimulate our thoughts. Through afterimages and aftermaths, we form our opinions on all things. There is no need to see the Higgs boson. We need only observe the effects of the actions of the energy derived from its existence. In the physical world, everything enlarges upon the field of human cognition, which constantly searches for ways to decode guarded secrets that define our own existence. It is thus worth to think about the labyrinths of comprehension in order to touch the essence of silence, carefully pondering the echo of its aftermath.

Spondylodiscitis: Surgical Treatment And Indications

2024-03-11T12:55:39+00:00

Spondylodiscitis is a serious infectious disease affecting the spine, causing inflammation of the vertebral bodies and intervertebral discs. It is caused by a bacterial infection and can lead to significant disability if left untreated. Initial management of the disease is conservative. Aiming to evaluate the indications and the methods of surgical management in patients with spondylodiscitis, a literature review was conducted searching the keywords: “spondylodiscitis” AND (“surgical treatment” OR ‘”surgical management” OR “indications”) on Pubmed database. The search included only prospective studies. Initially, 308 studies were identified after primary search. At last, 26 studies remained for analysis. The study concluded that indications for surgical treatment include neurological deficits, spinal instability, abscess formation and failure of conservative treatment. Surgical management includes debridement of the infected tissues and spinal fusion with instrumentation, through an anterior, a posterior or a combined approach. The choice of material for spinal support and enhancement of spinal fusion does not influence the clinical result.

The effects of hydrotherapy on people with cervical spinal cord injury

2024-03-11T13:01:50+00:00

The primary goal of this study was to systematically review the effects of hydrotherapy in individuals with cervical spinal cord injuries (SCI). The aim was to focus on results in the musculoskeletal, respiratory and cardiovascular systems, the effect on pain and spasticity, as well as the contribution of aquatic therapy to gait retraining and quality of life. Furthermore, it was considered important to identify gaps in the literature and suggest future studies of therapeutic intervention in the aquatic environment in the field of neurological rehabilitation for patients with SCI.

Hyperbaric oxygen therapy after spinal cord injury. A systematic literature review

2024-03-11T13:09:48+00:00

Hyperbaric oxygen therapy is the inhalation of 100% pure O2 at increased pressure, i.e. at ambient pressure greater than 1 atm. The basic principles of hyperbaric oxygen therapy (ΗΒΟΤ) are based on the way in which the various gases – and especially O2 - behave and act upon the tissues and fluids of the human body, under the influence of different conditions of volume and pressure. Spinal cord injury (SCI) is a very serious and complicated medical condition which greatly disrupts the patient’s life. Historically, this condition has been associated with very high morbidity and mortality rates.
In the present study, the latest research data on the effectiveness of this method regarding spinal cord injuries was studied. In order to achieve this purpose, the research tool of systematic literature review was chosen.
Discussion: The systematic literature review resulted in the detection of 13 relevant published articles after 2015. There were 3 randomized controlled studies, 2 non-randomized clinical studies, 4 case series and 4 case reports. In total, 557 patients participated in the study. The main result of the study was that HBOT is a totally safe and without any clinically significant side effects adjuvant therapy for the treatment of SCIs, producing various degrees of improvement of the motor and sensory neurological condition of the patients suffering from various types of SCIs, along with their psychological condition.
Conclusion: Hyperbaric oxygen treatment is a totally safe adjuvant treatment method for patients suffering from spinal cord injuries, having the potential to improve both the neurological status (motor and sensory) and the psychological condition of the affected patients. Further research is needed to obtain specific guidelines in relation to the indications and the application protocols of the method.

Physiotherapy interventions for enhancing neuroplasticity in people with spinal cord injuries: A systematic review of randomized control trials

2024-03-11T13:15:20+00:00

A systematic review of randomized control trials was conducted to provide an overview of the effectiveness of physiotherapy interventions for enhancing neuroplasticity and by extension functional recovery in people with SCI.
The appropriate MESH keywords were used in September of 2022 to search the global databases: PubMed, Science Direct, Cochrane and Scopus. In the review, only randomized controlled trials (RCTs) were included, which met the inclusion and exclusion criteria. The RCTs that were included in this review evaluate the effect of different physiotherapy interventions on neuroplasticity in people with spinal cord injuries. All studies were assessed for risk of bias using the Pedro scale.
In our study, we included 6 randomized control trials. Interventions such as massed practice with somatosensory stimulation, exercise with corticospinal neural stimulation, endurance training, intermittent hypoxia (IH) combined with Body weight supported treadmill training and paired transcranial direct current stimulation (tDCS) with Locomotor training with a robot-assisted gait orthosis (LT-RGO) were shown to enhance neuroplasticity and induce functional recovery in people with SCI. Therefore, further research needs to be done.

Activity-based therapy in infants with spinal cord injury, the impact on standing, quality of life and health

2024-03-11T13:20:12+00:00

Spinal cord-related injury treatment has been massively revamped recently by the principles of neuroplasticity, a fundamental principle of ABT which includes five practices such as: weight-bearing activities, FES, task-specific practice, massed practice, and locomotive training.
This study explores the state of activity-based therapy for different classes of people ranging from adults to infants and its impact on standing, quality of life and health. Herein, activity-based therapies will be explored alongside how they affect the condition of infant spinal cord injury later in life and also where clinicians and researchers should focus to improve protocols at this age.

Physiotherapeutic methods for promoting neuroplasticity in patients with multiple sclerosis.

2024-03-11T13:26:02+00:00

Multiple sclerosis (MS) is a disease of the central nervous system of autoimmune origin, characterized by inflammation, demyelination, gliosis (fibrous proliferation of the glial cells in the affected area) and finally, destruction of the neural cells (neural loss). Non pharmacological interventions for patients with MS focus primarily on physical and psychological rehabilitation.
Neuroplasticity can be defined as the ability of the brain to change, remodel and reorganize itself to obtain the ability to adapt to new situations. Although the concept of neuroplasticity is quite novel, it is one of the most important discoveries in neuroscience. The aim of the present scoping was to investigate and present the recent literature data regarding physiotherapeutic and other methods for promoting neuroplasticity in patients with multiple sclerosis.
In total, 102 relevant scientific papers (reviews, systematic reviews and original trials), published after 2010 were analyzed. The findings of the review are encouraging - a number of physiotherapeutic methods (such as therapeutic exercise or neurophysiological rehabilitation techniques, for example) appear to be effective in promoting neuroplasticity in patients with MS; on the other hand, the findings of newer and increasingly popular methods such as, for example, robotic – assisted rehabilitation are not clear.
However, as the relevant research is based on small and not always high quality clinical studies, it is clear that additional research is needed, with randomized controlled trials of sufficient statistical power in order to extract more solid scientific data.