OSG-Distorsion: Konservative Therapie der lateralen Bandläsion

Ankle sprains are among the most frequent injuries seen within a sportsmedical practice. Consequently, questions such as optimal treatment options (surgical vs. non-surgical), planing of specific physiotherapeutic therapies and timing of return to competition represent major challenges for the physician in charge. Therefore, immediate therapeutic management should focus on lace-up bracing, manual therapeutic joint mobilisation and sensorimotor training. In case of grade III-IV lesions or persistent instability after six month of non-surgical treatment surgical intervention might be re-evaluated. In order to make use of alternative non-surgical procedures such as PRP- or hyaluronic acid injections further research is needed.     

儿童肘内翻支具的设计与应用

目的研制一种旋转中心为尼龙66材质且可透过X线的儿童肘内翻支具,用于儿童肱骨髁上骨折并发肘内翻的预防性治疗。方法根据肘内翻发生机制并结合儿童的发病机理,对支具的外倾角、骨折端加压固方法、上臂和前臂的相对范围等关键点进行创新设计,并用solidworks三维软件制作三维图、工程图。结果该支具与患者手臂结合紧密,透过其尼龙主板可清晰看到骨骼断端,且患者无不适感,有效地对抗了肘内翻的发生。结论该支具的疗效明显,值得临床推广。     

Night-time braces for treatment of Adolescent Idiopathic Scoliosis

Purpose. This review article aims at providing an update on the basic science and clinical information underlying the use of nocturnal braces for adolescent idiopathic scoliosis.

Method. The National Institutes of Health online medical database (Medline) was used to retrieve all articles pertinent to clinical research on night-time bracing; data were also collected from manufacturing companies. Additional information was obtained from literature on pathomechanics of scoliosis.

Results. The cardinal feature of night-time braces lays in their ability to hypercorrect the scoliotic curvature, thereby eliminating the asymmetric water accumulation that occurs in the apical and adjacent intervertebral discs. Previously wedge-shaped discs resume a nearly cylindrical configuration, thus restoring a close-to-normal force application to the endplates through the Hueter-Volkmann principle and preventing curve progression. The two night-time braces mostly used hypercorrect the spine through different mechanisms.

Conclusions. On the basis of clinical results available, night-time braces constitute an attractive option for single-major lumbar/thoracolumbar curves not exceeding 35° in magnitude. Multi-center, randomized studies using strict criteria set forth by the Scoliosis Research Society (SRS) and the Society on Spinal Orthopaedic and Rehabilitation Treatment (SOSORT) are needed to better define the role of nocturnal bracing in the conservative treatment of adolescent idiopathic scoliosis.     

Effects of an ankle brace on the in vivo kinematics of patients with chronic ankle instability during walking on an inversion platform

BackgroundAs in vivo tibiotalar and subtalar joint kinematics are not currently known following the application of an ankle brace, an investigation of these kinematics may provide insight into the mechanisms of ankle braces.Research questionThis study aimed to determine the effect of an ankle brace on in vivo kinematics of patients with chronic ankle instability.MethodsEleven patients with chronic ankle instability were recruited in this study. A dual fluoroscopic imaging system and a solid modeling software were utilized to calculate the joint positions of the participants as they walked barefooted on a level platform, walked barefooted on a 15° inversion platform, and walked with an ankle brace on a 15° inversion platform. The joint positions during the three walking conditions were compared.ResultsTibiotalar joints were more inverted (pose 2, p = .004), and subtalar joints were more anteriorly translated (pose 2–6, p = .003), more plantarflexed (pose 2, p = .008; pose 3, p = .013; pose 5, p = .008; pose 6, p = .016) and more inverted (pose 1–5, p = .003; pose 6, p = .013) during barefooted walking on the inversion platform than during walking on the level platform. The inversion of subtalar joints was decreased after the brace application (pose 2–4, p = .003; pose 5, p = .004; pose 7, p = .016).SignificanceBrace application reduced the increased subtalar inversion induced by the inversion platform. Nevertheless, increased subtalar anterior translation and plantarflexion persisted after brace application. The ankle brace might be beneficial for clinical populations with increased subtalar inversion.     

Modified Broström repair with suture tape augmentation for lateral ankle instability: A systematic review

BackgroundThere is increasing interest in augmentation of modified Broström repairs for lateral ankle instability with a prosthetic reconstruction using suture tape internal bracing. The aim of this study was to investigate if suture tape augmentation resulted in improved clinical and radiological outcomes compared to a standard modified Broström repair alone.MethodsA systematic review following PRISMA guidelines was undertaken. All clinical studies published in Medline, Embase, Pubmed and the Cochrane Library Database from inception until January 2020 reporting on the use of suture tape augmentation to a modified Broström repair for lateral ankle instability.Results78 studies were identified of which 10 (assessing 333 patients) met the criteria for inclusion. Mean follow up was 24.8 months (range 6–52 months). All studies showed a statistically significant improvement across multiple clinical outcome measures post-surgery in both suture tape augmentation and modified Broström groups, however there were no statistically significant inter-group differences.Pooled results suggested there may be a reduction in recurrence of instability with suture tape augmentation when compared to modified Broström repair alone (p < 0.05). Overall quality of evidence was moderate to poor with limited data to support use of suture tape augmentation.ConclusionClinical and radiographic outcomes using a suture tape internal bracing for lateral ankle instability are excellent, and are equivalent to standard treatment across multiple clinical and radiographic assessment measures. There is minimal evidence to suggest functional outcomes are better, or recurrence rates are lower than modified Broström repair alone.PROSPERO REGISTRYCRD42020169876.Level of evidenceII.     

Change in Electromyographic Activity of Wrist Extensor by Cylindrical Brace

Purpose

To verify the effect of a newly-developed cylindrical type forearm brace, which was designed to give focal counterforce perpendicularly on the muscle belly of the wrist extensor.

Materials and Methods

The dominant hands of 24 (12 males, 12 females) healthy subjects were tested. Two types of forearm braces (focal cylindrical type and broad pneumatic type) were examined. The braces were applied at the extensor carpi radialis brevis, 5 to 7 cm distal to the lateral epicondyle. Two surface electrodes were attached to the proximal and distal parts of the brace. By quantitative electromyography, the mean amplitudes of voluntary extensor carpi radialis brevis contraction before and after applying each brace were recorded and analyzed.

Results

The mean amplitudes of the focal cylindrical brace and broad pneumatic brace were reduced significantly compared to no brace (p<0.05), with a larger reduction for the cylindrical brace than the pneumatic brace (p<0.05). There was no significant difference between the proximal and distal mean amplitudes with each brace.

Conclusion

A cylindrical type brace decreased electromyographic activity in the wrist extensor more effectively than did the pneumatic type brace.     

Foot Posture and Plantar Loading With Ankle Bracing

ContextArch height is one important aspect of foot posture. An estimated 20% of the population has pes planus and 20% has pes cavus. These abnormal foot postures can alter lower extremity kinematics and plantar loading and contribute to injury risk. Ankle bracing is commonly used in sport to prevent these injuries, but no researchers have examined the effects of ankle bracing on plantar loading.ObjectiveTo evaluate the effects of ankle braces on plantar loading during athletic tasks.DesignCross-sectional study.SettingLaboratory.Patients or Other ParticipantsA total of 36 participants (11 men, 25 women; age = 23.1 ± 2.5 years, height = 1.72 ± 0.09 m, mass = 66.3 ± 14.7 kg) were recruited for this study.Intervention(s)Participants completed walking, running, and cutting tasks in 3 bracing conditions: no brace, lace-up ankle-support brace, and semirigid brace.Main Outcome Measure(s)We analyzed the plantar-loading variables of contact area, maximum force, and force-time integral for 2 midfoot and 3 forefoot regions and assessed the displacement of the center of pressure. A 3 × 3 mixed-model repeated-measures analysis of variance was used to determine the effects of brace and foot type (α = .05).ResultsFoot type affected force measures in the middle (P range = .003–.047) and the medial side of the foot (P range = .004–.04) in all tasks. Brace type affected contact area in the medial midfoot during walking (P = .005) and cutting (P = .01) tasks, maximum force in the medial and lateral midfoot during all tasks (P < .001), and force-time integral in the medial midfoot during all tasks (P < .001). Portions of the center-of-pressure displacement were affected by brace wear in both the medial-lateral and anterior-posterior directions (P range = .001–.049).ConclusionsAnkle braces can be worn to redistribute plantar loading. Additional research should be done to evaluate their effectiveness in injury prevention.     

护理专案在胸腰椎疾病病人术后支具佩戴中的应用

目的:探讨护理专案在提高胸腰椎疾病病人术后支具佩戴正确率中的效果。方法:选择2019年3月—2019年4月外科收治的初次行胸腰椎手术的42例病人作为对照组,对其进行支具佩戴情况的调查,分析支具佩戴错误的性质及原因,制定护理专案改善措施。选择2019年7月—2019年8月开展护理专案后外科收治的初次行胸腰椎手术的39例病人作为试验组,比较两组病人的支具佩戴正确率与对护士工作的满意度。结果:开展护理专案后试验组病人支具佩戴正确率为84.62%,明显高于对照组的42.86%(P<0.05);试验组病人出院时对护士工作的满意度高于对照组(P<0.05)。结论:针对胸腰椎疾病病人术后支具佩戴问题进行护理专案改善活动,能明显提高病人佩戴支具的正确率,提高病人满意度。     

Ulnar Collateral Ligament Repair of the Elbow—Biomechanics,Indications, and Outcomes

Purpose of ReviewTraditionally medial elbow injuries in overhead athletes have been treated with ulnar collateral ligament (UCL) reconstruction as first described by Dr. Frank Jobe. Recent literature has shown favorable outcomes in select patients treated with UCL repair. Newer techniques utilizing suture augmentation demonstrate biomechanical profiles as good or better than the native state and/or reconstruction. This review aims to evaluate these biomechanical studies and the clinical outcomes of ulnar collateral ligament repair with suture augmentation.Recent FindingsUCL repair has favorable outcomes in select patients with specific tear type patterns. Clinical outcomes have shown return to play rates of 92–97% with mean time of 2.5–6 months post-operatively. Biomechanical data comparing UCL repair to reconstruction techniques have shown improved resistance to common forces applied to the elbow during overhead activities. Additionally, suture tape augmentation dramatically improves stability of ligament repair without over-constraining the elbow.SummaryInitial ulnar collateral ligament repair data was poor, and thus UCL reconstruction became the mainstay of treatment for overhead athletes. Recent studies evaluating the biomechanical properties as well as clinical outcomes have demonstrated favorable data when UCL repair is performed. When considering the drawbacks of a prolonged recovery associated with reconstruction, UCL repair is a viable option in select patients.