Use of a relative motion flexion orthosis for postoperative management of zone I/II flexor digitorum profundus repair: A retrospective consecutive case series

Study DesignA retrospective, single-center, consecutive case series.IntroductionIn concept, a relative motion flexion (RMF) orthosis will induce a “quadriga effect” on a given flexor digitorum profundus (FDP) tendon, limiting its excursion and force of flexion while still permitting a wide range of finger motion. This effect can be exploited in the rehabilitation of zone I and II FDP repairs.Purpose of the StudyTo describe the use of RMF orthoses to manage zone I and II FDP 4-strand repairs.MethodsMedical record review of 10 consecutive zone I and II FDP tendon repairs managed with RMF orthosis for 8 to 10 weeks in combination with a static dorsal blocking or wrist orthosis for the initial 3 weeks.ResultsIndications included sharp lacerations (n = 6), ragged lacerations (n = 2), staged flexor tendon reconstruction (n = 1), and type IV avulsion (n = 1). In 8 of the 10 cases that completed follow-up, the mean arc of proximal interphalangeal/distal interphalangeal active motion were as follows: sharp, 0° to 106°/0° to 75°; ragged, 0° to 90°/0° to 25°; reconstruction, 0° to 90°/10° to 45°; and avulsion, 0° to 95°/0° to 20°. Grip performance available for 6 of 10 cases was 62% to 108% of the dominant hand. There were no tendon ruptures, secondary surgeries, or proximal interphalangeal joint contractures.ConclusionBased on this small series, the RMF approach appears to be safe and effective. It can lead to similar mobility and functional recovery as other early active motion protocols, with certain practical advantages and without major complications. Further investigation with larger, multicenter, prospective, longitudinal cohorts and/or randomized clinical trials is necessary.     

What are the biomechanical consequences of a structural leg length discrepancy on the adolescent spine during walking?

BackgroundStructural leg length discrepancy (LLD) is a common phenomenon. However, its effect on spinal gait kinematics remains unclear.Research questionHow does LLD affect spinal gait kinematics in patients with structural LLD and what is the immediate effect of a shoe lift?.Methods10 adolescents with structural LLD (20–60 mm) and 14 healthy controls were included. All of whom were fitted with a trunk marker set and requested to walk barefoot as well as with an orthotic shoe lift (only patients). Data were collected using a 12-camera motion capture system. Group comparisons were conducted using one-dimensional Statistical Parametric Mapping (SPM).ResultsPatients with LLD showed statistically significant increased frontal plane lumbar bending angles to the longer side (p = 0.007), increased pelvic drop on the shorter side (p < 0.001) and increased hip adduction angles on the longer leg (p < 0.001) compared to the healthy controls. In the sagittal plane, patients demonstrated changed knee (shorter leg) and ankle joint (longer leg) motion. All gait deviations observed in patients with LLD could immediately be altered by correcting the LLD using a shoe lift.SignificanceDue to the LLD, patients showed a lateral pelvic drop on the shorter side, which appeared to be compensated for by a contralateral bending in the lumbar spine and a lateral shift of the pelvis towards the longer side. In addition, the use of an orthotic correction seems to be a suitable option to instantly normalize gait kinematics in patients with mild to moderate LLD.     

The influence of an orthopaedic walker boot on forefoot force

BackgroundIn the treatment of an Achilles tendon rupture the patients are commonly equipped with an orthopaedic walker boot with wedges. To what extent this influences the tensile force placed on the Achilles tendon is unclear.PurposeTo assess the forefoot force and describe changes in muscle activity of the medial gastrocnemius, soleus and tibialis anterior when using one or three wedges during ambulation in a weightbearing orthopaedic walker boot.MethodsThe force on the forefoot was measured with a force sensor insole and muscle activity of the medial gastrocnemius, soleus and tibialis anterior were measured using surface electromyography in 10 healthy participants. Three different types of ambulation were performed (walking without crutches (unass.), walking with crutches (+crutch) and walking with crutches and verbal instructions to place body weight on heel (heel + crutch) with one and three heel wedges respectively.FindingsThe total peak force displayed an interaction where forefoot force decreased when wearing three wedges only for the +crutch ambulation type (80 N, p = 0.001) although there was a trend to decrease with three wedges also for the heel + crutch ambulation type (48 N, p = 0.05). The relative peak force on the forefoot showed a main effect with a significant decrease when using three wedges compared to one wedge across all three ambulation types (19.1%, p = 0.009).InterpretationThe force on the forefoot and hereby the Achilles tendon significantly decreased when using three wedges compared to one wedge. These findings have important implications for the rehabilitation post Achilles tendon rupture.     

Editorial: Degrees of sense

The principal aim of this investigation was to relate perceived confidence in task performance without falling and observer-assessed balance, both to each other and to motor function at three different times after a fi rst stroke. Sixty-two patients 24-65 years of age participated in this study. Perceived confidence in task performance was self-reported using a Swedish modification of the Falls-Efficacy Scale (FES(S)). For observer assessments the Berg Balance Scale and the balance and motor function sections of the Fugl-Meyer Stroke Assessment Instrument were used. Assessments were performed on admission, at discharge, and at a 10-month follow-up. FES(S) was significantly associated with observer-assessed balance (rho = 0.46-0.68) and motor function (rho = 0.45-0.56) onadmission and on discharge (rho = 0.38-0.51). At follow-up these correlations were generally weaker, ranging from 0.20-0.49. We conclude that self-reported confidence in task performance is a valuable measure in clinical practice, adding information to that gained from objective assessments.     

步行矫形器在脊柱脊髓损伤患者康复中的应用初探

目的：探讨步行矫形器配合综合康复治疗在完全性脊髓损伤患者康复中的效果。方法：13例完全性脊髓损伤患者，男10例，女3例，其中C7 1例、T4 1例、T6 1例、T10～L1 10例；年龄21～41岁，平均33．2岁；在装配步行矫形器前进行强化康复治疗，包括肌肉力量、心肺功能、转移、日常活动能力（ADL）、膀胱功能等，矫形器装配后配合步态步行训练；分别于矫形器装配前和出院前应用限时的步行功能检查（包括6min步行评测和10m步行时间评测）、步态分析及改良Barthel指数（MBI）作为指标进行评定。结果：13例患者矫形器装配及训练后10m步行时间平均55．2s，6min步行距离为74．9m，平均步长37．9cm；12例应用往复式截瘫步行器（RGO）可作功能性步行，1例四肢瘫患者借助ARGO可作治疗性步行；训练后ADL能力明显改善，MBI评分平均提高31．5分。结论：步行矫形器配合系统的康复治疗对改善完全性脊髓损伤患者步行能力及ADL效果理想。     

Treatment outcome at 1 year did not differ between use of cast or walker in the first 3 weeks after an acute Achilles tendon rupture. A registry study of 1304 patients from the Danish Achilles tendon database

BackgroundThe best choice of orthosis in the treatment of acute Achilles tendon rupture is still under debate.ObjectiveTo investigate if choice of orthosis in the first 3 weeks of treatment affected patient reported outcome (Achilles tendon Total Rupture Score (ATRS)), tendon elongation (Achilles Tendon Resting Angle (ATRA) and Heel Rise Height (HRH)) and re-rupture.MethodsRegistry study in the Danish Achilles tendon Database. Patients treated with cast and patients treated with walker in the first 3 weeks of treatment were compared using a linear mixed-effects model adjusted for potential confounders.Results1304 patients were included in the study. No clinically relevant difference was found: Adjusted mean difference (using walker the whole period as reference)(95% CI) ATRS after 1 year = 0.1(?3.0; 4.1), ATRS after 6 months = 2.0(?4.5; 5.8), ATRS after 2 years = 3.0(?0.7; 7.0), HRH difference = 0.6(?6.6; 8.2), ATRA difference = 0.03°(?1.5; 1.6), re-rupture(odds ratio) = 0.812(0.4; 1.61).ConclusionPatients treated with cast the first 3 weeks after acute Achilles tendon rupture did not have better treatment outcome than patients treated with walker.     

Comparative Effectiveness of Orthoses for Thumb Osteoarthritis: A Systematic Review and Network Meta-analysis

ObjectiveTo evaluate the best option among orthoses for carpometacarpal (CMC) osteoarthritis (OA) of the thumb, using a network meta-analysis.Data SourcesMedline, Embase, Cochrane, and ClinicalTrials.gov registry databases were used. PubMed, Embase, Cochrane Controlled Trials Register, Cochrane, and other databases were used without language restrictions.Study SelectionWe searched randomized controlled trials (RCTs) on adults with OA of the thumb by studying any orthosis from the beginning to March 10, 2020.Data ExtractionData were extracted and checked for accuracy and completeness by pairs of reviewers. Outcomes were pain and function. Comparative treatment effects were analyzed by random-effects model for direct pairwise comparisons and Bayesian network meta-analyses to integrate direct and indirect evidence.Data SynthesisEleven RCTs involving 619 patients were included. We evaluated 5 groups, for 4 different orthoses: short thermoplastic CMC splint (rigid CMC) (n=5), long thermoplastic carpometacarpal-metacarpophalangeal splint (rigid CMC-MCP) (n=7), short neoprene CMC splint (soft CMC) (n=1), long neoprene CMC-MCP splint (soft CMC-MCP) (n=5), and one as a control group (n=5). Our results show that all splints were superior to placebo to reduce pain intensity and the top-ranked intervention was the rigid CMC-MCP (surface under the cumulative ranking curve analysis [SUCRA], score: 65.4). In function evaluation, we report a 71.6 SUCRA for rigid CMC.ConclusionsAlthough the current evidence is unclear on the use of the splint in OA of the thumb, it is not known which orthosis is more effective and whether the orthosis is more effective than other interventions. The network meta-analysis shows that a long thermoplastic splint it is the best choice for pain relief and the short thermoplastic CMC splint is the best treatment to increase function. These results may suggest initial treatment with a long rigid orthosis and then a short rigid orthosis.