T-condylar fractures of the distal humerus in children: does early motion affect final range of motion?

Purpose

T-condylar fractures of the distal humerus are infrequent injuries in children. There are little data regarding outcomes in this age group. The adult literature demonstrates a high rate of postinjury stiffness. We describe a large series of T-condylar fractures in children and set out to identify factors that influence the postoperative range of motion (ROM) in children. Our hypothesis was that starting motion early (<3 weeks) would favorably influence the postoperative ROM.

Methods

Patients were identified based on the Current Procedural Terminology (CPT) code for ORIF of supracondylar distal humerus fractures with intracondylar extension (24546). Patient records and radiographs were reviewed to determine the demographics, fracture characteristics, surgical approach and fixation, and postoperative immobilization time. Our outcome measure was ROM in flexion/extension at 3 months, 6 months, 1 year, and final follow-up. Patients were analyzed by Morrey’s criteria of −30° extension and 130° flexion to assess for postoperative elbow stiffness.

Results

Thirty-eight potential patients from 1992 to 2010 were identified with specific T-condylar patterns. Twelve patients were excluded due to insufficient follow-up or lack of final ROM data. Our cohort included 26 patients (average age 13.4 years). The average postoperative immobilization time was 3.4 weeks (range 0.9−12 weeks). At the final follow-up, patients had −12° average extension and 130° average flexion. Nine patients (35 %) were stiff and 17 patients (65 %) had functional motion postoperatively. At 3 and 6 months, starting motion early yielded better flexion and extension ROM. Late-motion patients obtained similar results at the 1-year follow-up. Open fractures, gender, and age were all not significantly associated with elbow stiffness in our series, given the limited numbers.

Conclusion

Early ROM was associated with an earlier gain of functional motion without clear adverse consequences. Despite similar findings at the final follow-up, practitioners should consider instituting early ROM protocols to decrease the duration of stiffness and potential disability for the child and the family.     

关节活动度（Range of motion，ROM）

关节活动度是指关节活动时可达到的最大弧度，又称关节活动范围，分为主动活动和被动活动范围。主动活动范围是指作用于关节的肌肉随意收缩使关节运动时所通过的运动弧，被动活动范围是指由外力使关节运动时所通过的运动弧。     

Global spinal motion in subjects with lumbar spondylolysis and spondylolisthesis: does the grade or type of slip affect global spinal motion?

STUDY DESIGN: This was a prospective pilot study to investigate the global motion characteristics of the spondylolysis and spondylolisthesis populations. OBJECTIVES: The aim of this study is to determine the influence of a spondylolisthesis or a spondylolysis on global spinal motion and to establish whether this is dependent on the cause of the slip or the degree/grade of the slip. SUMMARY OF BACKGROUND DATA: The condition of spondylolisthesis has been extensively discussed in the literature with respect to its etiology and management. However, the mechanics and movement of the spine in relation to pathology and the effect of this condition on function have received scant attention. METHODS: The motion of the lumbar spine was investigated in 31 patients (19 men, 12 women, mean age 47.7 +/- 17.8 years) who were diagnosed as having either a lumbar spondylolysis or a spondylolisthesis. These patients were compared with a preexisting database of 203 normal subjects (100 men, 103 women, mean age 39.8 +/- 13.4 years). Patients were graded according to the type of spondylolisthesis or spondylolysis they had, and the extent of slip was rated using Meyerding's classification (1932) and measured directly using methods of Boxall et al (1979) and Wiltse et al (1983). RESULTS: Direct measurements of the extent of slip using Boxall et al (1979) and Wiltse et al (1983) methods were found to have no significant correlation with the resultant range of motion (ROM) or the speed of movement. This study suggests that motion parameters are influenced by the grade of slip in patients with spondylolisthesis, and the type of spondylolisthesis i.e., whether isthmic or degenerative. In the A-P flexion-extension plane, the results indicate that subjects with a defect only, i.e., a spondylolysis, and thus no slip present with a spinal hypermobility (P < 0.01). Subjects with an isthmic slip tend to be either slightly hypermobile or within the anticipated range of motion, whereas those subjects with a degenerative slip tend to be hypomobile (P < 0.05). Movements into lateral flexion were restricted in both the isthmic and degenerative spondylolisthesis patients, whereas rotation was only influenced by the level at which the defect occurred. In terms of degree of displacement, in higher grades of displacement, there was a trend towards hypermobility. CONCLUSIONS: The findings of this study suggest that the grade and type of spondylolisthesis do influence global motion parameters. This information may be useful in the clinical assessment of this patient group.     

Looking down on sperm motion： a useful addeddimension？

The assumed association of sperm motility with fertility has long beena preoccupation of clinicians. Whereas assessing fertility of a couple has relatively easy end-points （time to pregnancy, number of children）, assessing motility does not. ＂[he many methods developed to determine it include assessing a sperm population subjectively （by grading） and objectively （by measuring its motion-induced movement into a light beam by spectrophotometry or nephelometry）, and making measurements on individual sperm cells （by stroboscopic or multiple-exposure photography or digitized video-recordings）.     

Do inflammatory cytokine genes confer susceptibility to diabetic nephropathy?

Microinflammation has been recognized as an important process for the progression of diabetic nephropathy. Inflammatory cytokines, such as interleukin-6 produced by infiltrating cells or renal cells, play important roles in the pathogenesis of diabetic nephropathy. Although the mechanisms underlying the regulation of these cytokines in the kidneys of patients with diabetes mellitus remain unclear, genetic variations in the genes encoding the inflammatory cytokines might confer susceptibility to the disease by altering their functions or expressions.     

Does hand-behind-back range of motion accurately reflect shoulder internal rotation?

Shoulder internal rotation (IR) is commonly assessed by an indirect method where the hand is placed behind the back and the distance reached by the tip of the extended thumb is recorded. The aim of this study was to assess the validity of measuring active IR range of motion (ROM) by use of the indirect hand-behind-back (HBB) ROM method in subjects with shoulder pain of mechanical origin. We recruited 137 subjects with unilateral shoulder pain. HBB ROM was determined by measuring the distance between the T1 spinous process and the radial styloid process. Active shoulder IR was measured in the supine position in 45 degrees or 90 degrees abduction. Correlation coefficients adjusted for measurement error were calculated. HBB ROM demonstrated only a low to moderate correlation with active shoulder IR. Active HBB ROM is not an accurate method of measuring active shoulder IR in patients with shoulder pain.     

Is motion analysis a valid tool for assessing laparoscopic skill?

Background

The use of simulation for laparoscopic training has led to the development of objective tools for skills assessment. Motion analysis represents one area of focus. This study was designed to assess the evidence for the use of motion analysis as a valid tool for laparoscopic skills assessment.

Methods

Embase, MEDLINE and PubMed were searched using the following domains: (1) motion analysis, (2) validation and (3) laparoscopy. Studies investigating motion analysis as a tool for assessment of laparoscopic skill in general surgery were included. Common endpoints in motion analysis metrics were compared between studies according to a modified form of the Oxford Centre for Evidence-Based Medicine levels of evidence and recommendation.

Results

Thirteen studies were included from 2,039 initial papers. Twelve (92.3 %) reported the construct validity of motion analysis across a range of laparoscopic tasks. Of these 12, 5 (41.7 %) evaluated the ProMIS Augmented Reality Simulator, 3 (25 %) the Imperial College Surgical Assessment Device (ICSAD), 2 (16.7 %) the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), 1 (8.33 %) the Advanced Dundee Endoscopic Psychomotor Tester (ADEPT) and 1 (8.33 %) the Robotic and Video Motion Analysis Software (ROVIMAS). Face validity was reported by 1 (7.7 %) study each for ADEPT and ICSAD. Concurrent validity was reported by 1 (7.7 %) study each for ADEPT, ICSAD and ProMIS. There was no evidence for predictive validity.

Conclusions

Evidence exists to validate motion analysis for use in laparoscopic skills assessment. Valid parameters are time taken, path length and number of hand movements. Future work should concentrate on the conversion of motion data into competency-based scores for trainee feedback.     

The catalogue of ambulatory sickness benefits -- realistic? Feasible? Put into practice?

Ambulatory surgery at German hospitals is an underdeveloped field. New legal regulations allow contracts between hospitals and insurance companies which will improve this situation. Besides the establishment of quality parameters and a fixed payment for the operations the contract lists 307 operations which can be performed on an outpatient basis. However, only few operations need to be done obligatory as ambulatory surgery. This reflects just incompletely what is already operated ambulatory outside the hospitals. Due to altered financial structures in case of in-patient treatment and because of a decrease of hospital beds, the listed operations in the contract may be reviewed and ambulatory surgery at the hospitals will increase in the future. The hospitals need to change their structure to establish successfully ambulatory surgery within the hospital setting. Finally, German patients need to be convinced that operations done on an out-patient basis show the same quality standards like procedures under in-patient conditions.     

Disease associations. Chance, artifact, or susceptibility genes?

Numerous genes that might contribute to the development of diabetes mellitus and/or its complications have been isolated and characterized. One approach to determining whether these "candidate" genes influence susceptibility to diabetes is to compare the frequency of a DNA marker(s) (restriction-fragment-length polymorphism) for each gene is appropriately matched groups of patients and control subjects. The identification of a DNA-marker association would suggest that genetic variation at this gene may increase or reduce the risk of developing diabetes. However, the absence of an association does not necessarily imply that this gene does not contribute to the development of diabetes. We discuss the genetic rationale of disease association studies and the importance of sample size and disease-marker allele frequencies in these studies.     

Does restricted wrist motion influence the disability of the upper limb?

The purpose of this study was to correlate wrist motion (ROM) and disability of the upper limb. A total number of 205 patients who had undergone various wrist operations were included in this study, in which the range of motion of the wrist was correlated with the DASH (disability of arm, shoulder and hand) score. There was a significant correlation between the DASH score and the ROM of the wrist, but the correlation was rather weak (r = 0.24). Inclusion of patients with wrist arthrodesis resulted in a stronger correlation. Preservation of some ROM of the wrist is worthwhile. Evaluation of corporeal damage should be adapted in a more functional way.     

Trochanteric fracture-implant motion during healing – A radiostereometry (RSA) study

Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail.Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft.Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft.Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out.     

Do Modic changes affect cervical sagittal alignment and motion in symptomatic patients?

Purpose

The cervical segmental instability often occurs simultaneously with Modic changes (MCs). However, it is unknown whether there is a relation between the two diseases. The aim of this study was to evaluate the relationship between MCs and cervical segmental instability, cervical curvature and range of motion (ROM) in the cervical spine.

Methods

A total of 464 patients with neck pain or cervical neurologic symptoms who underwent imaging examination were analyzed retrospectively. Based on MRI imaging cervical MCs were diagnosed, and patients were divided into with or without MCs groups. The cervical curvature and range of motion were measured. We compared the incidence of cervical instability, cervical curvature and ROM between the two group patients and their relationships with MCs were studied. Logistic regression was used to study the risk factors associated with MCs.

Results

MCs were observed in 94 of 464 patients and 122 of total 2320 cervical segments and were most frequent at C5–6 segment. The incidence of the cervical instability was significantly higher in patients with MCs than those without MCs at cervical level C3–7. In addition, cervical curvature and ROM in patients with MCs were less than those without MCs. Logistic regression analysis showed that the occurrence of cervical spine instability, less cervical curvature and ROM were risk factors for MCs.

Conclusions

Patients with MCs were prone to have cervical instability at the same cervical level and may have a higher possibility of less cervical curvature and ROM.

     

Is left ventricular regional wall motion after CABG influenced by cardioplegic protection?]

This clinical study was conducted to determine whether different techniques of cardioplegic protection reflected left ventricular regional wall motion after CABG. A total of 43 patients with more than 90% stenosis of the LAD (seg 6 and/or 7) before CABG, who had patent grafts were allocated to two groups: namely, the crystalloid group, comprised of 23 patients given cold crystalloid cardioplegia and topical ice slush, and the blood group, comprised of 20 patients given tepid blood cardioplegia delivered intermittently antegrade. Each group was divided into two subgroups according to whether the left ventricular regional wall motion showed no change or deterioration after CABG. We also examined the relationship between the grading of the collateral artery before CABG and the postoperative ventricular regional wall motion. The number of patients who showed deterioration after CABG was higher in the crystalloid group than in the blood group (p = 0.008). Moreover, patients in the crystalloid group whose collateral artery had been graded as 0 before CABG tended to show deterioration of left ventricular local wall motion after CABG (p = 0.07). Whereas those patients in the blood group did not. In conclusion, the incidence of deterioration after CABG was higher in the crystalloid group than in the blood group.     

How does reverse shoulder replacement change the range of motion in activities of daily living in patients with cuff tear arthropathy? A prospective optical 3D motion analysis study

Background

Reverse total shoulder arthroplasty (RSA) can improve function in cuff tear arthropathy (CTA) shoulders, but limited exact data are available about the maximum values in 3D motion analysis, and as to how improvements translate into the normal range of motion (ROM) in activities of daily living (ADLs).

Methods

This study included nine consecutive patients (n = 9) who received RSA for CTA without muscle transfers. We measured shoulder movement by a novel 3D motion analysis using the Heidelberg upper extremity model (HUX) which can eliminate compensatory movements of the scapula, and the trunk. The measurement included active maximum values, and four ADLs.

Results

Comparing the pre- to the 1-year postoperative status, RSA was associated with a significant increase in the mean maximum values for active flexion of about 43° (SD ± 31) from 66° to 109° (p = 0.001), for active abduction of about 37° (SD ± 26) from 57° to 94° (p = 0.001), and for the active adduction of about 28° (SD ± 10) from 5° to 33° (p = 0.002). Comparing the preoperative to the postoperative ROM in the ADLs in flexion/extension, ROM improved significantly in all ADLs, in abduction/adduction in three of four ADLs. No significant changes were observed in internal/external rotation in any ADLs.

Conclusion

RSA improves the active maximum ROM for flexion, abduction, and adduction. The patients are able to take advantage of this ROM increase in ADLs in flexion and in most ADL in abduction, but only in trend in internal and external rotation.

Level of evidence

Level IV, Case Series with no comparison group.