The role of kinesiotherapy in heterotopic ossification remains unclear. The goal of this study was to revisit the literature on the preventive role of kinesiotherapy against heterotopic ossification ...formation and maturation.
A systematic review was performed in MEDLINE, OVID, Scopus, and Cochrane databases.
A high-quality clinical trial is missing from the literature. Of 9617 studies primarily identified, nine studies offered the proper data and were included. They infer that satisfactory results on neurogenic heterotopic ossification prevention were achieved with passive exercises, including continuous passive motion, that were initiated early and at a painless range of motion. On the contrary, for elbow posttraumatic heterotopic ossification and major joints burn-associated heterotopic ossification, active range of motion is indicated as early as possible.
Because of the very low quality of the studies included in this review, firm conclusions cannot be drawn about the effectiveness of kinesiotherapy. Nevertheless, it is recommended that controlled passive range of motion exercises (especially continuous passive motion) be applied early and pain-free especially in the neurogenic heterotopic ossification patients while active range of motion in painless limits is beneficial in the heterotopic ossification prevention of traumatic elbows or burn joints.
The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated ...into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. These groups were further subdivided in two subgroups (+ and −) depending on cementing or not of the tibial tray only. The total blood loss averaged 961 ml in group A and 692 ml in group B, while it was estimated 763 ml in the cemented group and 890 ml in the non-cemented group. The total blood loss within subgroups was Group A+ 904 ml, Group A− 1017 ml, Group B+ 622 ml and Group B− 762 ml. The mean number of blood units transfused per patient was 4.7 in Group A and 4.0 in Group B, while the mean operating time was 79 min and 66 min, respectively. Complications such as deep vein thrombosis, haematomata and minor wound complications occurred in patients of Group A and Group B, 0 and 2, 0 and 2, 8 and 11, respectively. Intraoperative tourniquet release seems to be related with significantly greater blood loss (
P<0.001) and demands in blood transfusion
P<0.05 as well as a longer operating time (
P<0.001). Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (
P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.
Burst fractures of the thoracolumbar spine are a common injury and can be source of great pain and disability. Fortunately, in most instances, treatment can be nonoperative with excellent results. ...However, there are certain situations in which a surgical approach may be indicated: a fracture with a significant neurological deficit or an “unstable” burst fracture with disruption of the posterior ligamentous complex. The literature is reviewed and surgical outcomes are presented.
Abstract
Purpose: To compare the effects of botulinum toxin injection with and without needle electromyographic guidance for the treatment of spasticity. Method: A randomized controlled study was ...conducted in a tertiary university hospital. Twenty-seven adult hemiplegic patients with spasticity due to brain or spinal cord damage were included. Spastic muscles were injected with botulinum toxin with or without EMG guidance. The modified Ashworth scale and modified Barthel index in each patient pre- and post-injection were documented. Results: In group A, which consisted of 15 patients (55.55%), the injection was administered with needle electromyographic guidance, while in 12 patients (44.44%) of group B without electromyographic guidance with the use of anatomic landmarks only. The follow-up period was 3 months. At 3 weeks post-injection, spasticity was decreased (p < 0.05) in all patients and the mean (SD) reduction of spasticity was higher (p < 0.05) in group A (1.67 (0.5)) than group B (1.25 (0.46)). Similarly, the mean (SD) functional modified Barthel index improved statistically significantly (p < 0.001) post-injection (45.37 (8.43)) than pre-injection (54.07 (9.610), especially in group A (p < 0.05). Conclusion: The effectiveness of intramuscular botulinum toxin injection for the treatment of spasticity in hemiplegic patients is superior when performed with needle electromyographic guidance than without electromyography.Implications for RehabilitationIt is recommended that botulinum toxin muscle injections of hemiplegic limbs be performed with EMG guidanceMore spasticity reduction and functional improvement at 3 months post-injection was observed in patients injected with botulinum toxin by the use of combined EMG guidance and anatomic landmarksEMG guidance might also save amount of botulinum toxin due to less spasticity observed during injection than when injection is performed with anatomic landmarks only
Retrospective clinical cohort study.
To determine the efficacy of posterior lateral mass screw/rod fixation and fusion for the treatment of symptomatic pseudarthrosis of anterior cervical fusion.
...Both anterior revision and posterior repair of cervical pseudarthrosis have been reported. To date, there is still debate in the literature as how the patient with symptomatic cervical pseudarthrosis should be addressed.
Thirty-eight consecutive patients with symptomatic anterior cervical pseudarthrosis were treated with posterior lateral mass screw/rod fixation and fusion. The average follow-up was 28 months (24 to 60 mo) and patients were assessed with clinical examination, questionnaires, flexion-extension lateral radiographs, and/or computed tomography scans. The clinical results were classified as excellent, good, fair, or poor, according to Zdeblick criteria.
All patients achieved a solid radiographic fusion at the final follow-up. The result was excellent in 10 patients, good in 22, fair in 6, and poor in none.
Patients with symptomatic cervical pseudarthrosis that develops after anterior cervical discectomy and fusion may be managed successfully with posterior lateral mass screw fixation and fusion.
Authors' Reply Vasileiadis, George Ioannis; Varvarousis, Dimitris N; Manolis, Ioannis ...
American journal of physical medicine & rehabilitation,
04/2022, Letnik:
101, Številka:
4
Journal Article
AimsThe standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of ...phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.MethodsThe MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest.ResultsThree studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184).ConclusionRotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
Given that patients who suffer from extremity malignancies are primarily young, the validation and refinement of the management techniques for these type of tumors appear essential. Prosthetic ...reconstruction has already been established as a reliable surgical procedure for patients with lower limb bone neoplasms. Reconstruction with allograft has also been considered a viable treatment alternative for these patients, but evidence regarding the comparison of the efficacy between these techniques is scarce. The aim of this study is to evaluate and compare the impact of these two procedures on the gait parameters of patients that underwent lower limb tumor resection. The Medline, Scopus, and Cochrane databases were systematically scrutinized in January 2022. The outcomes of interest were gait parameters. Four studies were included in our analysis, from which three included allograft versus prosthetic reconstruction of the knee (distal femur or proximal tibia) and only one that evaluated the proximal femur. Compared to prosthetic reconstruction, allografts non-significantly increased gait velocity (0.04 m/s; 95% CI: − 0.03, 0.10;
I
2
= 0%) and stride length (0.43% height; 95% CI: − 3.50%, 4.36%;
I
2
= 27.7%), significantly increased cadence (4.12 stride/min; 95% CI: 1.40, 6.84;
I
2
= 0%), and non-significantly reduced stance time (− 0.57% cycle time; 95% CI: − 1.16%, 0.02%;
I
2
= 0%). Our results highlight the potential of allograft reconstruction and suggest that it should not be neglected as a valid treatment option with substantial functional outcomes, comparable to prosthetic reconstructive procedures. Larger studies are required to validate these conclusions.
Abstract Background context Discography has been successfully used to distinguish painful from asymptomatic intervertebral discs. Purpose To report a case of chronic back pain following two-level ...interbody and posterolateral fusion in the lumbar spine that was evaluated with marcaine injection into the disc space. Study design Case report. Methods A patient with chronic back pain after a two-level anteroposterior lumbar fusion was evaluated. A complete description of the history, physical examination, and relevant radiographic images along with a brief review of the pertinent literature are included. Results Injection of marcaine into the area of previous interbody fusion resolved the painful symptoms, and surgery confirmed the nonunion. Conclusions In cases of interbody lumbar fusion with questionable solidity, marcain injection within the disc space can help in the assessment of the source of pain even at the intervertebral spaces with cages.
