(1) Background: Knee osteoarthritis causes pain, weakness, muscle atrophy, and disability. The application of whole-body vibration in patients with knee osteoarthritis can improve strength, balance, ...and functional activities. The purpose of the study is to evaluate the effects of early whole-body vibration intervention in patients after total knee arthroplasty. (2) Method: A single-blinded randomized control trial. Fifty-two patients with knee osteoarthritis post total knee replacement from a medical center in southern Taiwan were randomly assigned to either a whole-body vibration group or control group. Main outcome measures included pain severity, leg circumference, knee range of motion, knee extensor strength, a five-times sit to stand test, and a timed up and go test. (3) Results: Immediately post treatment, the patients in the vibration group showed a significant increase in knee extensor strength and improvement in calf swelling compared to the control group. A trend toward decrease in pain severity and improvement in functional performance were observed in both groups without a significant difference between the groups. There was no significant difference in knee range of motion (ROM) and functional performance between the groups. (4) Conclusions: The whole-body vibration intervention in patients early post total knee arthroplasty showed significant immediate effect in increasing knee extensor strength and decreasing calf swelling.
Aims and objectives. The aim of this study was to evaluate the effects of continuous passive motion on the range of motion, postoperative pain and life quality of patients undergoing total knee ...arthroplasty within six months after the operation.
Background. Total knee arthroplasty reduces pain and improves range of motion of the osteoarthritic knee joint. Continuous passive motion increases postoperative movement, but there is some controversy regarding whether aggressive continuous passive motion can improve range of motion or life quality, and whether it induces more pain.
Design. A prospective controlled study was conducted in a medical centre in Taiwan from January to December 2006.
Methods. One hundred and seven patients were recruited. The patients underwent the basic rehabilitation protocols (the control group) or the basic rehabilitation protocols and additional daily use of continuous passive motion for more than six hours per day (the experimental group). The range of motion, modified Short Form‐36 (SF‐36) and semi‐quantitative visual analogue scale were recorded.
Results. Range of motion increased from 109° preoperatively to 125° at six months postoperatively in the treatment group and from 111° preoperatively to 125° at six months postoperatively in the control group. Visual analogue scale decreased from 7·78 preoperatively to 0·37 at six months postoperatively in the treatment group and from 7·92 preoperatively to 0·21 at six months postoperatively in the control group. The SF‐36 improved from 3·76 preoperatively to 1·77 at six months postoperatively in the treatment group and from 3·68 preoperatively to 1·83 at six months postoperatively in the control group. There was no significant difference in range of motion, visual analogue scale and SF‐36 between groups at each visit.
Conclusion. With the advances in total knee arthroplasty surgical technique, aggressive continuous passive motion does not provide obvious benefits.
Relevance to clinical practice. Total knee arthroplasty can alleviate pain and improve range of motion, but aggressive continuous passive motion does not provide additional benefits.
Melorheostosis is a rare disease that usually burdens the patient with painful disability or soft tissue compromise. The treatment is usually symptomatic and conservative. Patients with severe and ...complicated forms of the disease may require surgery. Involvement of the distal part of a limb usually carries more morbidity, such as tumefaction pain, cosmetic and psychosocial or functional problems that render conservative treatment unsatisfactory to patients. In our series, surgical debulking or decompression of the mass effect provided prompt symptom relief.
Objective
Shockwave application is a potential treatment for osteoarthritis (OA), but the underlying mechanism remains unknown. Oxidative stress and a counterbalancing antioxidant system might be the ...key to understanding this mechanism. We hypothesized that reactive oxygen species (ROS) and the transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2),which is an important regulator of cellular redox homeostasis, are plausible elements.
Design
Porcine chondrocytes were cultured in a 3-dimensional pellet model and subjected to shockwaves. The effects of shockwaves with various energy-flux densities on optimal extracellular matrix (ECM) synthesis were assessed. ROS, mitogen-activated protein kinase (MAPK) signaling, and the redox activity of Nrf2 were measured. To investigate the signaling mechanism involved in the shockwave treatment in chondrocytes, specific inhibitors of ROS, MAPK signaling, and Nrf2 activity were targeted.
Results
Shockwaves increased ECM synthesis without affecting cell viability or proliferation. Furthermore, they induced transient ROS production mainly through xanthine oxidase. The phosphorylation of ERK1/2 and p38 and the nuclear translocation of Nrf2 were activated by shockwaves. By contrast, suppression of ROS signaling mitigated shockwave-induced MAPK phosphorylation, Nrf2 nuclear translocation, and ECM synthesis. Pretreatment of chondrocytes with the specific inhibitors of MEK1/2 and p38, respectively, mitigated the shockwave-induced nuclear translocation of Nrf2 and ECM synthesis. Nrf2 inhibition by both small hairpin RNA knockdown and brusatol reduced the shockwave-enhanced ECM synthesis.
Conclusions
Shockwaves activated Nrf2 activity through the induction of transient ROS signaling and subsequently enhanced ECM synthesis in chondrocytes. This study provided fundamental evidence confirming the potential of shockwaves for OA management.
Mid-shaft clavicle fractures have traditionally been treated conservatively, although this has been associated with non-union and unsatisfactory shoulder function. The preferred approach is plate ...fixation, with a reconstruction plate for open reduction and internal fixation. Infection is a potential complication after such surgery, with rates of 0.4-7.8% reported in the literature. In our cases, an infection rate of 4.9% (7 of 142 patients) was noted; five of the seven patients suffered from acute postoperative infection within 1 month of surgery. The average time to presentation with an infection was 28 (23-32) days, with signs and symptoms of wound dehiscence in one patient and sinus discharge in four patients. Two patients suffered from subacute infections, with durations of 72 and 103 days, presenting with local heat and radiographic findings of screw loosening. Six of the cases healed with primary bony union after intensive debridement and early removal of the implants.
Intramedullary titanium elastic nails have been reported to fix displaced midclavicular fractures with excellent functional outcomes and minor complications. This study reports and analyzes the ...complications and technical pitfalls associated with titanium elastic nail fixation of displaced midclavicular fractures and describes how to prevent these problems. The authors operated on 27 patients (17 men, 10 women; mean age, 45.8 years; range, 16.5-66.9 years) with marked displaced midclavicular fractures using intramedullary titanium elastic nail fixation. The mean Constant score and Disability of the Arm, Shoulder, and Hand score were 93.58 (range, 66.5-100) and 6.22 (range, 0-35), respectively. The mean length difference compared with the contralateral clavicle was a shortening of 0.3 cm (range, -1.5 to 1 cm). Eight patients (30%) had different levels of difficulty at the medial entry point. Clavicular length shortening of more than 1 cm occurred in 5 patients (19%), and all of these patients experienced medial nail tip prominence/protrusion. One patient had 1-cm lengthening of the injured clavicle caused by distraction of the fracture site during titanium elastic nail insertion. Iatrogenic perforation of the posterolateral cortex occurred in 3 patients. Initial misplaced nail insertion occurred in 1 woman who underwent revision with the mini-open method. In 2 patients it was impossible to remove the full nail under general anesthesia. In conclusion, high patient satisfaction and functional outcomes were achieved after titanium elastic nail fixation of displaced midclavicular fractures. However, some complications and technical pitfalls must be considered before titanium elastic nails are used to fix displaced midclavicular fractures.
OBJECTIVES:Clavicular fractures account for 2.6% of all fractures, and more than 80% involve the middle third of the clavicle. Plate fixation has been the most common method of fixation reported but ...has been associated with complications such as infection, wound breakdown, nonunion, implant failures, poor cosmetic outcome, and local skin numbness. We report on a series of cases receiving minimally invasive insertion of titanium elastic nails (TEN) to fix the displaced midclavicular fractures.
DESIGN:Prospective, clinical study.
SETTING:Regional referral center.
PATIENTS/PARTICIPANTS:From November 2006 to October 2007, we operated on 23 patients (16 men) with displaced (no cortical contact between the proximal and distal fragments radiographically and/or greater than 2 cm of shortening) midclavicular fractures fixed with TEN. The mean age of the patients was 41.57 years.
INTERVENTION:All patients with displaced midclavicular fractures were treated with TEN. The nails were inserted from the medial entry point on the sternal end and passed through the fracture site under fluoroscopy monitoring.
MAIN OUTCOME MEASUREMENTS:Complications, clavicular shortening after TEN fixation, Constant shoulder score, and Disability of the Arm, Shoulder, and Hand score for functional outcome measurement.
RESULTS:Closed reduction was successful in 16 patients, and seven patients needed open reduction. There was no nonunion, infection, nail breakage, or refracture after nail removal in our series. The mean operative wound length was 2.2 cm, and mean clavicular length shortening was 0.32 cm. Iatrogenic perforation of the lateral cortex occurred in two patients, and nail misplacement occurred in one patient requiring revision. All patients followed up greater than 12 months. The mean Disability of the Arm, Shoulder, and Hand score was 6 (range, 0-35; standard deviation, 10.47) and mean Constant score was 96 (range, 78-100; standard deviation, 6.34).
CONCLUSIONS:Minimally invasive fixation with TEN is a safe method and can be performed with minor complications. This method of fixation of displaced midclaviclular fractures should result in a good cosmetic appearance and satisfactory stabilization of displaced midclavicular fractures without comminution.
Low-grade fibromyxoid sarcoma (LGFMS) is a rare neoplasm that commonly arises in the deep soft tissues of the lower extremities, particularly in the thigh. LGFMS occurs preferentially in young male ...adults. The microscopic appearance of LGFMS exhibits bland fibroblastic spindle cells with a whorled or linear arrangement in fibrous and myxoid areas. Although LGFMS has a deceptively benign histologic appearance, local recurrence and late metastases have frequently been reported. Diagnosis of LGFMS is still difficult because of its characteristic bland-looking histologic features that can be confused with other benign or low-grade fibromyxoid lesions. Although immunohistochemical staining can offer an overview of the differential diagnosis of myxoid tumors of soft tissue, it is sometimes limited for diagnosis of LGFMS. However, recent cytogenetic and molecular analyses have provided significant improvements in the diagnosis of LGFMS. Such analyses have demonstrated that most cases of LGFMS have a characteristic t (7,16) (q33;p11) translocation, resulting in the FUS-CREB3L2 fusion gene. We report a 29-year-old female who presented with a LGFMS located in the soleus muscle of her left lower leg. Preoperative imaging suggested the possibility of an intramuscular histiocytoma of the left soleus muscle. In conclusion, diagnosis of LGFMS can be challenging in routine practice in surgical pathology because of its bland-looking features. The immunohistochemical and ultrastructural findings were consistent with the fibroblastic properties of LGFMS. Cytogenetic and/or molecular genetic analyses can be used as ancillary diagnostic tools for LGFMS.
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