Arm rotated medially with supination – the ARMS variant: description of its surgical correction

<p>Abstract</p> <p>Background</p> <p>Patients who have suffered obstetric brachial plexus injury (OBPI) have a high incidence of musculoskeletal complications stemming from the initial nerve injury. The presence of muscle imbalances and contractures leads to typical bony changes affecting the shoulder, including the SHEAR (Scapular Hypoplasia, Elevation and Rotation) deformity. The SHEAR deformity commonly occurs in conjunction with Medial Rotation Contracture (MRC) of the arm. OBPI also causes muscle imbalances at the level of the forearm, that lead to a fixed supination deformity (SD) in a small number of patients. Both MRC and SD will cause severe functional limitations without surgical intervention.</p> <p>Methods</p> <p>Fourteen OBPI patients were diagnosed with MRC of the shoulder and SD of the forearm along with SHEAR deformity during a 16 month study period, with eight patients available to long-term follow-up (age range 2.2 – 18 years). Surgical correction of the MRC was performed as a triangle tilt or humeral osteotomy depending on the age of the child, after which, the patients were treated with a radial osteotomy to correct the fixed supination deformity. Function was assessed using the modified Mallet scale, examination of apparent supination and appearance of the extremity at rest.</p> <p>Results</p> <p>Significant functional improvements were observed in patients with surgical reconstruction. Mallet score increased by an average of 5.2 (p < 0.05). Overall forearm position was not significantly changed from an average of 5° to an average of 34° maximum apparent supination after both shoulder rotation and forearm rotation corrective surgeries.</p> <p>Conclusion</p> <p>The simultaneous presence of two opposing deformities in the same limb will visually offset each other at the level of the wrist and hand, giving the false impression of neutral positioning of the limb. In reality, the neutral-appearing position of the hand indicates a fixed supination posture of the forearm in the face of a medial rotation contracture of the shoulder. Both of these deformities require surgical attention, and the presence of concurrent MRC and SD should be monitored for in OBPI patients.</p

Energy converting layers for the efficiency improvement of thin-film flexible photovoltaic structures

International audienceThe paper presents research focused on the efficiency improvement of inorganic flexible thin-film solar cells, using energy converting layers. The light capture enhancement was achieved through the introduction of layers, based on rare-earth elements, as top coatings on the amorphous silicon photovoltaic structures. Such luminescent layers are converting high-energy photons into low-energy ones, which are more efficient in photovoltaic conversion of the investigated solar cells. Towards this goal, powders consisting rare-earth elements were applied as active particles in polymer layer. For practical experiments, screen-printing method, as cheap, reliable and industrially-ready technology was used for layers deposition. For the experiments two compositions were selected: Sr4Al14O25: Eu,Dy (BGL-300M) and SrAl2O4:Eu,Dy (G-300M). These materials are characterized by excellent thermal and optical stability and interesting luminescent properties (they absorb ultraviolet and emit in the visible range). For the verification of investigated materials and methods, various compositions of powders and proportions were tested and analyzed