Supplementary Medial Locking Plate Fixation Of Ludloff Osteotomy versus Sole Lag Screw Fixation: A Biomechanical evaluation

Background: The Ludloff oblique osteotomy is inherently unstable, which might lead to delayed union and loss of correction. Supplementary fixation to two lag screw fixation has been proposed. The hypothesis is that the osteotomy fixation constructs supplemented by a mini locking plate provide greater resistance to osteotomy gaping and loss of angular correction in response to cyclic loading. Methods: Twenty fourth generation composite 1st metatarsals were used and underwent a Ludloff osteotomy. They were divided in two fixation groups: two lag screws (Group A), and with a supplementary mini locking plate (Group B). Specimens were subjected to either monotonic loading up to failure or to fatigue (cyclic) tests and tracked using an optical system for 3D Digital Image Correlation. Findings: The osteotomy gap increased in size under maximum loading and was significantly greater in Group A throughout the test. This increase was observed very early in the loading process (within the first 1000 cycles). The most important finding though, was that with the specimens completely unloaded the residual gap increase was significantly greater in Group A after only 5000 cycles of loading up to the completion of the test. The lateral angle change under maximum loading was also significantly greater in Group A throughout the test, with that increase observed early in the loading process (5000 cycles). With the specimens completely unloaded the residual lateral angle change was also significantly greater in Group A at the completion of the test. Interpretation: Supplementary fixation with a mini locking plate of the Ludloff osteotomy provided greater resistance to osteotomy gaping and loss of angular correction compared to sole lag screws, in response to cyclic loading

Sarcopenic Obesity in Individuals With Neurodisabilities: The SarcObeNDS Study.

IntroductionPatients with neurodisabilities (NDS) are prone to alterations in body composition. Sarcopenic obesity (SO) is a condition characterized by increased adipose tissue accompanied by sarcopenia. The aim of this study was to investigate the prevalence of SO in patients with NDS, including stroke, spinal cord, and traumatic brain injuries.MethodsThe study Sarcopenic Obesity in NeuroDisabled Subjects (acronym: SarcObeNDS) was a cross-sectional study of hospitalized patients (n = 82) and healthy controls (n = 32) with a mean age of 60.00 ± 14.22 years old. SO and sarcopenia were assessed through total body fat % (TBF %), fat mass index (fat mass to height2: FMI = FM/h2; kg/m2), and skeletal muscle index (appendicular skeletal muscle to height2: SMI = ASM/h2; kg/m2) via full-body dual-energy X-ray absorptiometry (DXA). This study was registered in the international database ClinicalTrials.gov with the unique identification number NCT03863379.ResultsA statistically significant difference was found in SMI (7.18 ± 0.95 vs. 6.00 ± 1.13 kg/m2, p p = 0.783) and FMI (p = 0.143) between groups. The results remained the same after controlling the results for gender and BMI. A strong positive correlation was demonstrated between BMI and TBF for the total population (r = 0.616, p r = 0.616, p r = 0.728, p ConclusionIn summary, we observed significantly lower BMI and SMI scores in both genders compared to healthy controls. At the clinical level, a timely diagnosis and rapid treatment of sarcopenia and/or obesity in this population may prevent further metabolic repercussions accompanied by higher functional decline and lower quality of life

Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV

Combined Optimized Effect of a Highly Self-Organized Nanosubstrate and an Electric Field on Osteoblast Bone Cells Activity

The effect of an electric field within specific intensity limits on the activity of human cells has been previously investigated. However, there are a considerable number of factors that influence the in vitro development of cell populations. In biocompatibility studies, the nature of the substrate and its topography are decisive in osteoblasts bone cells development. Further on, electrical field stimulation may activate biochemical paths that contribute to a faster, more effective self-adjustment and proliferation of specific cell types on various nanosubstrates. Within the present research, an electrical stimulation device has been manufactured and optimum values of parameters that led to enhanced osteoblasts activity, with respect to the alkaline phosphatase and total protein levels, have been found. Homogeneous electric field distribution induced by a highly organized titanium dioxide nanotubes substrate had an optimum effect on cell response. Specific substrate topography in combination with appropriate electrical stimulation enhanced osteoblasts bone cells capacity to self-adjust the levels of their specific biomarkers. The findings are of importance in the future design and development of new advanced orthopaedic materials for hard tissue replacement

The Effects of Group and Home-Based Exercise Programs in Elderly with Sarcopenia: A Randomized Controlled Trial

Physical exercise is effective for sarcopenic elderly but evidence for the most effective mode of exercise is conflicting. The objective of this study was to investigate the effects of a three-month group-based versus home-based exercise program on muscular, functional/physical performance and quality of life (QoL) across elderly with sarcopenia. 54 elderly (47 women, 7 men aged 72.87 ± 7 years) were randomly assigned to one of three interventions: supervised group (n = 18), individualized home-based exercise (n = 18) and control group (n = 18). Body composition was determined by bioelectrical impedance analysis, calf measurement with inelastic tape and strength assessments (grip and knee muscle strength) via hand-held and isokinetic dynamometers. Functional assessments included four-meter (4 m), Τimed-Up and Go (TUG) and chair stand (CS) tests. QoL was assessed with Greek Sarcopenia Quality of Life (SarQol_GR) questionnaire. Outcomes were assessed at baseline, immediately post-intervention (week 12), and 3 months post-intervention (week 24). Significant group x time interactions (p < 0.001) were observed in QoL, calf circumference, TUG, CS, and 4 m tests, grip and knee muscle strength. Group-based compared to home-based exercise yielded significant improvements (p < 0.05) in muscle mass index, CS and 4 m tests, calf circumference, muscle strength at 12 weeks. Most improvements at 24 weeks were reported with grouped exercise. No changes were found across the control group. Results suggest group-based exercise was more effective than home-based for improving functional performance

Initial and continued adherence to wearing appropriate footwear in people with diabetic foot disease: results of a pilot study

Background: For the prevention and healing of diabetic foot ulcers, appropriate footwear or medical devices are utilized. However, initial and continued adherence of patients with diabetes-related foot problems in using such therapeutic means, is not satisfactory. bjective: To explore initial and continued adherence to wearing appropriate footwear in people with diabetic foot disease. Methods: A cross-sectional study was conducted, from March to November 2016, at general and special hospitals in Athens, Greece. Forty-one outpatients with type 1 and 2 Diabetes Mellitus, with medical recommendation for wearing appropriate footwear, participated. A structured quantitative interview guide and medical measuring instruments were used. For data analysis, descriptive and inferential statistic methods were applied using the IBM SPSS 24 software package. Results: Suitable for diabetes footwear were worn from the 56.1% of participants. The 27.3% of risk patients wore their preventive shoes ≥60% (≥9.6 hours) of daytime. The patients with active foot ulcers wore appropriate footwear at a lesser percentage than the ones at risk (44.4% versus 78.6%, χ2(1) =4.36, p=0.037; OR 4.58, 95% CI 1.04-20.24, p=0.045) and the initially adherent group had significantly subordinate Visual Analogue Scale score in relation to the satisfaction from the footwear price (Mdn=5.00) than the one that was not initially adherent (Mdn=8.00), U=97.00, z=-2.36, p=0.019, r=-.38. Conclusion: For the enhancement of initial and continued adherence in wearing appropriate footwear, health care professionals could pay more attention to the education of patients with active foot ulcers, underling the importance of using right shoes. Additionally, they could provide patients with multiple price options concerning their footwear (e.g. by suggesting effective and affordable products)

Frailty education: promoting geriatric competencies among Physical Medicine and Rehabilitation residents.

AbstractFrailty, a geriatric syndrome of growing importance in recent years, has been shown to be associated with increased risk of disability, adverse health and socio-economic outcomes. Therefore, there is a need for new educational strategies for Physical Medicine and Rehabilitation (PMR) residents to promote greater geriatric competencies, with a focus on developing customized evaluation and management plans. With this paper, we aimed at offering a quick reference tool summarizing the latest evidence on the rehabilitative management of frailty. Indeed, a comprehensive geriatric evaluation is needed before developing an evidence-based and individually tailored rehabilitation program including physical activity, educative strategies, nutritional interventions and proposals for social reintegration. In the future, appropriate educational training may allow a more careful management of these patients, with consequent improvements in quality of life and functionality

Cross cultural adaptation of the Greek sarcopenia quality of life (SarQoL) questionnaire

Purpose: To translate and validate into the Greek language and setting the Sarcopenia Quality of Life (SarQoL®) questionnaire. Methods: A convenience sample of 176 Greek elderly people (136 females, 40 males; aged 71.19 ± 7.95 years) was recruited, 50 of which (36 females, 14 males) were diagnosed sarcopenic. Questionnaire was back-translated and culturally adapted into Greek according to international guidelines. To validate the Greek SarQoL®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test–retest reliability) and floor/ceiling effects. Participants were divided into sarcopenic and non-sarcopenic. Sarcopenic subjects apart from the Greek SarQoL (SarQoLGR) filled out the Greek versions of two generic questionnaires; Short Form-36 and EuroQoL 5-dimension. Results: The Greek SarQoL questionnaire was translated without major difficulties. SarQoLGR mean scores were 52.12 ± 11.04 (range: 24.74–71.81) for sarcopenic subjects and 68.23 ± 14.1 (range: 24.83–94.81) for non-sarcopenic ones. Results indicated good discriminative power across sarcopenic and non-sarcopenic subjects (p = 0.01), high internal consistency (Cronbach’s alpha of 0.96) and excellent test–retest reliability (ICC = 0.96, 95% CI = 0.95–0.97). Neither a floor nor a ceiling effect was observed. Conclusions: The Greek SarQoL was found to be a reliable and valid measure of quality of life for sarcopenic patients. It is therefore, available for use in future clinical research and practice. Implications for rehabilitation The Greek version of the SarQoL® questionnaire is a valid and reliable outcome measure for assessing patients with sarcopenia. The Greek SarQoL is recommended to be use in clinical settings and research. The Greek SarQoL® questionnaire is available online www.sarqol.org