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Sample records for ankle arthroscopy distraction

  1. Ankle arthroscopy

    MedlinePlus

    Ankle surgery; Arthroscopy - ankle; Surgery - ankle - arthroscopy; Surgery - ankle - arthroscopic ... You will likely receive general anesthesia before this surgery. This means you will be asleep and unable ...

  2. Posterior Ankle and Hind Foot Arthroscopy

    PubMed Central

    Gökkuş, Kemal; Aydın, Ahmet Turan

    2014-01-01

    Objectives: While anterior ankle arthroscopy is a widely accepted technique, posterior ankle/hind foot arthroscopy is still a relatively new procedure. The arthroscopic visualisation was often initially limited and vulnerabilty of the posteromedial neurovascular structures to injury scared orthopaedic surgeons. The goal of this review is to highlight the indications, and to present the long term follow up results of posterior ankle/hind foot arthroscopy. Methods: The study included 21 ankles in 21 patients (12 male and 9 female ).The mean age was 37.7 , the mean duration of preoperative symptoms 12.8 months . Arthroscopy performed with the patient prone , under general and spinal anesthesia with tourniquet hemostasis . Preoperative intravenous antibiotic prophylaxis is performed (cefazolin 1g) , sand bag placed under ipsilateral anteresuperior iliac spine to correct natural external rotated posture of the ankle and ankle is left hanging of the table so that it can moved freely during surgery. We applied noninvasive distraction method with simple rope which tied and knotted waist of the surgeon . The posterolateral and posteromedial portals which described by Van Dijk was utilized . The arthroscopic visualisation was often initially limited and careful debritement of some adipose tissue of the kager fat pad (Kager's fat pad, also known as the pre-Achilles fat pad) was necessary to create more space to aid visualization .The most valuable point to stay clear from trouble is to understand , know and aware where the flexor hallucis longus tendon exist .So neurovascular structures located beyond this tendon. Principally the process must advance into lateral to medial manner. The mean follow up period was 55 months. The most common preoperative diagnoses were osteochondral lesions of talus (ten ),painful os trigonum syndrome with (five )or without (three) FHL tenosynovitis (total eight ), posterior talofibular ligament thickenning (two ), Haglund’s deformity (one

  3. Combined Posterior and Anterior Ankle Arthroscopy

    PubMed Central

    Scholten, Peter E.; van Dijk, C. Niek

    2012-01-01

    Treatment of combined anterior and posterior ankle pathology usually consists of either combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with the extensive exposure, the latter technique provides limited access to the posterior ankle joint. A case is described of combined anterior and posterior arthroscopy, with the patient lying prone and then turned supine, addressing both anterior and posterior ankle pathologies in one tempo. This minimally invasive combined approach allows quick recovery and early return to work and sports activities. PMID:23227391

  4. Editorial Commentary: Big Data Suggest That Because of a Significant Increased Risk of Postoperative Infection, Steroid Injection Is Not Recommended After Ankle Arthroscopy.

    PubMed

    Brand, Jefferson C

    2016-02-01

    A recent study addressing infection rate after intra-articular steroid injection during ankle arthroscopy gives pause to this practice, with an odds ratio of 2.2 in the entire population that was injected with a steroid simultaneously with ankle arthroscopy compared with patients who did not receive an ankle injection. Big data, used in the study upon which the Editor comments here, suggest that because of a significant increased risk of postoperative infection, steroid injection is not recommended after ankle arthroscopy.

  5. Intermediate-Term Follow-up After Ankle Distraction for Treatment of End-Stage Osteoarthritis

    PubMed Central

    Nguyen, Mai P.; Pedersen, Douglas R.; Gao, Yubo; Saltzman, Charles L.; Amendola, Annunziato

    2015-01-01

    Background: Treatment of end-stage ankle osteoarthritis remains challenging, especially in young patients. Initial reports have shown early benefits of joint distraction for the treatment of ankle osteoarthritis. We report the five to ten-year results of a previously described patient cohort following ankle distraction surgery. Methods: All thirty-six patients who had undergone ankle distraction surgery between December 2002 and October 2006 were contacted. Patients were evaluated by a clinical investigator and completed the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) surveys. Radiographs as well as computed tomography and magnetic resonance imaging scans of the ankles were obtained at the follow-up visits. Results: Twenty-nine patients (81%) were followed for a minimum of five years (mean and standard deviation, 8.3 ± 2.2 years). Sixteen (55%) of the twenty-nine patients still had the native ankle joint whereas thirteen patients (45%) had undergone either ankle arthrodesis or total ankle arthroplasty. Positive predictors of ankle survival included a better AOS score at two years (hazard ratio [HR] = 0.048, 95% confidence interval [CI] = 0.0028 to 0.84, p = 0.04), older age at surgery (HR = 0.91, 95% CI = 0.83 to 0.99, p = 0.04), and fixed distraction (HR = 0.094, 95% CI = 0.017 to 0.525, p < 0.01). Radiographs and advanced imaging revealed progression of ankle osteoarthritis at the time of final follow-up. Conclusions: Ankle function following joint distraction declines over time. Patients should be well informed of the commitment that they must make during the treatment period as well as the long-term results after surgery. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:25834084

  6. Use of a Pneumatic Limb Positioner for Invasive Skeletal Traction in Posterior Hindfoot Arthroscopy

    PubMed Central

    Vopat, Bryan G.; Lareau, Craig R.; Sangal, Rohit B.; Fantry, Amanda J.; Blankenhorn, Brad D.

    2015-01-01

    Posterior hindfoot arthroscopy is a useful tool to treat a variety of foot and ankle pathologies. Skeletal distraction of the hindfoot to increase visualization in posterior ankle arthroscopy has been described in previous studies, but the described distractor is not readily available in most operating rooms. We describe a case of posterior hindfoot distraction in the prone position using a pneumatic limb positioner and other readily available Food and Drug Administration–approved equipment to apply tension to a transcalcaneal wire. The distraction technique we describe does not require any custom equipment, can fit on most standard operating tables, and is readily available in standard operating rooms. This method achieves adequate distraction, resulting in better visualization and more space for arthroscopic instrumentation. PMID:26697297

  7. Wrist arthroscopy

    MedlinePlus

    ... Arthroscopy - wrist; Surgery - wrist - arthroscopy; Surgery - wrist - arthroscopic; Carpal tunnel release ... small, fluid-filled sac that grows from the wrist joint. It is harmless, but it can be painful ...

  8. Instrumentation in Arthroscopy.

    PubMed

    Barp, Eric A; Erickson, John G; Reese, Eric R

    2016-10-01

    In recent years, arthroscopic procedures of the foot and ankle have seen a significant increase in both indications and popularity. Furthermore, technological advances in video quality, fluid management, and other arthroscopy-specific instruments continue to make arthroscopic procedures more effective with reproducible outcomes. As surgeons continue to use this approach, it is important that they have a complete understanding of the instrumentation available to them, including their indications and limitations. PMID:27599434

  9. Hip arthroscopy.

    PubMed

    de Amorim Cabrita, Henrique Antônio Berwanger; de Castro Trindade, Christiano Augusto; de Campos Gurgel, Henrique Melo; Leal, Rafael Demura; de Souza Marques, Ricardo da Fonseca

    2015-01-01

    Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff), although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve.

  10. Small Joint Arthroscopy in the Foot.

    PubMed

    Reeves, Christopher L; Shane, Amber M; Payne, Trevor; Cavins, Zac

    2016-10-01

    Arthroscopy has advanced in the foot and ankle realm, leading to new innovative techniques designed toward treatment of small joint abnormality. A range of abnormalities that are currently widespread for arthroscopic treatment in larger joints continues to be translated to congruent modalities in the small joints. Small joint arthroscopy offers relief from foot ailments with a noninvasive element afforded by arthroscopy. Early studies have found comparable results from arthroscopic soft tissue procedures as well as arthrodesis of the small joints when compared with the standard open approach. PMID:27599441

  11. Arthroscopy language.

    PubMed

    Zahiri, H; Brazina, G; Zahiri, C A

    1994-09-01

    The authors have devised an "arthroscopy language" to make orthopaedic surgeons' intraoperative communication clear, comprehensive, and concise. This language specifically eliminates surgeons' "freestyle" conversation at the most crucial moments of their procedure, when concentration and the coordinated work of two surgeons are essential. The language uses current arthroscopic terminology and new words that have been adapted by the authors to describe all the basic maneuvers that are used during any arthroscopic procedure. The authors believe the language brings the necessary scientific sophistication into arthroscopic surgeons' speech in the operating theater. PMID:7800401

  12. Trends in Wrist Arthroscopy

    PubMed Central

    Obdeijn, Miryam C.; Tuijthof, Gabrielle J. M.; van der Horst, Chantal M. A. M.; Mathoulin, Christophe; Liverneaux, Philippe

    2013-01-01

    Background Wrist arthroscopy plays a role in both the diagnosis and the treatment of wrist pathology. It has evolved in the last three decades. Questions The present status of wrist arthroscopy was investigated by answering the following questions: -What is its current position in the treatment wrist pathologies according to the literature? -What is its current position according to hand surgeons? Methods Analysis of the number of publications on wrist arthroscopy was performed and compared with the number of publications on other arthroscopy topics to assess the current position of wrist arthroscopy. The members of the EWAS (European Wrist Arthroscopy Society) and the members of eight national hand surgery societies were questioned on wrist arthroscopy in daily practice. Results From 1975 till now, 925 papers on wrist arthroscopy were found. The publications on wrist arthroscopy increased from an average of 8/year (1986) to 26/year (2012). More than half (56.9%) of the respondents of the EWAS perform fewer than 5 wrist arthroscopies per month, and only 7 (10.8%) indicate the performance of more than 10 wrist arthroscopies per month. Seventy-four percent of the orthopedic hand surgeons perform wrist arthroscopy (in 48.5% for therapeutic indications) against 36.8% of plastic surgery hand surgeons (in 23.1% for therapeutic indications). Conclusion Wrist arthroscopy has taken up a place in the armamentarium of the hand surgeon. The place of wrist arthroscopy in daily practice is related to the background of the hand surgeon. PMID:24436823

  13. Distracted Driving

    MedlinePlus

    ... combines all three types of distraction. 3 How big is the problem? Deaths In 2013, 3,154 ... European countries. More A CDC study analyzed 2011 data on distracted driving, including talking on a cell ...

  14. Ankle pain

    MedlinePlus

    Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

  15. Ankle replacement

    MedlinePlus

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... You may not be able to have a total ankle replacement if you have had ankle joint infections ...

  16. Imaging of Common Arthroscopic Pathology of the Ankle.

    PubMed

    Grambart, Sean T

    2016-10-01

    Arthroscopy of the ankle is used in the treatment and diagnosis of a spectrum of intra-articular pathology including soft tissue and osseous impingement, osteochondral lesions, arthrofibrosis, and synovitis. To help identify the correct pathology, imaging techniques are often used to aid the surgeon in diagnosing pathology and determining best treatment options. This article discusses the use of imaging in various ankle pathologies.

  17. [Callus distraction].

    PubMed

    Giebel, G

    1995-09-01

    Fibroblast networks that form collagen and connect the two ends of bone develop in the haematoma after corticotomy. This regenerative tissue is vascularized and distracted. Even during the lengthening, mineralization starts. This starts at the ends created by the osteotomy, in the form of conical bony columns 200 microns thick, which grows towards each other in a manner reminiscent of stalagmites and stalactites, until the central, fibrous inner zone (growth zone) formed during distraction is completely mineralized. Connective tissue and bony bars are arranged lengthwise. As a rule, intramembranous callus formation takes place during distraction osteogenesis with no intermediate cartilaginous step.

  18. Arthroscopy and joint lavage.

    PubMed

    Ayral, Xavier

    2005-06-01

    Arthroscopy is used by rheumatologists for research purposes in cases with knee osteoarthritis and inflammatory arthritis. This chapter explains the technical characteristics of 'research arthroscopy' including the simplification of the procedure, video-recording, as well as risks and training. Lavage of the knee joint is proposed as a treatment procedure for osteoarthritis and inflammatory and septic arthritis. Tidal irrigation and the two-needle technique of lavage are described. In the absence of clear predictive factors for efficacy, the indications for these techniques are a matter of debate. PMID:15939366

  19. Hip Arthroscopy: A Brief History.

    PubMed

    Kandil, Abdurrahman; Safran, Marc R

    2016-07-01

    Hip arthroscopy is a fast-growing and evolving field. Like knee and shoulder arthroscopy, hip arthroscopy began as a diagnostic procedure and then progressed to biopsy and resection of abnormalities. Subsequently, it has evolved to repair of various tissues and treatment of underlying causes. As the understanding of the hip joint and its associated pathophysiology grows, indications will continue to expand for this diagnostic and therapeutic modality. This article outlines the historic developments of hip arthroscopy, including advancements in instrumentation and techniques from the days of the first hip arthroscopies to the present day.

  20. Knee arthroscopy - series (image)

    MedlinePlus

    ... ligaments are among the ligaments of the knee joint. ... the joint (synovium), and the rest of the joint. Damaged tissues can be removed. Arthroscopy can also be used to help view the inside of the knee while ligaments or tendons are repaired from the outside.

  1. Dry Arthroscopy of the Elbow

    PubMed Central

    Phadnis, Joideep; Bain, Gregory

    2015-01-01

    Dry arthroscopy is attractive because it affords an unsurpassed clarity of view and minimizes swelling. The elbow is a challenging joint to assess arthroscopically; however, dry arthroscopy has some particular benefits in the elbow. The primary benefit is the quality of the tissue definition, but dry arthroscopy also increases the working time for surgery by reducing swelling and results in less postoperative discomfort for the patient. With dry arthroscopy, all joint surfaces are covered in synovial fluid, which reflects light, to provide a clearer image of the joint surfaces and depth of field. The air-fluid interface provides an uninterrupted appreciation of the synovial recesses and tissue perfusion. This article describes the technique and indications for dry elbow arthroscopy, which will allow other surgeons to reap the benefits of dry arthroscopy without the need for special equipment or changes in their basic technique. PMID:26759772

  2. Deadly distractions.

    PubMed

    Zuzek, Crystal

    2013-04-01

    In 2011, the National Transportation Safety Board urged all states to ban the use of portable electronic devices while driving, including hand-held and hands-free devices. Texting while driving concerns several Texas legislators, who have filed bills, backed by the Texas Medical Association, to ban the practice. TMA physicians recognize that the use of hand-held and hands-free devices and other factors associated with distracted driving affect their patients' safety. PMID:23546834

  3. Arthroscopically Assisted Open Reduction-Internal Fixation of Ankle Fractures: Significance of the Arthroscopic Ankle Drive-through Sign.

    PubMed

    Schairer, William W; Nwachukwu, Benedict U; Dare, David M; Drakos, Mark C

    2016-04-01

    Standalone open reduction-internal fixation (ORIF) of unstable ankle fractures is the current standard of care. Intraoperative stress radiographs are useful for assessing the extent of ligamentous disruption, but arthroscopic visualization has been shown to be more accurate. Concomitant arthroscopy at the time of ankle fracture ORIF is useful for accurately diagnosing and managing syndesmotic and deltoid ligament injuries. The arthroscopic ankle drive-through sign is characterized by the ability to pass a 2.9-mm shaver (Smith & Nephew, Andover, MA) easily through the medial ankle gutter during arthroscopy, which is not usually possible with both an intact deltoid ligament and syndesmosis. This arthroscopic maneuver indicates instability after ankle reduction and fixation and is predictive of the need for further stabilization. Furthermore, when this sign remains positive after fracture fixation, it may guide the surgeon to further evaluate the adequacy of fixation for the possible need for further fixation of the syndesmosis or deltoid. We present the case of an ankle fracture managed with arthroscopy-assisted ORIF and describe the clinical utility of the arthroscopic ankle drive-through sign. PMID:27462542

  4. Distraction osteogenesis.

    PubMed

    Sidman, James; Tatum, Sherard Austin

    2014-02-01

    James Sidman, MD, and Sherard A. Tatum, MD, address the following questions for discussion and debate. Is neonatal distraction osteogenesis (DO) better than lip-tongue adhesion or tracheotomy for micrognathic airway compromise? What role does DO have in adult orthognathic surgery situations? In monobloc and Le Fort III procedures, are internal or external devices preferable? What role does DO play in craniofacial microsomia? Is endoscopic DO better than open procedures for synostosis management? How has your technique changed or evolved over the past 5 years and what has doing this technique taught you?

  5. Heterotopic ossification after hip arthroscopy

    PubMed Central

    Amar, Eyal; Sharfman, Zachary T.; Rath, Ehud

    2015-01-01

    Heterotopic ossification (HO) after hip arthroscopy is the abnormal formation of mature lamellar bone within extra skeletal soft tissues. HO may lead to pain, impaired range of motion and possibly revision surgery. There has been a substantial amount of recent research on the pathophysiology, prophylaxis and treatment of HO associated with open and arthroscopic hip surgery. This article reviews the literature on the aforementioned topics with a focus on their application in hip arthroscopy. PMID:27011859

  6. Imaging of Common Arthroscopic Pathology of the Ankle.

    PubMed

    Grambart, Sean T

    2016-10-01

    Arthroscopy of the ankle is used in the treatment and diagnosis of a spectrum of intra-articular pathology including soft tissue and osseous impingement, osteochondral lesions, arthrofibrosis, and synovitis. To help identify the correct pathology, imaging techniques are often used to aid the surgeon in diagnosing pathology and determining best treatment options. This article discusses the use of imaging in various ankle pathologies. PMID:27599435

  7. Posterior ankle impingement syndrome: A systematic four-stage approach

    PubMed Central

    Yasui, Youichi; Hannon, Charles P; Hurley, Eoghan; Kennedy, John G

    2016-01-01

    Posterior ankle impingement syndrome (PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior two-portal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot (superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem. PMID:27795947

  8. Fluid pump systems for arthroscopy: a comparison of pressure control versus pressure and flow control.

    PubMed

    Ogilvie-Harris, D J; Weisleder, L

    1995-10-01

    We set out to compare two pump systems, one in which pressure alone could be controlled and the second in which pressure and flow could be controlled separately. Assessments were carried out by two observers independently. A variety of arthroscopic procedures were studied including arthroscopy of the knee, anterior cruciate ligament reconstruction, arthroscopy and acromioplasty of the shoulder, and arthroscopy of the elbow and ankle. We found that both systems used a similar amount of fluid. However, the operative time was significantly decreased with separate control of pressure and flow. This was related to the fact that there was better visualization and better technical ease with the latter pump. There was significantly less extravasation in the soft tissues. Therefore, based on our assessment, pumps that separately control pressure and flow are significantly better than pumps that control pressure alone. There is distinct advantage in less operative time, greater visualization, technical ease, and less soft tissue extravasation. PMID:8534302

  9. Evaluation of traction stirrup distraction technique to increase the joint space of the shoulder joint in the dog: A cadaveric study.

    PubMed

    Devesa, V; Rovesti, G L; Urrutia, P G; Sanroman, F; Rodriguez-Quiros, J

    2015-06-01

    The objective of this study was to evaluate technical feasibility and efficacy of a joint distraction technique by traction stirrup to facilitate shoulder arthroscopy and assess potential soft tissue damage. Twenty shoulders were evaluated radiographically before distraction. Distraction was applied with loads from 40 N up to 200 N, in 40 N increments, and the joint space was recorded at each step by radiographic images. The effects of joint flexion and intra-articular air injection at maximum load were evaluated. Radiographic evaluation was performed after distraction to evaluate ensuing joint laxity. Joint distraction by traction stirrup technique produces a significant increase in the joint space; an increase in joint laxity could not be inferred by standard and stress radiographs. However, further clinical studies are required to evaluate potential neurovascular complications. A wider joint space may be useful to facilitate arthroscopy, reducing the likelihood for iatrogenic damage to intra-articular structures.

  10. Ankle Sprains.

    PubMed

    1986-02-01

    In brief: Ankle sprain is a risk for many athletes, especially those in the jumping sports (eg, volleyball and basketball) as well as football and soccer, where players tend to roll over on the ankle. Lateral sprains occur much more frequently than medial eversion sprains, but the latter are more devastating. In addition to types of sprains, this panel of specialists discussed surgical vs nonsurgical treatment, tape vs brace for support, rehabilitation and exercise, and ways to prevent ankle sprains.

  11. Ankle Sprains

    MedlinePlus

    ... What's the Treatment for a Sprained Ankle? More Serious Sprains en español Esguinces de tobillo As a field hockey player, Jill was used to twisting her ankle. She'd always been able to walk it off and get back in the game. But one day she stepped on another player's ...

  12. Ankle impingement.

    PubMed

    Lavery, Kyle P; McHale, Kevin J; Rossy, William H; Theodore, George

    2016-01-01

    Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed. PMID:27608626

  13. Ankle impingement.

    PubMed

    Lavery, Kyle P; McHale, Kevin J; Rossy, William H; Theodore, George

    2016-09-09

    Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.

  14. Hip Arthroscopy: Tales From the Crypt.

    PubMed

    Matsuda, Dean K; Philippon, Marc J; Safran, Marc R; Sampson, Thomas G

    2016-01-01

    Complications after hip arthroscopy vary in frequency and severity, even for experienced surgeons. It is important for surgeons to be aware of some of the more dramatic, often unusual, and always memorable (nightmarish) complications of hip arthroscopy and understand how they are caused, how they can be treated, and how they can be prevented.

  15. Hip Arthroscopy: Tales From the Crypt.

    PubMed

    Matsuda, Dean K; Philippon, Marc J; Safran, Marc R; Sampson, Thomas G

    2016-01-01

    Complications after hip arthroscopy vary in frequency and severity, even for experienced surgeons. It is important for surgeons to be aware of some of the more dramatic, often unusual, and always memorable (nightmarish) complications of hip arthroscopy and understand how they are caused, how they can be treated, and how they can be prevented. PMID:27049210

  16. Arthroscopy Authors Seek Innovative International Readers.

    PubMed

    Lubowitz, James H; Provencher, Matthew T; Rossi, Michael J; Brand, Jefferson C; Schmidt, Melissa B

    2016-08-01

    Arthroscopy and Arthroscopy Techniques attract authors as a result of our large, innovative, and global audience. In addition, the journals attract authors because of our robust and rapid review process, our wide indexing and search availability, and our openness to diverse article types including Technical Notes with video. PMID:27495852

  17. Role of simulation in arthroscopy training.

    PubMed

    Madan, Simerjit Singh; Pai, Dinker R

    2014-04-01

    Arthroscopy uses a completely different skill set compared with open orthopedic surgery. Hitherto, arthroscopy had not been given enough emphasis in the core orthopedic curricula. Simulation has been seen as an excellent way to teach the skills required in arthroscopy. The simulators used for arthroscopy training can be broadly classified into physical simulators such as cadavers, animals, models and box trainers, virtual-reality simulators, and hybrid simulators that combine virtual-reality simulation with physical components that allow real tactile feedback. The advantages and disadvantages of each of these types have been described in this article. The factors that determine skill acquisition using these simulators have been highlighted. In conclusion, simulation seems to be a valuable tool for arthroscopy training, although further studies are needed to state whether this translates into better operative skill on real patients.

  18. First Metatarsophalangeal Joint Arthroscopy for Osteochondral Lesions.

    PubMed

    Sherman, Thomas I; Kern, Michael; Marcel, John; Butler, Alexander; McGuigan, Francis X

    2016-06-01

    Small-joint arthroscopy has supplanted open procedures because it offers the potential for improvement in joint visualization, reduced scarring, and accelerated recovery. Despite these advantages, arthroscopy of the first metatarsophalangeal joint is not commonly performed and reports of its use are lacking. The reason for this is not clear but may be because of perceived technical complexity and poorly defined indications. In our experience, however, arthroscopy of the first metatarsophalangeal joint is a versatile procedure that facilitates treatment of many different pathologic processes through a minimally invasive approach with few complications. We present our technique for arthroscopic management of osteochondral lesions of the hallux. PMID:27656371

  19. Posterior Ankle Impingement in Two Athletic Twin Brothers, Could Genetics Play a Role?

    PubMed

    Bech, Niels H; de Leeuw, Peter A J; Haverkamp, Daniel

    2016-01-01

    Pain posteriorly in the ankle can be caused by bony impingement of the posterolateral process of the talus. This process impinges between the tibia and calcaneus during deep forced plantar flexion. If this occurs it is called posterior ankle impingement syndrome. We report the case of 2 athletic monozygotic twin brothers with bony impingement posteriorly in the left ankle. Treatment consisted of ankle arthroscopy in both patients during which the symptomatic process was easily removed. At 3 months after surgery, both patients were completely free of pain, and 1 of the brothers had already returned to sports. The posterior ankle impingement syndrome is not a rare syndrome, but it has not been described in siblings thus far. That these 2 patients are monozygotic twin brothers suggests that genetics could play a role in the development of skeletal deformities that can result in posterior ankle impingement syndrome.

  20. Distractions in Everyday Driving

    MedlinePlus

    ... about one hour and 15 minutes in their vehicles every day? Unfortunately, people often treat this as ... easy access to information, entertainment, and communications, in-vehicle distractions are increasing – as is the temptation to ...

  1. Postoperative pectoral swelling after shoulder arthroscopy

    PubMed Central

    ERCIN, ERSIN; BILGILI, MUSTAFA GOKHAN; ONES, HALIL NADIR; KURAL, CEMAL

    2015-01-01

    Fluid extravasation is possibly the most common complication of shoulder arthroscopy. Shoulder arthroscopy can lead to major increases in the compartment pressure of adjacent muscles and this phenomenon is significant when an infusion pump is used. This article describes a case of pectoral swelling due to fluid extravasation after shoulder arthroscopy. A 24-year-old male underwent an arthroscopic Bankart repair for recurrent shoulder dislocation. The surgery was performed in the beach chair position and lasted two hours. At the end of the procedure, the patient was found to have left pectoral swelling. A chest radiography showed no abnormality. Pectoral swelling due to fluid extravasation after shoulder arthroscopy has not previously been documented. PMID:26889473

  2. Chlorhexidine burns after shoulder arthroscopy.

    PubMed

    Sanders, Thomas H; Hawken, Samuel M

    2012-04-01

    Chlorhexidine is an antiseptic and disinfectant commonly used for surgical site preparation and cleansing. It is active against a broad spectrum of bacteria, viruses, mycobacteria, and fungi. We report 3 cases of patients with superficial partial thickness burns immediately following shoulder arthroscopic surgery with the use of a Chloraprep 26 mL applicator (2% chlorhexidine gluconate and 70% isopropyl alcohol; CareFusion, Leawood, Kansas). All 3 patients reported pain as the anesthetic waned at a localized area on the anterior arm near the axilla. Erythema and blistering were noticeable. These areas were immediately treated with irrigation and local application of ice, and subsequently with topical triple-antibiotic ointment. All 3 cases were resolved within 3 months of surgery, but noticeable scars remained. We believe a combination of chlorhexidine skin preparation, local swelling inherent to shoulder arthroscopy, and traction contributed to these postoperative complications.

  3. ARTHROSCOPY OF THE SCAPULOTHORACIC JOINT: CASE REPORTS

    PubMed Central

    Andreoli, Carlos Vicente; Ejnisman, Benno; Pochini, Alberto de Castro; Monteiro, Gustavo Cará; Cohen, Moisés; Faloppa, Flávio

    2015-01-01

    Scapulothoracic arthroscopy is a procedure presenting restricted indications, for resecting free bodies, benign tumors, bursitis, and snaping scapula. The authors report four cases of scapulothoracic joint arthroscopy; in the first case, only a benign tumor (osteochondroma) could be visualized; in the second case, arthroscopic resection of an osteochondroma was found; in the third case, arthroscopic bursectomy due to scapulothoracic bursitis, and; in the fourth case, bursectomy and partial superomedial arthroscopic scapulectomy due to snaping scapula. PMID:27022519

  4. Neonatal mandibular distraction osteogenesis.

    PubMed

    Flores, Roberto L

    2014-11-01

    Mandibular distraction has revolutionized the treatment of Robin sequence associated with severe airway obstruction. The distraction technique remains the only intervention that directly corrects mandibular hypoplasia and the retropositioned tongue, providing efficient relief of airway stenosis. Multiple studies have demonstrated the efficacy of distraction in avoiding tracheostomy and decreasing the severity airway obstruction in this patient population. The benefit to avoiding tracheostomy and relieving airway obstruction is superior to that of tongue-lip adhesion. It is, therefore, not surprising that mandibular distraction has become the first-line intervention at many centers for the surgical treatment of Robin sequence. The complication profile associated with mandibular distraction appears low; the most common complication is infection, which can be treated by antibiotics alone. The severity of airway obstruction can be quantified by polysomnogram: This tool has become one of the most widely used objective metrics in the Robin sequence population. Therefore indications for surgery, timing of palatoplasty and long-term assessment of airway function should be performed in conjunction with sleep study analysis. The effects of mandibular lengthening on feeding difficulty in Robin sequence patient remains a topic of controversy. Studies have demonstrated conflicting results: This can be an area of future study. Agreed-upon indications for surgery and definitive protocols of care have yet to be formulized; future research should focus on achieving these goals. Such studies would require agreed-upon terminology for Robin sequence, an increase in comparative and prospective analysis, and the use of quantifiable metrics of clinical results.

  5. Single Portal Knee Arthroscopy: 2015 Technique Update

    PubMed Central

    Cooper, Daniel E.

    2016-01-01

    A technique of single portal knee arthroscopy was reported in 2013. Using a parallel working cannula assembled to the arthroscope cannula, the instruments are passed into the joint in line with the arthroscope. The original technique video in Arthroscopy Techniques shows the use of a 25 mm tube assembly with a parallel portal through which biters and proximally bent cutter instruments are used to perform procedures in the knee. This 2015 technical update shows the current preferred and most versatile method of single portal knee arthroscopy using a parallel locking and rotating hub for passage of biters and double-bend cutters. The video shows adequate completion of a partial meniscectomy using only 1 portal. PMID:27073772

  6. Single Portal Knee Arthroscopy: 2015 Technique Update.

    PubMed

    Cooper, Daniel E

    2016-02-01

    A technique of single portal knee arthroscopy was reported in 2013. Using a parallel working cannula assembled to the arthroscope cannula, the instruments are passed into the joint in line with the arthroscope. The original technique video in Arthroscopy Techniques shows the use of a 25 mm tube assembly with a parallel portal through which biters and proximally bent cutter instruments are used to perform procedures in the knee. This 2015 technical update shows the current preferred and most versatile method of single portal knee arthroscopy using a parallel locking and rotating hub for passage of biters and double-bend cutters. The video shows adequate completion of a partial meniscectomy using only 1 portal.

  7. Elbow arthroscopy in a mostly athletic population.

    PubMed

    Ward, W G; Anderson, T E

    1993-03-01

    The effectiveness of elbow arthroscopy was assessed in 35 consecutive patients (primarily weight lifters and baseball players) treated by one surgeon. The most commonly treated lesions were loose bodies and impinging spurs. Most elbow problems resulted from repetitive or acute athletic trauma. Repetitive stress injuries usually involved the athlete's dominant arm (91%). A standardized rating system demonstrated significant improvement at 24 months' average follow-up. Flexion and extension improved an average of 9 and 6 degrees, respectively. Elbow arthroscopy appears to be a safe and effective treatment for athletes, allowing most a full return to participation in sports.

  8. Total ankle joint replacement.

    PubMed

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications.

  9. The value of wrist arthroscopy. An evaluation of 129 cases.

    PubMed

    De Smet, L; Dauwe, D; Fortems, Y; Zachee, B; Fabry, G

    1996-04-01

    In order to evaluate diagnostic and therapeutic wrist arthroscopy we analyzed 129 arthroscopies with a follow-up of at least 6 months. Seventy-seven arthroscopies were performed for therapeutic purposes; 52 arthroscopies were diagnostic. There were diagnostic benefits in 55 arthroscopies (42.5%), therapeutic benefits in 29 arthroscopies (22.5%), combined diagnostic and therapeutic benefits in 39 (30%) and no benefits in six (5%). In 65 cases of the therapeutic group (with preoperative diagnosis) the authors found that the arthroscopy had been worthwhile. For the diagnostic group without a preoperative diagnosis, an arthroscopic diagnosis was made in 44 cases. Complications occurred in two patients: one tendon incision over a Kirschner wire in the therapeutic group and one superficial infection in the diagnostic group. PMID:8732403

  10. The virtual reality arthroscopy training simulator.

    PubMed

    Müller, W; Bockholt, U

    1998-01-01

    Arthroscopy has already become an irreplaceable method in diagnostics. The arthroscope, with optics and light source, and the exploratory probe are inserted into the knee joint through two small incisions underneath the patella. Currently, the skills required for arthroscopy are taught through hands-on clinical experience. As arthroscopies became a more common procedure even in smaller hospitals, it became obvious that special training was necessary to guarantee qualification of the surgeons. On-the-job training proved to be insufficient. Therefore, research groups from the Berufsgenossenschaftliche Unfallklinik Frankfurt am Main approached the Fraunhofer Institute for Computer Graphics to develop a training system for arthroscopy based on virtual reality (VR) techniques. Two main issues are addressed: the three-dimensional (3-D) reconstruction process and the 3-D interaction. To provide the virtual environment a realistic representation of the region of interest with all relevant anatomical structures is required. Based on a magnetic resonance image sequence a realistic representation of the knee joint was obtained suitable for computer simulation. Two main components of the VR interface can be distinguished: the 3-D interaction to guide the surgical instruments and the 2-D graphical user interface for visual feedback and control of the session. Moreover, the 3-D interaction has to be realized by means of Virtual Reality techniques providing a simulation of an arthroscope and an intuitive handling of other surgical instruments. Currently, the main drawback of the developed simulator is the missing of haptic perception, especially of force feedback. In cooperation with the Department of Electro-Mechanical Construction at the Technical University Darmstadt a haptic display is designed and built for the VR arthroscopy training simulator. In parallel we developed a concept for the integration of the haptic display in a configurable way. PMID:10180528

  11. The use of navigation forces for assessment of wrist arthroscopy skills level.

    PubMed

    Obdeijn, Miryam C; van Baalen, Sophie J; Horeman, Tim; Liverneaux, Philippe; Tuijthof, Gabrielle J M

    2014-05-01

    Purpose To provide an efficient learning process, feedback on performance is crucial. In skills laboratories, it is possible to measure the skills and progression of skills of the trainees objectively. This requires metrics that represent the learning curve of the trainee, which were investigated for wrist arthroscopy. The research questions were: What are the forces used by novices during wrist arthroscopy?What aspects of these navigation forces are discriminative for the wrist arthroscopy skills level?Methods A cadaver wrist was mounted in a custom-made distraction device mounted in front of a force platform (ForceTrap). Eleven novices were invited to perform two tasks on the wrist: Insertion of the scope through the 3-4 portal and the hook through the 6R portal, and visualization of the hook in the center of the imageNavigation through the wrist from radial to ulnar with probing and visualization of five predefined landmarksThe second task was repeated 10 times. The absolute force (F abs) and the direction of force were measured. The angle α is defined in the vertical plane, and the angle β in the horizontal plane. Results The median F abs used by novices remained below the force threshold as defined from the expert data (7.3 N). However, the direction of the applied forces by novices in both planes was not consistent with expert data and showed a wider range. Also, there was no improvement after more trials. Conclusion Our study suggests by the absence of a learning curve for the novices and a significant difference between novices and experts that novices can benefit from feedback on the magnitude and direction of forces to improve their performance. PMID:25077049

  12. The use of navigation forces for assessment of wrist arthroscopy skills level.

    PubMed

    Obdeijn, Miryam C; van Baalen, Sophie J; Horeman, Tim; Liverneaux, Philippe; Tuijthof, Gabrielle J M

    2014-05-01

    Purpose To provide an efficient learning process, feedback on performance is crucial. In skills laboratories, it is possible to measure the skills and progression of skills of the trainees objectively. This requires metrics that represent the learning curve of the trainee, which were investigated for wrist arthroscopy. The research questions were: What are the forces used by novices during wrist arthroscopy?What aspects of these navigation forces are discriminative for the wrist arthroscopy skills level?Methods A cadaver wrist was mounted in a custom-made distraction device mounted in front of a force platform (ForceTrap). Eleven novices were invited to perform two tasks on the wrist: Insertion of the scope through the 3-4 portal and the hook through the 6R portal, and visualization of the hook in the center of the imageNavigation through the wrist from radial to ulnar with probing and visualization of five predefined landmarksThe second task was repeated 10 times. The absolute force (F abs) and the direction of force were measured. The angle α is defined in the vertical plane, and the angle β in the horizontal plane. Results The median F abs used by novices remained below the force threshold as defined from the expert data (7.3 N). However, the direction of the applied forces by novices in both planes was not consistent with expert data and showed a wider range. Also, there was no improvement after more trials. Conclusion Our study suggests by the absence of a learning curve for the novices and a significant difference between novices and experts that novices can benefit from feedback on the magnitude and direction of forces to improve their performance.

  13. Ankle replacement - discharge

    MedlinePlus

    Murphy GA. Total ankle arthroplasty. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 10. Wexler D, Grosser DM. Ankle arthrtitis. ...

  14. Craniofacial distraction osteogenesis.

    PubMed

    Winters, Ryan; Tatum, Sherard A

    2014-11-01

    Distraction osteogenesis (DO) may be the most versatile tool to become available to the craniofacial surgeon in recent years. It can be used in an ever-expanding register of clinical scenarios and offers major advantages over conventional craniofacial techniques in some circumstances. Craniofacial surgery has significant complications, some of which can be mitigated but not eliminated by choosing DO over conventional approaches. Although some DO applications are in their infancy with limited data, this article provides an overview of current uses of this versatile technology.

  15. Assessment of Ankle Injuries

    ERIC Educational Resources Information Center

    Mai, Nicholas; Cooper, Leslie

    2009-01-01

    School nurses are faced with the challenge of identifying and treating ankle injuries in the school setting. There is little information guiding the assessment and treatment of these children when an injury occurs. It is essential for school nurses to understand ankle anatomy, pathophysiology of the acute ankle injury, general and orthopedic…

  16. Arthroscopic Ankle Arthrodesis.

    PubMed

    Hutchinson, Byron

    2016-10-01

    Arthroscopic ankle arthrodesis is a cost-effective option for many patients with posttraumatic arthritis of the ankle joint. Rehabilitation is generally quicker than conventional open techniques, and rates of fusion are comparable or better than traditional open techniques. Unless the arthroscopic surgeon has considerable experience, the best results are seen in patients with very little deformity in the ankle joint. PMID:27599442

  17. Major vascular injuries complicating knee arthroscopy

    PubMed Central

    Bancu, Serban; Muresan, Mircea; Sala, Daniela

    2015-01-01

    Starting with a case report, we made a detailed review of the literature, with the purpose of identifying and analyzing the type of iatrogenic vascular lesion following knee arthroscopy and the method of vascular repair. A PubMed literature search was undertaken to locate all reported cases of major vascular iatrogenic injuries during arthroscopic knee procedures. We identified 39 papers which report a total of 62 cases of major iatrogenic popliteal lesions after knee arthroscopy, between 1985 and 2014. The type of arthroscopic intervention performed, the type of iatrogenic vascular lesion encountered, the time passed until its discovery and treatment, the method of vascular reconstruction, and the postoperative course are presented. Postarthroscopy vascular complications are infrequent but potentially disastrous for the condition of the affected inferior limb. An early diagnosis and reintervention are mandatory for a good postoperative outcome. PMID:26240627

  18. New methods in arthroscopy: preliminary investigations.

    PubMed Central

    Frizziero, L; Zizzi, F; Leghissa, R; Ferruzzi, A

    1986-01-01

    The microhysteroscope, which affords direct in vivo observation of otherwise inaccessible surfaces, can be used to great advantage in arthroscopy. Although conventional arthroscopy can distinguish between 'inflammatory' and 'reactive' (post-traumatic) synovial changes, the microendoscope offers the possibility of more precise differentiation. Synovial membranes, joint cartilage, and menisci were studied at four different magnifications, including microscopic observation of vitally stained cells. Frankly pathological synovia (e.g., rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) were compared and distinguished from examples of less florid synovial changes. The fibrocartilaginous structure of the menisci and secondary undulations and tertiary depression of joint cartilage become visible in vivo with the microendoscope; these may well point to early damage to these structures. The authors believe that the three dimensional images at the magnifications provided by this microendoscope go some way towards bridging the gap between the conventional arthroscope, the light microscope, and the scanning electron microscope. This report presents preliminary findings with this new technique. Images PMID:3740979

  19. Neural Basis of Visual Distraction

    ERIC Educational Resources Information Center

    Kim, So-Yeon; Hopfinger, Joseph B.

    2010-01-01

    The ability to maintain focus and avoid distraction by goal-irrelevant stimuli is critical for performing many tasks and may be a key deficit in attention-related problems. Recent studies have demonstrated that irrelevant stimuli that are consciously perceived may be filtered out on a neural level and not cause the distraction triggered by…

  20. Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation.

    PubMed

    Mannava, Sandeep; Howse, Elizabeth A; Stone, Austin V; Stubbs, Allston J

    2015-08-01

    Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine patient positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for patient positioning and operative setup improves patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeon's standard approach to hip arthroscopy cases.

  1. Arthroscopy Journal Prizes Are Major Decisions.

    PubMed

    Lubowitz, James H; Brand, Jefferson C; Provencher, Matthew T; Rossi, Michael J

    2016-01-01

    According to the Harvard Business Review, the optimal number of people in a decision-making group is no more than 8. Thus, it is no surprise that 18 Arthroscopy journal associate editors had difficulty making a major decision. In the end, 18 editors did successfully select the 2015 winner of the Best Comparative Study Prize. All studies have limitations, but from a statistical standpoint, the editors believe that the conclusions of the winning study are likely correct.

  2. Arthroscopy Journal Prizes Are Major Decisions.

    PubMed

    Lubowitz, James H; Brand, Jefferson C; Provencher, Matthew T; Rossi, Michael J

    2016-01-01

    According to the Harvard Business Review, the optimal number of people in a decision-making group is no more than 8. Thus, it is no surprise that 18 Arthroscopy journal associate editors had difficulty making a major decision. In the end, 18 editors did successfully select the 2015 winner of the Best Comparative Study Prize. All studies have limitations, but from a statistical standpoint, the editors believe that the conclusions of the winning study are likely correct. PMID:26743401

  3. [Front Block distraction].

    PubMed

    Esnault, Olivier

    2015-03-01

    The contribution of the segmental osteotomies in the ortho-surgical protocols is no longer to demonstrate and found a new lease of life thanks to the combination with the bone distraction techniques. The osteotomy of Köle, initially described to close infraclusies, and then used to level very marked curves of Spee has more recently been used to correct anterior crowding. This support is therefore aimed at patients with an incisor and canine Class 2 but molar Class 1 with an isolated mandibular footprint. With minimal orthodontic preparation we can create in two weeks bilateral diastemas that will then be used to align the incisivocanin crowding without stripping or bicuspid extractions. Dental orthodontic movements can be resumed one month after the end of the distraction. This technique is therefore likely to avoid bicuspid extraction and replace some sagittal osteotomy advancement by correction of the overjet. It also helps to correct a incisors labial or lingual tipping playing on differential activation of the cylinders and the distractor. This segmental surgery can be combined with Le Fort 1 surgeries with correction of the transverse and associated meanings, but in a second time, to a mandibular advancement and/or a genioplasty. PMID:25888045

  4. Return to sport after hip arthroscopy: aggregate recommendations from high-volume hip arthroscopy centers.

    PubMed

    Domb, Benjamin G; Stake, Christine E; Finch, Nathan A; Cramer, T Luke

    2014-10-01

    Hip arthroscopy is a minimally invasive surgical technique often performed in athletes who want an expeditious return to sport. To the authors' knowledge, no studies in the literature provide a time frame or criteria for return to sport after hip arthroscopy. The purpose of this study was to develop an aggregate recommendation for return to sport after hip arthroscopy based on data assimilated from high-volume hip arthroscopy centers. Twenty-seven orthopedic surgeons from high-volume hip arthroscopy centers completed a survey regarding return to sport after hip arthroscopy. The questionnaire asked surgeons to give a time frame for return to sport and to choose meaningful criteria that an athlete must meet prior to return to sport. Surgeons were asked to categorize various common sports as high, medium, or low risk with regard to the hip. The aggregate results were used to create standardized recommendations for time, criteria, and risk for return to competitive sports. Regarding time frame for return to sport, 70% of surgeons recommended 12 to 20 weeks. In addressing criteria for return to sport, 85% of surgeons recommended that patients need to be able to reproduce all motions involved in their sport without pain. A majority of surgeons recommended criteria of pain-free running, jumping, lateral agility drills, and single-leg squats. Finally, surgeons categorized sports requiring the most movement and impact of the hip joint (football, basketball, wrestling, and martial arts) as high-risk sports. Sports with less impact on the hip, such as golf, were ranked as low risk.

  5. Ankle sprains and instability.

    PubMed

    Czajka, Cory M; Tran, Elaine; Cai, Andrew N; DiPreta, John A

    2014-03-01

    Ankle injuries are among the most common injuries presenting to primary care providers and emergency departments and may cause considerable time lost to injury and long-term disability. Inversion injuries about the ankle involve about 25% of all injuries of the musculoskeletal system and 50% of all sports-related injuries. Medial-sided ankle sprains occur less frequently than those on the lateral side. High ankle sprains occur less frequently in the general population, but do occur commonly in collision sports. Providers should apply the Ottawa ankle rules when radiography is indicated and refer fractures and more severe injuries to orthopedic surgery as needed. PMID:24559877

  6. Radiographic and anatomic landmarks to approach the anterior capsule in hip arthroscopy.

    PubMed

    Salas, Antonio Porthos

    2015-12-01

    Hip arthroscopy (HA) is considered to be a very difficult and demanding surgical procedure, special instruments, an image intensifier and a fracture table or hip distractor are required to access the hip joint, the most common and worldwide used HA technique is entering blindly to the central compartment with the use of fluoroscopy and continuous distraction; with the potential danger if performed in unskillful hands of labral penetrations, labral resections and scuffing of the femoral head cartilage. Our technique describes the arthroscopic management of femoroacetabular impingement (FAI), performing a preoperative planning using radiographic and anatomic landmarks to approach the anterior capsule without the use of fluoroscopy. Access to the hip joint is made extra-articularly from the peritrochanteric compartment palpating the greater trochanter and posteriorly penetrating the iliotibial band sliding the arthroscopic sheath and obturator from the trochanteric border to the anterior femoral neck to visualize the anterior capsule bursa and anterior capsule fibers and posteriorly following our previous landmarks perform an anterior oblique Inverted 'T' or 'H' capsulotomy with a radiofrequency wand to access the cam-type impingement and distraction is made under direct controlled arthroscopic vision. Our technique in HA aiming the anterior capsule using radiographic and anatomic landmarks is safe, reliable and reproducible in FAI with big cams, deep sockets and cases with mild arthritis where the capsule is thick, stiff and calcified. PMID:27011869

  7. Radiographic and anatomic landmarks to approach the anterior capsule in hip arthroscopy

    PubMed Central

    2015-01-01

    Hip arthroscopy (HA) is considered to be a very difficult and demanding surgical procedure, special instruments, an image intensifier and a fracture table or hip distractor are required to access the hip joint, the most common and worldwide used HA technique is entering blindly to the central compartment with the use of fluoroscopy and continuous distraction; with the potential danger if performed in unskillful hands of labral penetrations, labral resections and scuffing of the femoral head cartilage. Our technique describes the arthroscopic management of femoroacetabular impingement (FAI), performing a preoperative planning using radiographic and anatomic landmarks to approach the anterior capsule without the use of fluoroscopy. Access to the hip joint is made extra-articularly from the peritrochanteric compartment palpating the greater trochanter and posteriorly penetrating the iliotibial band sliding the arthroscopic sheath and obturator from the trochanteric border to the anterior femoral neck to visualize the anterior capsule bursa and anterior capsule fibers and posteriorly following our previous landmarks perform an anterior oblique Inverted ‘T’ or ‘H’ capsulotomy with a radiofrequency wand to access the cam-type impingement and distraction is made under direct controlled arthroscopic vision. Our technique in HA aiming the anterior capsule using radiographic and anatomic landmarks is safe, reliable and reproducible in FAI with big cams, deep sockets and cases with mild arthritis where the capsule is thick, stiff and calcified. PMID:27011869

  8. Young and Older Adults' Reading of Distracters.

    PubMed

    Kemper, Susan; McDowd, Joan; Metcalf, Kim; Liu, Chiung-Ju

    2008-06-01

    We used eye-tracking technology to examine young and older adults' performance in the reading with distraction paradigm. One-, 2- and 4-word distracters that formed meaningful phrases were used. There were marked age differences in fixation patterns. Young adults' fixations to the distracters and targets increased with distracter length, suggesting that they were attempting to integrate the distracters with the sentence and had more and more difficulty doing so as the distracters increased in length. Young adults did have better comprehension of the sentences than older adults and also better recognition memory for target words and distracters.

  9. [Thromboprophylaxis is indicated for knee arthroscopy and cast immobilisation].

    PubMed

    Nurmohamed, M T

    2007-08-01

    There is no uniform policy regarding thromboprophylaxis in patients undergoing knee arthroscopy or plaster-cast immobilisation. The available literature indicates that the risk of venous thromboembolism is substantial in patients undergoing knee arthroscopy (10%) and plaster-cast immobilisation (200%). Therefore, thromboprophylaxis should be considered mandatory in these patients.

  10. The sprained ankle.

    PubMed

    Puffer, J C

    2001-01-01

    The sprained ankle is the most common musculoskeletal injury seen by physicians caring for active youngsters and adults. It accounts for approximately one fourth of all sports-related injuries and is commonly seen in athletes participating in basketball, soccer, or football. It has been shown that one third of West Point cadets suffer an ankle sprain during their 4 years at the military academy. While diagnosis and management of the sprained ankle is usually straightforward, several serious injuries can masquerade as an ankle sprain, and it is important for the clinician to recognize these to prevent long-term morbidity. In this article the basic anatomy of the ankle, mechanisms by which the ankle is injured, and the differential diagnosis of the acutely injured ankle are reviewed. Appropriate evaluation of the injured ankle and the criteria that should be utilized for determining the necessity of radiographs are discussed as well as management of the acutely sprained ankle and the role of prevention in reducing the risk of ankle injury.

  11. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy.

    PubMed

    Batista, Jorge Pablo; Del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592

  12. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    PubMed Central

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592

  13. Distracted Driving Raises Crash Risk

    MedlinePlus

    ... Raises Crash Risk Video technology and in-vehicle sensors showed that distracted driving, especially among new drivers, ... whenever the cars were moving. A suite of sensors recorded acceleration, sudden braking or swerving, and other ...

  14. Context effects on auditory distraction

    PubMed Central

    Chen, Sufen; Sussman, Elyse S.

    2014-01-01

    The purpose of the study was to test the hypothesis that sound context modulates the magnitude of auditory distraction, indexed by behavioral and electrophysiological measures. Participants were asked to identify tone duration, while irrelevant changes occurred in tone frequency, tone intensity, and harmonic structure. Frequency deviants were randomly intermixed with standards (Uni-Condition), with intensity deviants (Bi-Condition), and with both intensity and complex deviants (Tri-Condition). Only in the Tri-Condition did the auditory distraction effect reflect the magnitude difference among the frequency and intensity deviants. The mixture of the different types of deviants in the Tri-Condition modulated the perceived level of distraction, demonstrating that the sound context can modulate the effect of deviance level on processing irrelevant acoustic changes in the environment. These findings thus indicate that perceptual contrast plays a role in change detection processes that leads to auditory distraction. PMID:23886958

  15. Distracted driving: a neglected epidemic.

    PubMed

    Dildy, Dale W

    2012-10-01

    In 2009, the National Highway Traffic Safety Administration (NHTSA) estimated nearly 6,000 distracted driver fatalities and 515,000 injuries in the United States alone. Distracted driving is a worldwide problem that needs to be addressed. Software is available to disable cell phone usage while driving, but using the advanced technology may require legislation along with a renewed sense of driver responsibility. PMID:23061239

  16. Return to Play Following Hip Arthroscopy.

    PubMed

    Lee, Simon; Kuhn, Andrew; Draovitch, Pete; Bedi, Asheesh

    2016-10-01

    Femoroacetabular impingement may be particularly disabling to the high-demand athlete, especially those with significant cutting and pivoting requirements. If nonoperative treatment fails to adequately alleviate symptoms or sufficiently restore function in the athlete, hip arthroscopy can lead to improved pain, improved range of motion, and high rates of return to play with proper postoperative rehabilitation. The rate of return to previous level of competition is also high with accurate diagnosis and well-executed correction of deformity. A clear understanding of the etiology, diagnosis, management, and outcomes is essential for clinicians to optimally help patients to return to play.

  17. Return to Play Following Hip Arthroscopy.

    PubMed

    Lee, Simon; Kuhn, Andrew; Draovitch, Pete; Bedi, Asheesh

    2016-10-01

    Femoroacetabular impingement may be particularly disabling to the high-demand athlete, especially those with significant cutting and pivoting requirements. If nonoperative treatment fails to adequately alleviate symptoms or sufficiently restore function in the athlete, hip arthroscopy can lead to improved pain, improved range of motion, and high rates of return to play with proper postoperative rehabilitation. The rate of return to previous level of competition is also high with accurate diagnosis and well-executed correction of deformity. A clear understanding of the etiology, diagnosis, management, and outcomes is essential for clinicians to optimally help patients to return to play. PMID:27543404

  18. Leading to distraction: Driver distraction, lead car, and road environment.

    PubMed

    Kountouriotis, G K; Merat, N

    2016-04-01

    Driver distraction is strongly associated with crashes and near-misses, and despite the attention this topic has received in recent years, the effect of different types of distracting task on driving performance remains unclear. In the case of non-visual distractions, such as talking on the phone or other engaging verbal tasks that do not require a visual input, a common finding is reduced lateral variability in steering and gaze patterns where participants concentrate their gaze towards the centre of the road and their steering control is less variable. In the experiments presented here, we examined whether this finding is more pronounced in the presence of a lead car (which may provide a focus point for gaze) and whether the behaviour of the lead car has any influence on the driver's steering control. In addition, both visual and non-visual distraction tasks were used, and their effect on different road environments (straight and curved roadways) was assessed. Visual distraction was found to increase variability in both gaze patterns and steering control, non-visual distraction reduced gaze and steering variability in conditions without a lead car; in the conditions where a lead car was present there was no significant difference from baseline. The lateral behaviour of the lead car did not have an effect on steering performance, a finding which indicates that a lead car may not necessarily be used as an information point. Finally, the effects of driver distraction were different for straight and curved roadways, indicating a stronger influence of the road environment in steering than previously thought. PMID:26785327

  19. Leading to distraction: Driver distraction, lead car, and road environment.

    PubMed

    Kountouriotis, G K; Merat, N

    2016-04-01

    Driver distraction is strongly associated with crashes and near-misses, and despite the attention this topic has received in recent years, the effect of different types of distracting task on driving performance remains unclear. In the case of non-visual distractions, such as talking on the phone or other engaging verbal tasks that do not require a visual input, a common finding is reduced lateral variability in steering and gaze patterns where participants concentrate their gaze towards the centre of the road and their steering control is less variable. In the experiments presented here, we examined whether this finding is more pronounced in the presence of a lead car (which may provide a focus point for gaze) and whether the behaviour of the lead car has any influence on the driver's steering control. In addition, both visual and non-visual distraction tasks were used, and their effect on different road environments (straight and curved roadways) was assessed. Visual distraction was found to increase variability in both gaze patterns and steering control, non-visual distraction reduced gaze and steering variability in conditions without a lead car; in the conditions where a lead car was present there was no significant difference from baseline. The lateral behaviour of the lead car did not have an effect on steering performance, a finding which indicates that a lead car may not necessarily be used as an information point. Finally, the effects of driver distraction were different for straight and curved roadways, indicating a stronger influence of the road environment in steering than previously thought.

  20. Arthroscopy of the knee without pathological findings.

    PubMed

    Schlepckow, P; Weber, M; Hempel, K

    1994-01-01

    From 1983 to 1990, 82 knee arthroscopies (8.2%) carried out in our patients found nothing pathological. Sixty-four percent of these patients were active in sports, but trauma was noted in 32% of the cases only. Football and other ball games, skiing, and track and field athletics were the main causes. Twenty-six percent of the patients had undergone previous surgery in the affected knee. At a mean of 4.6 years postoperatively, clinical and radiological re-assessment was conducted so as to compare our pre- and intraoperative findings with the further course of events. We found that 48.2% of the patients were symptom-free after the diagnostic arthroscopy, 37.5% had persistent discomfort and 14.3% had a recurrence of discomfort after 6 months to 2 years. The objective measurement score (Zarins Rowe score), at 47.5 out of 50 points, was better than the subjective score, at 40 out of 50 points. Our diagnoses had to be changed retrospectively: meniscal lesions were diagnosed too frequently, while chondropathia patellae and instability were often missed. Additionally, complaints could be related to abnormal axis, limited range of motion of the hip or knee, leg length inequality and hypermobility. Being unable to verify a presumed intra-articular lesion arthroscopically is frustrating for both doctor and patient. Our data suggest that meniscal signs should be looked at more critically and emphasise the need for a complete evaluation of the whole locomotor system.

  1. Iliotibial band syndrome following hip arthroscopy: An unreported complication

    PubMed Central

    Seijas, Roberto; Sallent, Andrea; Galán, María; Alvarez-Diaz, Pedro; Ares, Oscar; Cugat, Ramón

    2016-01-01

    Background: Hip arthroscopy is considered a safe procedure, considering the relatively low rate of complications. Despite several complications have been described following this surgical procedure, the present event has not yet been described. The purpose of the present study is to report an unpublished complication following hip arthroscopy, after reviewing 162 hip arthroscopies and finding iliotibial band syndrome (ITBS) in the knee during followup. Materials and Methods: A retrospective review of 162 hip arthroscopies performed between September 2007 and June 2011 was carried out, evaluating patients who presented ITBS during followup. Indication for hip arthroscopy was failure of conservative treatment in patients with symptomatic femoroacetabular impingement. Results: During a minimum followup of 2 years, nine patients (5.5%) developed ITBS. All patients were diagnosed with ITBS within the first 45 postoperative days. Conservative treatment was successful in 6 patients while 3 had to undergo surgery. The increased internal rotation, synovitis and increased adduction of the hip can be attributed as predisposing factors to the development of ITBS. Conclusions: This is a newly described observation within followup of hip arthroscopy. These findings may help orthopedic surgeons when planning rehabilitation after hip arthroscopy, including stretching exercises to prevent this syndrome. PMID:27746490

  2. Local or general anaesthetic in day case arthroscopy?

    PubMed Central

    Fairclough, J. A.; Graham, G. P.; Pemberton, D.

    1990-01-01

    A series of 66 patients who have undergone arthroscopy of the knee using three local anesthetic techniques is presented. Over a similar period of time 70 patients had knee arthroscopy performed under general anaesthesia. In the local anaesthetic group the technique was successful in 50 cases, partially successful in 12 cases and totally unsatisfactory in 4 cases. In the general anaesthetic group all the procedures were successful. Local anaesthetic techniques were found to be satisfactory for diagnostic arthroscopy but general anaesthesia was better for operative procedures and was more acceptable to the surgeon and patient. PMID:2334091

  3. Distraction Osteogenesis Update: Introduction of Multidirectional Cranial Distraction Osteogenesis.

    PubMed

    Gomi, Akira; Sunaga, Ataru; Kamochi, Hideaki; Oguma, Hirofumi; Sugawara, Yasushi

    2016-05-01

    In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique.

  4. Distraction Osteogenesis Update: Introduction of Multidirectional Cranial Distraction Osteogenesis

    PubMed Central

    Sunaga, Ataru; Kamochi, Hideaki; Oguma, Hirofumi; Sugawara, Yasushi

    2016-01-01

    In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique. PMID:27226854

  5. Effects of irrigation fluid in shoulder arthroscopy

    PubMed Central

    Gupta, Surbhi; Manjuladevi, M; Vasudeva Upadhyaya, KS; Kutappa, AM; Amaravathi, Rajkumar; Arpana, J

    2016-01-01

    Background and Aims: Extravasation of irrigation fluid used in shoulder arthroscopy can lead to life-threatening airway and systemic complications. This study was conducted to assess the effect of irrigation fluid absorption on measurable anthropometric parameters and to identify whether these parameters predict airway/respiratory compromise. Methods: Thirty six American Society of Anaesthesiologists physical status one or two patients aged 15–60 years undergoing shoulder arthroscopy under general anaesthesia were recruited. Measured variables preoperatively (baseline) and at the end of surgery were neck, chest, midarm and midthigh circumferences, weight, haemoglobin and serum sodium. Temperature, endotracheal tube cuff pressure, airway pressure, duration of surgery, amount of irrigation fluid and intravenous fluid used were also noted. Measured parameters were correlated with the duration of surgery and the amount of irrigation fluid used. Results: Postoperatively, the changes in variables showed a significant increase in the mean values (cm) for neck, chest, midarm and midthigh circumference (mean ± standard deviation: 2.35 ± 1.9, P < 0.001; 2.9 ± 3.88 cm, P < 0.001; 3.28 ± 2.44, P < 0.001 and 0.39 ± 0.71, P = 0.002, respectively) and weight (kg) (1.17 ± 1.24, P < 0.001). The post-operative haemoglobin (g/dL) levels decreased significantly (0.89 ± 1.23, P < 0.001) as compared to the baseline. No significant change was found in the serum sodium levels (P = 0.92). No patient experienced airway/respiratory compromise. Conclusion: Regional and systemic absorption of irrigation fluid in arthroscopic shoulder surgery is reflected in the degree of change in the measured anthropometric variables. However, this change was not significant enough to cause airway/respiratory compromise. PMID:27053783

  6. 77 FR 51610 - Distracted Driving Grant Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-24

    ... National Highway Traffic Safety Administration Distracted Driving Grant Program AGENCY: Department of... and enforcing distracted driving laws. The FY 2013 funds are subject to an annual obligation... FY 2013 may be less than the amount identified above. A State's distracted driving law must...

  7. [The evolution of surgical arthroscopy in Israel and worldwide].

    PubMed

    Haviv, Barak; Bronak, Shlomo; Thein, Rafael

    2015-04-01

    Arthroscopy is a minimal invasive surgical technique to treat joint disorders with the use of fiber optics for indirect vision and small surgical tools. The first endoscopic direct inspection of the knee joint was documented at the beginning of the 20th century; however, the clinical practice of arthroscopy started only fifty years later. The "historical fathers" of surgical arthroscopy were Kenji Takagi from Japan and Eugen Bircher from Switzerland. The arthroscopes had become safer and more dependable since the 1970's with the introduction of fiber optics, while vision became easier with the invention of television. Subsequently, in the 1980's and 90's instruments were refined and arthroscopy evolved from a diagnostic to a therapeutic tool with the advantages of minimal approach, few complications and short rehabilitation. The beginning of knee arthroscopy in Israel followed the development in North America in the1970's. Within a few years, knee arthroscopy in Israel had also evolved to be therapeutic rather than diagnostic and was specifically used for partial meniscectomies. Currently, arthroscopic surgery, particularly of the knee and shoulder, has become common practice worldwide. Arthroscopic procedures constitute more than a third of all orthopedic procedures performed at the Israeli Assuta private hospitals. With the development of various technologies, it is anticipated that arthroscopic techniques will further evolve and play an ever greater role in diagnosing and treating joint pathology. PMID:26065225

  8. Prevention of ankle sprains.

    PubMed

    Walsh, W M; Blackburn, T

    1977-01-01

    Ankles are sprained when supported on an unstable foundation, while too rididly fixed to the playing surface, or when forced into unnatural positions by extrinsic muscle tightness. The unstable foundation may be the shoe itself, a chuck-hole, or another player's foot. Undue fixation may be by 1-inch mud cleats, baseball spikes, or a modern wrestling mat. When these circumstances occur, heel cord tightness may alter the ankle's response. Thus, prevention of ankle sprains may be by modification of any of these factors.

  9. [The Taylor spatial frame fixator. Soft-tissue distraction for post-traumatic varus deformities of the hindfoot].

    PubMed

    Gessmann, J; Seybold, D; Baecker, H; Muhr, G; Graf, M

    2009-02-01

    Despite adequate primary treatment many ankle fractures result in post-traumatic deformities and arthrosis. Revision mostly requires a multidirectional correction whereas internal fixation procedures are often not applicable due to soft tissue damage and the extent of deformity. The Taylor spatial frame enables simultaneous correction of multidirectional deformities through a virtual hinge using the same ideas of distraction osteogenesis as the Ilizarov fixator. The presented case demonstrates minimally invasive correction of a complex deformity of the ankle with the Taylor spatial frame fixator. Orthogonal alignment was achieved and a stabilizing tibiotalar arthrodesis was performed achieving a good functional and pain-free result.

  10. Stress in Lumbar Intervertebral Discs during Distraction

    PubMed Central

    Gay, Ralph E.; Ilharreborde, Brice; Zhao, Kristin D.; Berglund, Lawrence J.; Bronfort, Gert; An, Kai-Nan

    2008-01-01

    BACKGROUND CONTEXT The intervertebral disc is a common source of low back pain. Prospective studies suggest that treatments that intermittently distract the disc might be beneficial for chronic low back pain. Although the potential exists for distraction therapies to affect the disc biomechanically their effect on intradiscal stress is debated. PURPOSE To determine if distraction alone, distraction combined with flexion or distraction combined with extension can reduce nucleus pulposus pressure and posterior anulus compressive stress in cadaveric lumbar discs compared to simulated standing or lying. STUDY DESIGN Laboratory study using single cadaveric motion segments. OUTCOME MEASURES Strain gauge measures of nucleus pulposus pressure and compressive stress in the anterior and posterior annulus fibrosus METHODS Intradiscal stress profilometry was performed on 15 motion segments during 5 simulated conditions: standing, lying, and 3 distracted conditions. Disc degeneration was graded by inspection from 1 (normal) to 4 (severe degeneration). RESULTS All distraction conditions markedly reduced nucleus pressure compared to either simulated standing or lying. There was no difference between distraction with flexion and distraction with extension in regard to posterior annulus compressive stress. Discs with little or no degeneration appeared to distributed compressive stress differently than those with moderate or severe degeneration. CONCLUSIONS Distraction appears to predictably reduce nucleus pulposus pressure. The effect of distraction therapy on the distribution of compressive stress may be dependent in part on the health of the disc. PMID:17981092

  11. Catastrophizing delays the analgesic effect of distraction.

    PubMed

    Campbell, Claudia M; Witmer, Kenny; Simango, Mpepera; Carteret, Alene; Loggia, Marco L; Campbell, James N; Haythornthwaite, Jennifer A; Edwards, Robert R

    2010-05-01

    Behavioral analgesic techniques such as distraction reduce pain in both clinical and experimental settings. Individuals differ in the magnitude of distraction-induced analgesia, and additional study is needed to identify the factors that influence the pain relieving effects of distraction. Catastrophizing, a set of negative emotional and cognitive processes, is widely recognized to be associated with increased reports of pain. We sought to evaluate the relationship between catastrophizing and distraction analgesia. Healthy participants completed three sessions in a randomized order. In one session (Pain Alone), pain was induced by topical application of a 10% capsaicin cream and simultaneous administration of a tonic heat stimulus. In another session (Pain+Distraction), identical capsaicin+heat application procedures were followed, but subjects played video games that required a high level of attention. During both sessions, verbal ratings of pain were obtained and participants rated their degree of catastrophizing. During the other session (Distraction Alone) subjects played the video games in the absence of any pain stimulus. Pain was rated significantly lower during the distraction session compared to the "Pain Alone" session. In addition, high catastrophizers rated pain significantly higher regardless of whether the subjects were distracted. Catastrophizing did not influence the overall degree of distraction analgesia; however, early in the session high catastrophizers had little distraction analgesia, though later in the session low and high catastrophizers rated pain similarly. These results suggest that both distraction and catastrophizing have substantial effects on experimental pain in normal subjects and these variables interact as a function of time.

  12. Ankle injuries in basketball players.

    PubMed

    Leanderson, J; Nemeth, G; Eriksson, E

    1993-01-01

    We carried out a retrospective study of the frequency of ankle sprains in basketball players. A questionnaire about previous ankle injuries, time off after such injuries, current ankle problems, personal data, number of practice hours and the use of prophylactic measures was sent out to 102 basketball players in a second division league in Sweden. Ninety-six players answered. 92% of them had suffered an ankle sprain while playing basketball, and of these 83% reported repeated sprains of one ankle. In the last two seasons, 78% of the players had injured at least one ankle. The injury frequency in the investigation was 5.5 ankle injuries per 1000 activity hours. 22% of the players used some kind of prophylactic support of their ankle joints. Because of the great number of ankle sprains and the disability in terms of time away from sports that they cause, prevention of these injuries is essential.

  13. Editorial Commentary: Arthroscopy Is a Generally Effective Treatment for Septic Arthritis.

    PubMed

    Lubowitz, James H

    2015-07-01

    Hip bacterial septic arthritis is an indication for arthroscopy in combination with medical management. After arthroscopy, patients must be vigilantly observed; some patients require more than one irrigation and debridement.

  14. Ulnar impaction syndrome: Managed by wrist arthroscopy

    PubMed Central

    Hao, Jiajie; Xu, Zhijie; Zhao, Zhigang

    2016-01-01

    Background: The development of handicraft industry and increase of various such works that need a large amount of repeated wrist ulnar deviation strength, the incidence of ulnar impaction syndrome (UIS) is increasing, but the traditional simple ulnar shortening osteotomy has more complications. This study aimed to explore the early diagnostic criteria of UIS and its wrist arthroscopic treatment experience. Materials and Methods: 9 UIS patients were enrolled in this study. According to magnetic resonance imaging, X-ray and endoscopic features, the diagnostic criteria of UIS were summarized and the individualized treatment schedule was made. If the ulnar positive variance was less than 4 mm, the arthroscopic wafer resection was performed. If the ulnar positive variance was more than 4 mm, the arthroscopic resection of injury and degenerative triangular fibrocartilage complex and ulnar osteotomy were conducted. Results: In all patients, the wound healed without any complications. All patients returned to normal life and work, with no ulnar wrist pain again. One patient had wrist weakness. There was a significant difference of the wrist activity between the last followup and before operation (P < 0.05). According to the modified wrist function scoring system of Green and O’Brien, there were 6 cases of excellent, 2 cases of good and 1 case of appropriate and the overall excellent and good rate was 92.3%. Conclusion: In the treatment of UIS, the arthroscopy can improve the diagnosis rate, optimize the treatment plan, shorten the treatment cycle, with good treatment results. PMID:27053807

  15. DIAGNOSTIC AND THERAPEUTIC ARTHROSCOPY IN SYMPTOMATIC PATIENTS AFTER KNEE ARTHROPLASTY

    PubMed Central

    Severino, Fabricio Roberto; Souza, Clodoaldo José Duarte de; Severino, Nilson Roberto

    2015-01-01

    Objectives: Assess the worthiness of arthroscopy in investigating and treating knee pain after arthroplasty unexplained by clinical and subsidiary examinations. Methods: Among 402 patients submitted to total or unicompartimental arthroplasty between September 2001 and April 2007 at a public university hospital, 17 presented with pain on prosthetic articulation, without clear diagnosis by clinical, X-ray, laboratory, scintiscan, or nuclear magnetic resonance tests. All patients were submitted to arthroscopy and symptoms were assessed by using the Lysholm scale, comparing pre-and post-arthroscopy periods. Peroperative findings have been recorded. Results: The procedure was effective for pain relief in 14 of 17 patients (82.35%). The median for Lysholm scale climbed from 36 points before arthroscopy to 94 points after the procedure (p < 0.001). Most of the patients (12) were arthroscopically diagnosed with fibrosis known as “cyclop”; on the remaining five patients, anterior synovitis was found. All patients were treated by resection. Conclusions: Knee arthroscopy after arthroplasty in patients presenting unclear persistent pain shows localized arthrofibrosis (“cyclops”) or synovitis, which can be treated by using the same procedure, resulting in pain relief. PMID:27022517

  16. Post-arthroscopy septic arthritis: Current data and practical recommendations.

    PubMed

    Bauer, T; Boisrenoult, P; Jenny, J Y

    2015-12-01

    Septic arthritis develops after less than 1% of all arthroscopy procedures. The clinical symptoms may resemble those seen after uncomplicated arthroscopy, raising diagnostic challenges. The diagnosis rests on emergent joint aspiration with microscopic smear examination and prolonged culturing on specific media. Urgent therapeutic measures must be taken, including abundant arthroscopic lavage, synovectomy, and the concomitant administration of two effective antibiotics for at least 6 weeks. Preservation of implants or transplants is increasingly accepted, and repeated joint lavage is a component of the treatment strategy. After knee arthroscopy, infection is the most common complication; most cases occur after cruciate ligament reconstruction, and staphylococci are the predominant causative organisms. Emergent synovectomy with transplant preservation and appropriate antibiotic therapy ensures eradication of the infection in 85% of cases, with no adverse effect on final functional outcomes. After shoulder arthroscopy, infection is 10 times less common than neurological complications and occurs mainly after rotator cuff repair procedures; the diagnosis may be difficult and delayed if Propionibacterium acnes is the causative organism. The update presented here is based on both a literature review and a practice survey. The findings have been used to develop practical recommendations aimed at improving the management of post-arthroscopy infections, which are exceedingly rare but can induce devastating functional impairments. PMID:26412207

  17. Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement

    PubMed Central

    Zhang, Dagang; Chen, Long; Wang, Guanglin

    2016-01-01

    Abstract Background: This meta-analysis aims to evaluate the efficacy and safety of hip arthroscopy versus open surgical dislocation for treating femoroacetabular impingement (FAI) through published clinical trials. Methods: We conducted a comprehensive literature search using PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant studies on hip arthroscopy and open surgical dislocation as treatment options for FAI. Results: Compared with open surgical dislocation, hip arthroscopy resulted in significantly higher Nonarthritic Hip Scores (NAHS) at 3- and 12-month follow-ups, a significant improvement in NAHS from preoperation to 3 months postoperation, and a significantly lower reoperation rate. Open surgical dislocation resulted in a significantly improved alpha angle by the Dunn view in patients with cam osteoplasty from preoperation to postoperation, compared with hip arthroscopy. This meta-analysis demonstrated no significant differences in the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, or Hip Outcome Score-Sport Specific Subscale at 12 months of follow-up, or in complications (including nerve damage, wound infection, and wound dehiscence). Conclusion: Hip arthroscopy resulted in higher NAHS and lower reoperation rates, but had less improvement in alpha angle in patients with cam osteoplasty, than open surgical dislocation. PMID:27741133

  18. Validation of a simulator for temporomandibular joint arthroscopy.

    PubMed

    Monje Gil, F; Hernandez Vila, C; Moyano Cuevas, J L; Lyra, M; Pagador, J B; Sanchez Margallo, F M

    2016-07-01

    The traditional method of surgical training has followed the 'observe, practice, and teach' model, which is useful for open surgery, but is insufficient for minimally invasive surgery. This study presents the validation of a new simulator designed for TMJ arthroscopy training. A group of 10 senior maxillofacial surgeons performed an arthroscopy procedure using the simulator. They then completed a questionnaire analyzing the realism of the simulator, its utility, and the educational quality of the audiovisual software. The mean age of the 10 surgeons was 42.6 years, and they had performed a mean 151 arthroscopies. With regard to the realism of the simulator, 80% reported that it was of an appropriate size and design and 70% referred to the very realistic positions and relationships between the internal structures. Regarding its educational potential, 80% reported the simulator to be very useful for acquiring the basic skills and to acquire the sensation of depth during access to the TMJ. Finally, 90% reported the prototype to be very useful for TMJ arthroscopy training. These preliminary results showed a high degree of approval. The general opinion of the group of experts was that the experience was rewarding and inspiring, and that the prototype has the educational potential for the achievement of basic TMJ arthroscopy skills. PMID:26850940

  19. Post-arthroscopy septic arthritis: Current data and practical recommendations.

    PubMed

    Bauer, T; Boisrenoult, P; Jenny, J Y

    2015-12-01

    Septic arthritis develops after less than 1% of all arthroscopy procedures. The clinical symptoms may resemble those seen after uncomplicated arthroscopy, raising diagnostic challenges. The diagnosis rests on emergent joint aspiration with microscopic smear examination and prolonged culturing on specific media. Urgent therapeutic measures must be taken, including abundant arthroscopic lavage, synovectomy, and the concomitant administration of two effective antibiotics for at least 6 weeks. Preservation of implants or transplants is increasingly accepted, and repeated joint lavage is a component of the treatment strategy. After knee arthroscopy, infection is the most common complication; most cases occur after cruciate ligament reconstruction, and staphylococci are the predominant causative organisms. Emergent synovectomy with transplant preservation and appropriate antibiotic therapy ensures eradication of the infection in 85% of cases, with no adverse effect on final functional outcomes. After shoulder arthroscopy, infection is 10 times less common than neurological complications and occurs mainly after rotator cuff repair procedures; the diagnosis may be difficult and delayed if Propionibacterium acnes is the causative organism. The update presented here is based on both a literature review and a practice survey. The findings have been used to develop practical recommendations aimed at improving the management of post-arthroscopy infections, which are exceedingly rare but can induce devastating functional impairments.

  20. How Concentration Shields Against Distraction

    PubMed Central

    Marsh, John E.

    2015-01-01

    In this article, we outline our view of how concentration shields against distraction. We argue that higher levels of concentration make people less susceptible to distraction for two reasons. One reason is that the undesired processing of the background environment is reduced. For example, when people play a difficult video game, as opposed to an easy game, they are less likely to notice what people in the background are saying. The other reason is that the locus of attention becomes more steadfast. For example, when people are watching an entertaining episode of their favorite television series, as opposed to a less absorbing show, attention is less likely to be diverted away from the screen by a ringing telephone. The theoretical underpinnings of this perspective, and potential implications for applied settings, are addressed. PMID:26300594

  1. Foot, leg, and ankle swelling

    MedlinePlus

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Painless swelling may affect both legs and may include the calves or ... of gravity makes the swelling most noticeable in the lower ...

  2. Beach chair position with instrumental distraction for arthroscopic and open shoulder surgeries.

    PubMed

    Correa, Mario Chaves; Gonçalves, Lucas B J; Andrade, Ronaldo P; Carvalho, Lucio H

    2008-01-01

    Arthroscopy is widely used in the diagnosis and treatment of shoulder disorders. It can be performed in the lateral or sitting position (beach chair). Both have advantages and disadvantages. We present a simple, inexpensive, versatile, portable, continuous distraction device for arthroscopic, combined, and open shoulder surgeries in the sitting position that offers the advantages of the 2 classic positions without their disadvantages. The device was used in 101 consecutive procedures: 61 rotator cuff repairs (29 arthroscopic, 18 mini-open, 14 open), 4 two-part humeral fractures, 1 septic arthritis, 3 calcifying tendinitis, 9 capsular releases, 8 Bankart repairs (6 arthroscopic, 2 open), 13 acromioplasty and biceps tenotomy, and 2 superior labrum anteroposterior repairs. Our experience with this device is extremely positive. We have had no complications and have used it for shoulder arthroscopy, open, and combined surgeries. We have also not had difficulty visualizing or approaching the glenohumeral and subacromial spaces in the treatment of shoulder disorders. It is a safe, practical, easy, and fast set up. Its versatility makes it particularly helpful for the less experienced arthroscopic surgeon.

  3. Distraction and body-focused hand movements.

    PubMed

    Kenner, A N

    1992-08-01

    The hypothesis that apparently irrelevant self- or object-manipulatory hand movements may act as a means of coping with distraction was tested by experimentally manipulating the amount and type of distraction experienced by 10-year-old children while they engaged in the Stroop colour-confusion and colour-naming tasks. If the hypothesis was correct, then increases in distraction were expected to be associated with increases in the frequency of these body-focused movements. The external distractions consisted of either the occurrence of a light signalling the need to perform a reaction time task or listening to distracting sounds through headphones. None of the hand movements increased in frequency with increases in secondary distraction, whether the secondary distractor was visual or auditory. PMID:1528692

  4. Hip arthroscopy in the setting of hip dysplasia

    PubMed Central

    Yeung, M.; Kowalczuk, M.; Simunovic, N.

    2016-01-01

    Objective Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. Methods A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed. Results The systematic review identified 18 studies investigating hip arthroscopy in the setting of hip dysplasia, with 889 included patients. Criteria used by the studies to diagnose hip dysplasia and borderline hip dysplasia included centre edge angle in 72% of studies but the range of angles were quite variable. Although 89% of studies reported improved post-operative outcome scores in the setting of hip dysplasia, revision rates were considerable (14.1%), with 9.6% requiring conversion to total hip arthroplasty. Conclusion The available orthopaedic literature suggests that although improved outcomes are seen in hip arthroscopy in the setting of hip dysplasia, there is a high rate of re-operation and conversion to total hip arthroplasty. Furthermore, the criteria used to define hip dysplasia vary considerably among published studies. Cite this article: M. Yeung, M. Kowalczuk, N. Simunovic, O. R. Ayeni. Hip arthroscopy in the setting of hip dysplasia: A systematic review. Bone Joint Res 2016;5:225–231. DOI: 10.1302/2046-3758.56.2000533. PMID:27313136

  5. Current status of temporomandibular joint arthroscopy in the United Kingdom.

    PubMed

    Thomas, Sangeetha M; Matthews, N Shaun

    2012-10-01

    In an era during which minimally invasive procedures are increasingly becoming the norm, arthroscopy of the temporomandibular joint (TMJ) seems to be infrequently used for diagnosis and treatment of disorders of the TMJ. The reasons for this are not clear. The purpose of this study was to find out the current state of arthroscopy of the TMJ in the UK and, more specifically, how often it is used, the indications for its use, the level of experience of practising surgeons, and the reasons for not using it. Information was gathered between 2009 and 2010 from a postal and e-mail questionnaire to all oral and maxillofacial consultants in the UK. Of the 346 consultants, 215 (60%) responded to the questionnaire. Forty-two said that they currently used arthroscopy of the TMJ, and 33 of those (81%) have more than 5 years' experience. During the past year, a total of 8 consultants nationally have done 20 arthroscopies or more. Thirty-three of the procedures (81%) were done for both diagnosis and treatment. Lack of perceived need of patients and lack of interest in this specialty were the main reasons given for not doing arthroscopy, lack of training being a key secondary reason. The Storz and Olympus systems were the most commonly used within the UK. Results seem to support the opinion that arthroscopy of the TMJ is under-used, and consideration should be given to ensuring that trainees are instructed in its use, which is important in the diagnosis and treatment of disorders of the TMJ.

  6. Avoiding Failure in Hip Arthroscopy: Complications, Pearls, and Pitfalls.

    PubMed

    Burrus, Matthew Tyrrell; Cowan, James B; Bedi, Asheesh

    2016-07-01

    Although most patients have successful outcomes after hip arthroscopy, a minority of patients experience complications that may impact their recovery and long-term benefit. As most of these complications can be minimized by appropriate surgical technique, many tips have been recommended. Additionally, the reasons behind clinical failure postoperatively have been scrutinized, which include, most commonly, incomplete correction of osseous pathomorphology, underappreciated preexisting hip osteoarthritis, and/or an incorrect preoperative diagnosis. Meticulous preoperative planning, evaluation of advanced imaging studies, and proper patient selection will help to reduce the number of postoperative failures and increase the chance of a successful outcome following hip arthroscopy.

  7. Knee arthroscopy after yttrium or osmic acid injection

    SciTech Connect

    Guaydier-Souquieres, C.; Beguin, J.; Ollivier, D.; Loyau, G.

    1989-01-01

    This study presents the macroscopic and histologic results of 35 knee arthroscopies performed on patients with rheumatoid arthritis, some months after an yttrium or osmic acid intraarticular injection. The procedure was most often performed after a failure of the injection or a relapse of synovitis. Arthroscopy provides an understanding of the cause of synoviorthesis failure--insufficient action of the product on the synovitis or its poor diffusion, fibri-nonecrotic deposits, or cartilaginous lesions--and may be used both diagnostically and therapeutically.

  8. A reusable suture anchor for arthroscopy psychomotor skills training.

    PubMed

    Tillett, Edward D; Rogers, Rainie; Nyland, John

    2003-03-01

    For residents to adequately develop the early arthroscopy psychomotor skills required to better learn how to manage the improvisational situations they will encounter during actual patient cases, they need to experience sufficient practice repetitions within a contextually relevant environment. Unfortunately, the cost of suture anchors can be a practice repetition-limiting factor in learning arthroscopic knot-tying techniques. We describe a technique for creating inexpensive reusable suture anchors and provide an example of their application to repair the anterior glenoid labrum during an arthroscopy psychomotor skills laboratory training session.

  9. Avoiding Failure in Hip Arthroscopy: Complications, Pearls, and Pitfalls.

    PubMed

    Burrus, Matthew Tyrrell; Cowan, James B; Bedi, Asheesh

    2016-07-01

    Although most patients have successful outcomes after hip arthroscopy, a minority of patients experience complications that may impact their recovery and long-term benefit. As most of these complications can be minimized by appropriate surgical technique, many tips have been recommended. Additionally, the reasons behind clinical failure postoperatively have been scrutinized, which include, most commonly, incomplete correction of osseous pathomorphology, underappreciated preexisting hip osteoarthritis, and/or an incorrect preoperative diagnosis. Meticulous preoperative planning, evaluation of advanced imaging studies, and proper patient selection will help to reduce the number of postoperative failures and increase the chance of a successful outcome following hip arthroscopy. PMID:27343398

  10. Distracted by Your Mind? Individual Differences in Distractibility Predict Mind Wandering

    ERIC Educational Resources Information Center

    Forster, Sophie; Lavie, Nilli

    2014-01-01

    Attention may be distracted from its intended focus both by stimuli in the external environment and by internally generated task-unrelated thoughts during mind wandering. However, previous attention research has focused almost exclusively on distraction by external stimuli, and the extent to which mind wandering relates to external distraction is…

  11. Arthroscopic Assessment of Intra-Articular Lesion after Surgery for Rotational Ankle Fracture

    PubMed Central

    Cha, Seung-Do; Gwak, Heui-Chul; Ha, Dong-Jun; Kim, Jong-Yup; Kim, Ui-Cheol; Jang, Yue-Chan

    2015-01-01

    Background The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. Methods A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. Results Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. Conclusions Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes. PMID:26640633

  12. Spring-mediated mandibular distraction osteogenesis.

    PubMed

    Mofid, Mehrdad M; Inoue, Nozomu; Tufaro, Anthony P; Vander Kolk, Craig A; Manson, Paul N

    2003-09-01

    Successful performance of distraction osteogenesis requires rigorous patient compliance with a daily activation regimen of a percutaneous screw. Previous clinical studies have found that failure of patient compliance with this regimen is the most common complication leading to technical failure of the distraction process. The authors have developed an internalized spring-mediated device for mandibular distraction osteogenesis that can potentially abrogate the risks associated with patient compliance by allowing for automated distraction across an osteotomy. Twenty adult New Zealand White rabbits underwent unilateral mandibular osteotomy. A segment of nickel-titanium shape memory alloy reinforced at both ends with a pinball was fashioned into an inferiorly based arc and secured to the mandible with stainless steel wire. On postoperative day 12, spring activation commenced by cutting a wire binding the two pinballs to one another. Animals were observed for 6 weeks before they were killed. Radiographic studies and decalcified histologic analysis were performed on extracted mandibles. Temperature- and displacement-dependent properties of the shape memory alloy were also examined. Five animals were excluded from the study due to infection, nonunion, or device failure. A mean distraction of 1.2 mm in the distracted hemimandible relative to the nonoperated hemimandible was found (P <.001, two-tailed paired t test). The maximum distraction achieved in an experimental specimen using the spring distractor was 3.7 mm. There were no other histologic or radiographic differences found between study specimens and specimens subjected to traditional distraction methods. Biomechanical testing of the shape memory alloy revealed a temperature-dependent increase in force at body temperature compared with room temperature and a reduction in force with increased displacement of the spring. This study demonstrates the feasibility of spring-mediated distraction osteogenesis across an

  13. Hip arthroscopy: a report on a cohort of orthopaedic surgeons

    PubMed Central

    Byrd, J. W. Thomas; Jones, Kay S.; Chin, Paul C.

    2016-01-01

    Successful hip arthroscopy depends on proper patient selection and reasonable patient expectations. The purpose of this study is to report the results of hip arthroscopy in orthopaedic surgeons who represent the most informed cohort. This report is based on a retrospective review of prospectively collected data among 24 orthopaedic surgeons (1 bilateral). Follow-up averaged 48 months (range 12–120 months). They were all males with an average age of 45 years (range 30–64 years). All improved with an average of 18 points (preoperative 75; post-operative 93); although one underwent repeat arthroscopy and one was converted to total hip arthroplasty at 54 months. There were numerous diagnoses and procedures performed and one complication (acute coronary artery occlusion). They resumed seeing patients at an average of 1.6 weeks (range 2 days–4 weeks) and operating at an average of 3.1 weeks (range 6 days–8 weeks). This report spans three decades, thus representing a heterogeneous population in terms of diagnoses and treatment. Nonetheless, successful results are noted. As a cohort, orthopaedic surgeons possess the greatest insight into hip arthroscopy, but as patients, often they must modulate their expectations in order to match the understanding of the realities of the procedure. PMID:27583146

  14. Fifty Most Cited Articles for Femoroacetabular Impingement and Hip Arthroscopy.

    PubMed

    Lee, Simon; Shin, Jason; Haro, Marc; Khair, Michael; Riboh, Jonathan C; Kuhns, Benjamin D; Bush-Joseph, Charles A; Nho, Shane J

    2015-01-01

    Growing awareness of femoroacetabular impingement (FAI) and recent innovations in management have resulted in hip arthroscopy becoming one of the fastest-growing orthopedic subspecialties. The purpose of this study was to identify the 50 most cited articles related to the topic of FAI and hip arthroscopy and to analyze their characteristics. The overall number of citations within these articles ranged from 99 to 820. Citation density ranged from 4.41 to 74.55. Seven countries produced these articles with the majority attributed to the United States (n = 26) and Switzerland (n = 18). Clinical studies made up more than half of the top articles (n = 27). The Journal of Bone and Joint Surgery level of evidence most commonly encountered was level IV (n = 24), while the remaining articles were level III (n = 3). No randomized controlled trials or non-randomized controlled trials were encountered in this search. The level of evidence was not significantly correlated with the overall number of citations, publication year, or citation density. The current top 50 list provides orthopedic surgeons interested in hip arthroscopy with an up-to-date core list of the most cited articles in the scientific literature and represents a foundation to use to develop their knowledge regarding hip arthroscopy and FAI.

  15. Endoscopic Removal of a Scapular Osteophyte Using Scapulothoracic Arthroscopy

    PubMed Central

    Lycke, Christian; Theopold, Jan-Dirk; Marquass, Bastian; von Dercks, Nikolaus; Hepp, Pierre

    2016-01-01

    This article describes the removal of a scapular osteophyte from the subscapular space by scapulothoracic arthroscopy. The endoscopic technique allows a gentle approach to the subscapular space without causing a large amount of surgical trauma and therefore leads to good cosmetic and functional results. PMID:27073768

  16. [Thromboprophylaxis is not indicated for knee arthroscopy and cast immobilisation].

    PubMed

    Verheyen, C C P M

    2007-08-01

    The incidence ofvenous thromboembolism following knee arthroscopy and plaster-cast immobilisation of the lower extremity is considerable (10-20%). The available data are insufficient to demonstrate that pharmacological thromboprophylaxis reduces the incidence of venous thromboembolism significantly. Withholding patients thromboprophylaxis in these situations is therefore a reasonable approach.

  17. Shoulder arthroscopy in the throwing athlete: perspectives and prognosis.

    PubMed

    Andrews, J R; Gidumal, R H

    1987-07-01

    The efficacy of arthroscopy of the shoulder has been demonstrated as both a diagnostic and an operative tool. The throwing athlete has benefited greatly from this procedure. Intra-articular pathology resulting from throwing motion overuse can be visualized and treated, with relatively little morbidity and a rapid rehabilitation phase.

  18. The role of hip arthroscopy in the elite athlete.

    PubMed

    McCarthy, Joseph; Barsoum, Wael; Puri, Lalit; Lee, Jo-ann; Murphy, Steven; Cooke, Peter

    2003-01-01

    Intraarticular hip disorders in the elite athlete are a relatively rare but serious potential consequence of high-level competition. Axial and torsional forces involving the hips of elite athletes place them at potentially higher risk for chondral injuries, labral injuries, or both. Ten patients (13 hips) had arthroscopy. Of the 10 patients, the average age was 24 years. Nine patients were men and one was a woman. Of the 13 (10 patients) arthroscopies done two cases were bilateral, and one patient had the same hip operated on twice. Seven of the patients were professional hockey players, one patient was a football player, one patient was a baseball player, and one patient was a golfer. All 13 hips (10 patients) had anterior labral tears, whereas two hips had anterior and posterior labral tears. Two hips had an average of four loose bodies, four had evidence of chondral lesions, and one had an anterior margin acetabular fracture. Twelve of 13 arthroscopies were successful; however, one patient had recurrent symptoms. There were no surgical complications. Hip arthroscopy is a safe and reproducible method to diagnose and treat intraarticular hip disorders in athletes, which facilitates earlier return to their respective sport.

  19. Late rupture of extensor pollicis longus after wrist arthroscopy.

    PubMed

    Fortems, Y; Mawhinney, I; Lawrence, T; Trial, I A; Stanley, J K

    1995-06-01

    The first cases of impending rupture of the extensor pollicis longus after wrist arthroscopy are reported and the etiology is compared with extensor pollicis longus ruptures after nondisplaced or minimally displaced Colles fractures. Both cases were treated with extensor indices proprius to extensor pollicis longus transfer with good clinical results. PMID:7632309

  20. Distractions in the School Science Laboratory

    ERIC Educational Resources Information Center

    Hamza, Karim M.

    2013-01-01

    In this article, I make a case for the potential educative worth of distractions for learning science in the school laboratory. Distractions are operationalized as experiences lying outside the main purpose of the laboratory activity, thereby diverting students' attention from that purpose. Through a practical epistemology analysis, I…

  1. [The molecular biology of distraction osteogenesis].

    PubMed

    Boulétreau, P; Longaker, M T

    2004-02-01

    Distraction osteogenesis has become a mainstay in bone engineering and the recent application of this technique to the membranous craniofacial skeleton has significantly improved our armamentarium for reconstructive craniomaxillofacial procedures. However, if the biomechanical, histological and ultrastructural changes associated with distraction osteogenesis have been widely described, the molecular mechanisms governing the formation of new bone in the interfragmental gap of gradually distracted bone segments remain largely unclear. Recently, our laboratory has described a rat mandibular distraction model that provides an excellent environment for deciphering the molecular mechanisms that mediate distraction osteogenesis. In this Article, we present the hypotheses and current research that have furthered our knowledge of the molecular mechanisms that govern distraction osteogenesis. Recent studies have implicated a growing number of cytokines that are intimately involved in the regulation of bone synthesis and turnover. The gene regulation of numerous cytokines (Transforming Growth Factor-B, Bone Morphogenetic Proteins, Insulin-like Growth Factor-1, Fibroblast Growth Factor-2) during distraction osteogenesis have been best characterized and will be discussed in this text. We believe that novel systems like the rat model will facilitate our understanding of the biomolecular mechanisms that mediate membranous distraction osteogenesis and will ultimately guide the development of targeted-strategies designed to accelerate bone healing.

  2. 77 FR 61048 - Distracted Driving Grant Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-05

    ... grant program, 77 FR 51610 (Aug. 24, 2012), which established an application deadline of October 9, 2012... National Highway Traffic Safety Administration Distracted Driving Grant Program AGENCY: National Highway... Transportation (DOT) announced the availability of funding authorized for distracted driving grants on August...

  3. Hip Arthroscopy in the Presence of Acetabular Dysplasia

    PubMed Central

    Jayasekera, Narlaka; Aprato, Alessandro; Villar, Richard N

    2015-01-01

    Purpose : Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy. Our aim was to describe early outcomes of arthroscopic treatment for patients with DDH, who also had femoroacetabular impingement (FAI) treated when necessary, and to compare these outcomes against a control group of patients without DDH. Methods : Prospective case-control study of 68 consecutive hip arthroscopy patients assessed with a modified Harris Hip Score (mHHS) preoperatively and at six weeks, six months, and one year after surgery. Presence of DDH was determined using a standard anteroposterior (AP) pelvic radiograph to measure the centre-edge angle (CEA) of Wiberg, with a CEA < 20º used as threshold for diagnosis of DDH. Results : 12 patients (eight female and four male) with acetabular dysplasia and mean CEA of 15.4º (9º to 19º). The control, nondysplastic group comprised 54 patients (23 females and 31 males) with a mean CEA of 33.1º (22º to 45º). All patients in the dysplastic group had a labral tear and 11 (91.7%) had associated femoral cam impingement lesion addressed at arthroscopy. Our study demonstrates a significant (p=0.02) improvement in outcome in the dysplastic group at one year using the mHHS. Conclusion : Hip arthroscopy in the presence of DDH is effective in relieving pain for at least one year after surgery although does not address underlying acetabular abnormality. PMID:26069512

  4. [Ankle braces prevent ligament injuries].

    PubMed

    Karlsson, Jon

    2002-09-01

    The Cochrane collaboration has performed a meta-analysis of all studies found on the prevention of ankle ligament injuries, frequent in sports like soccer, European handball and basketball. Interventions include the use of modified footwear and associated supports, training programmes and health education. Five randomized trials totalling 3,954 participants were included. With the exception of ankle disc training, all prophylactic interventions entailed the application of an external ankle support in the form of a semi-rigid orthosis, air-cast or high top shoes. The studies showed a significant reduction in the number of ankle sprains in individuals allocated to external ankle support. This reduction was greater for those with a previous history of ankle sprains.

  5. Update on acute ankle sprains.

    PubMed

    Tiemstra, Jeffrey D

    2012-06-15

    Ankle sprains are a common problem seen by primary care physicians, especially among teenagers and young adults. Most ankle sprains are inversion injuries to the lateral ankle ligaments, although high sprains representing damage to the tibiofibular syndesmosis are becoming increasingly recognized. Physicians should apply the Ottawa ankle rules to determine whether radiography is needed. According to the Ottawa criteria, radiography is indicated if there is pain in the malleolar or midfoot zone, and either bone tenderness over an area of potential fracture (i.e., lateral malleolus, medial malleolus, base of fifth metatarsal, or navicular bone) or an inability to bear weight for four steps immediately after the injury and in the emergency department or physician's office. Patients with ankle sprain should use cryotherapy for the first three to seven days to reduce pain and improve recovery time. Patients should wear a lace-up ankle support or an air stirrup brace combined with an elastic compression wrap to reduce swelling and pain, speed recovery, and protect the injured ligaments as they become more mobile. Early mobilization speeds healing and reduces pain more effectively than prolonged rest. Pain control options for patients with ankle sprain include nonsteroidal anti-inflammatory drugs, acetaminophen, and mild opioids. Because a previous ankle sprain is the greatest risk factor for an acute ankle sprain, recovering patients should be counseled on prevention strategies. Ankle braces and supports, ankle taping, a focused neuromuscular training program, and regular sport-specific warm-up exercises can protect against ankle injuries, and should be considered for patients returning to sports or other high-risk activities. PMID:22962897

  6. Vertical Alveolar Ridge Augmentation by Distraction Osteogenesis

    PubMed Central

    Kumar, N. Nanda; Ravindran, C.

    2015-01-01

    Introduction Compromised alveolar ridge in vertical and horizontal dimension is a common finding in patients visiting practitioners for dental prosthesis. Various treatment modalities are available for correction of deficient ridges among which alveolar distraction osteogenesis is one. Aim To study the efficacy of alveolar distraction osteogenesis in augmentation of alveolar ridges deficient in vertical dimension. Materials and Methods Ten patients aged 16 to 46 years with deficient alveolar ridge underwent ridge augmentation in 11 alveolar segments using the distraction osteogenesis method. For each patient a custom made distraction device was fabricated. The device was indigenously manufactured with SS-316 (ISO 3506). Results The vertical bone gain reached more than 10mm without the use of bone transplantation. Certain complications like incorrect vector of distraction, paresthesia, pain and loss of transport segment were encountered during the course of the study. Conclusion Alveolar vertical distraction osteogenesis is a reliable and predictable technique for both hard and soft tissue genesis. Implant placement is feasible with primary stability in neogenerated bone at the level of the distracted areas. PMID:26816991

  7. Distractions in the School Science Laboratory

    NASA Astrophysics Data System (ADS)

    Hamza, Karim M.

    2013-08-01

    In this article, I make a case for the potential educative worth of distractions for learning science in the school laboratory. Distractions are operationalized as experiences lying outside the main purpose of the laboratory activity, thereby diverting students' attention from that purpose. Through a practical epistemology analysis, I examined in close detail the conversations of three groups of high school students trying to explain how a real galvanic cell works. The three groups experienced the same two distractions, (1) a nonworking light-emitting diode and (2) negative readings on a voltmeter. The analysis reveals how one of the groups, through a series of contingencies, successively made the two distractions continuous with the main purpose of the activity. In the remaining two groups, no such continuity was established. The results show that (a) experiences initially being distracting, perplexing, and confusing may indeed acquire significance for the students' possibilities of coping with the main purpose of the activity but that (b) the outcome is highly contingent on the particular experiences drawn upon by the students to cope with the distractions. Consequently, I discuss ways in which teachers may turn distractions encountered in laboratory activities into educative experiences for more than a few lucky students.

  8. 75 FR 45696 - Pipeline Safety: Personal Electronic Device Related Distractions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-03

    ... Electronic Devices, 75 FR 9754, May 18, 2010; Limiting the Use of Wireless Communication Devices, 75 FR 16391... distractions caused by the use of PEDs. Such distractions may also hinder their prompt recognition and reaction... distractions caused by the use of PEDs. Such distractions may also hinder their prompt recognition and...

  9. US in ankle impingement syndrome.

    PubMed

    Pesquer, Lionel; Guillo, Stephane; Meyer, Philippe; Hauger, Olivier

    2014-06-01

    Ankle impingement is a common condition occurring secondary to sprain or repeated microtrauma. Clinical symptoms are chronic pain located in the affected region and limited range of ankle motion. There are three types of ankle impingement syndrome: anterior impingement, which can be subdivided into anterolateral, anteromedial and purely anterior impingement; posterior impingement, which can be subdivided into posterior and posteromedial impingement; and calcaneal peroneal impingement which is secondary to planovalgus foot deformity. This paper evaluates physiological and clinical elements of these three types of ankle impingement syndrome as well as the role of ultrasound (US) imaging and US-guided treatment.

  10. Editorial Commentary: Love My Surgeon, Love My Surgery: Patient Satisfaction Matters After Hip Arthroscopy.

    PubMed

    Krych, Aaron J

    2016-08-01

    Patient satisfaction following hip arthroscopy is currently underreported and lacks uniformity when published. While current patient reported outcomes are important, they may not reflect overall patient satisfaction because it is complex and multifactorial. However, assessment and documentation of patient satisfaction following hip arthroscopy is critical to demonstrating value and quality. Therefore, it is of pressing importance that the hip arthroscopy community develops an accurate score that is consistent, valid, and reliable.

  11. Editorial Commentary: Love My Surgeon, Love My Surgery: Patient Satisfaction Matters After Hip Arthroscopy.

    PubMed

    Krych, Aaron J

    2016-08-01

    Patient satisfaction following hip arthroscopy is currently underreported and lacks uniformity when published. While current patient reported outcomes are important, they may not reflect overall patient satisfaction because it is complex and multifactorial. However, assessment and documentation of patient satisfaction following hip arthroscopy is critical to demonstrating value and quality. Therefore, it is of pressing importance that the hip arthroscopy community develops an accurate score that is consistent, valid, and reliable. PMID:27495866

  12. Reflections of distraction in memory: transfer of previous distraction improves recall in younger and older adults.

    PubMed

    Thomas, Ruthann C; Hasher, Lynn

    2012-01-01

    Three studies explored whether younger and older adults' free recall performance can benefit from prior exposure to distraction that becomes relevant in a memory task. Participants initially read stories that included distracting text. Later, they studied a list of words for free recall, with half of the list consisting of previously distracting words. When the memory task was indirect in its use of distraction (Study 1), only older adults showed transfer, with better recall of previously distracting compared with new words, which increased their recall to match that of younger adults. However, younger adults showed transfer when cued about the relevance of previous distraction both before studying the words (Study 2) and before recalling the words (Study 3) in the memory test. Results suggest that both younger and older adults encode distraction, but younger adults require explicit cueing to use their knowledge of distraction. In contrast, older adults transfer knowledge of distraction in both explicitly cued and indirect memory tasks. Results are discussed in terms of age differences in inhibition and source-constrained retrieval. PMID:21843024

  13. Arthroscopy of the wrist: anatomy and classification of carpal instability.

    PubMed

    Cooney, W P; Dobyns, J H; Linscheid, R L

    1990-01-01

    Carpal instability can be defined as the lack of ligamentous and skeletal support adequate to maintain a wrist stable to external forces of pinch and grasp. This instability may be static or dynamic. It has been classified as (a) carpal instability, dissociated (CID), a situation in which one or more of the ligaments are torn, and (b) carpal instability, nondissociative (CIND), a situation in which the ligaments are intact but stretched. Carpal instability can also be the result of carpal bone malalignment from various causes. Arthroscopy can be particularly useful in assessing carpal instability, however arthrography with contrast medium, fluoroscopy, and stress loading should precede this arthroscopic assessment. Arthroscopy allows visualization of the volar radiocarpal and ulnocarpal ligaments of the wrist, and the arthroscopic examination can be combined with manual manipulation of the carpal bones to detect laxity of those ligaments, to examine stability of the scapholunate and lunotriquetral interosseous ligaments, and to show instability of the distal radioulnar joint.

  14. Capsular Management in Hip Arthroscopy: An Anatomic, Biomechanical, and Technical Review

    PubMed Central

    Kuhns, Benjamin D.; Weber, Alexander E.; Levy, David M.; Bedi, Asheesh; Mather, Richard C.; Salata, Michael J.; Nho, Shane J.

    2016-01-01

    Hip arthroscopy has become an increasingly utilized surgical technique for the treatment of the young, active patients with hip pain. The clinical outcomes of hip arthroscopy in this patient population have been largely successful; however, there is increasing interest in the contribution of hip capsule in postoperative clinical and functional outcomes. The structure and function of the normal hip capsule will be reviewed. Capsular contributions to hip stability will be discussed in the setting of hip arthroscopy with an emphasis on diagnosis-based considerations. Lastly, clinical outcomes following hip arthroscopy will be discussed as they relate to capsular management. PMID:26973840

  15. Improvement of pain and function after arthroscopy and arthrocentesis of the temporomandibular joint: a comparative study.

    PubMed

    Goudot, P; Jaquinet, A R; Hugonnet, S; Haefliger, W; Richter, M

    2000-02-01

    In 1993 and 1994, 720 patients with pain in the temporo-mandibular joint area were examined and treated. The authors describe their therapeutic protocol. Sixty-two patients were not relieved by conservative nonsurgical therapy and were treated by arthroscopy or arthrocentesis. In both groups the differences in functional result and in pain control were analysed. Results show that both arthroscopy and lavage are useful in improving function and diminishing pain. Arthroscopy shows better results for functional treatment whereas arthrocentesis and arthroscopy show similar results in pain control.

  16. Psoas tunnel perforation—an unreported complication of hip arthroscopy

    PubMed Central

    Degen, Ryan M.; O’Sullivan, Eilish; Sink, Ernest L.; Kelly, Bryan T.

    2015-01-01

    The utilization of hip arthroscopy is rapidly increasing due to improved arthroscopic techniques and training, better recognition of pathology responsible for non-arthritic hip pain and an increasing desire for minimally invasive procedures. With increasing rates of arthroscopy, associated complications are also being recognized. We present a series of six patients who experienced psoas tunnel perforation during anchor insertion from the distal anterolateral portal during labral repair. All patients underwent prior hip arthroscopy and labral repair and presented with persistent symptoms at least partly attributable to magnetic resonance imaging (MRI)-documented psoas tunnel perforation. Their clinical records, operative notes and intra-operative photographs were reviewed. All patients presented with persistent pain, both with an anterior impingement test and resisted hip flexion. MRI imaging demonstrated medial cortical perforation with anchors visualized in the psoas tunnel, adjacent to the iliopsoas muscle. Four patients have undergone revision hip arthroscopy, whereas two have undergone periacetabular osteotomies. All patients had prominent anchors in the psoas tunnel removed at the time of surgery, with varying degrees of concomitant pathology appropriately treated during the revision procedure. Care must be utilized during medial anchor placement to avoid psoas tunnel perforation. Although this complication alone was not the sole cause for revision in each case, it may have contributed to their poor outcome and should be avoided in future cases. This can be accomplished by using a smaller anchor, inserting the anchor from the mid-anterior portal and checking the drill hole with a nitinol wire prior to anchor insertion. PMID:27011849

  17. Special Considerations in Distracted Driving with Teens

    PubMed Central

    Durbin, Dennis R; McGehee, Daniel V; Fisher, Donald; McCartt, Anne

    2014-01-01

    Novice teen drivers have long been known to have an increased risk of crashing, as well as increased tendencies toward unsafe and risky driving behaviors. Teens are unique as drivers for several reasons, many of which have implications specifically in the area of distracted driving. This paper reviews several of these features, including the widespread prevalence of mobile device use by teens, their lack of driving experience, the influence of peer passengers as a source of distraction, the role of parents in influencing teens’ attitudes and behaviors relevant to distracted driving and the impact of laws designed to prevent mobile device use by teen drivers. Recommendations for future research include understanding how engagement in a variety of secondary tasks by teen drivers affects their driving performance or crash risk; understanding the respective roles of parents, peers and technology in influencing teen driver behavior; and evaluating the impact of public policy on mitigating teen crash risk related to driver distraction. PMID:24776228

  18. Advances in arthroscopy-indications and therapeutic applications.

    PubMed

    Carr, Andrew J; Price, Andrew J; Glyn-Jones, Sion; Rees, Jonathan L

    2015-02-01

    Advances in optical technology, instrumentation and implants now enable arthroscopic surgery to be performed on all large joints and most small joints of the limbs. Arthroscopic techniques are usually a development of surgical procedures previously performed through a large open incision, although the critical element of each procedure (for example removal of a torn meniscus) usually remains unchanged. The smaller size of incisions and reduction in tissue damage associated with arthroscopic surgery can reduce morbidity and complications. Therapeutic arthroscopy now encompasses excision, reconstruction and replacement of damaged or abnormal tissue. Improvements in the accuracy of MRI, CT and high-definition ultrasonography have limited the use of diagnostic arthroscopy to rare indications, but in the past 10 years the rates of some arthroscopic surgeries have increased by over 7-fold. Considerable variation in the type and utilization of arthroscopic procedures exists in practice, partly explained by the slow diffusion of new techniques and technology, but also by differences in clinician and patient beliefs and expectations. This Review reflects on both the success of arthroscopy and the general lack of evidence-based assessment of the efficacy and cost-effectiveness of arthroscopic procedures-a clear sign that more clinical trials in this field are required.

  19. Augmented Reality-Based Navigation System for Wrist Arthroscopy: Feasibility

    PubMed Central

    Zemirline, Ahmed; Agnus, Vincent; Soler, Luc; Mathoulin, Christophe L.; Liverneaux, Philippe A.; Obdeijn, Miryam

    2013-01-01

    Purpose In video surgery, and more specifically in arthroscopy, one of the major problems is positioning the camera and instruments within the anatomic environment. The concept of computer-guided video surgery has already been used in ear, nose, and throat (ENT), gynecology, and even in hip arthroscopy. These systems, however, rely on optical or mechanical sensors, which turn out to be restricting and cumbersome. The aim of our study was to develop and evaluate the accuracy of a navigation system based on electromagnetic sensors in video surgery. Methods We used an electromagnetic localization device (Aurora, Northern Digital Inc., Ontario, Canada) to track the movements in space of both the camera and the instruments. We have developed a dedicated application in the Python language, using the VTK library for the graphic display and the OpenCV library for camera calibration. Results A prototype has been designed and evaluated for wrist arthroscopy. It allows display of the theoretical position of instruments onto the arthroscopic view with useful accuracy. Discussion The augmented reality view represents valuable assistance when surgeons want to position the arthroscope or locate their instruments. It makes the maneuver more intuitive, increases comfort, saves time, and enhances concentration. PMID:24436832

  20. Perioperative pain management in hip arthroscopy; what options are there?

    PubMed

    Bech, N H; Hulst, A H; Spuijbroek, J A; van Leuken, L L A; Haverkamp, D

    2016-08-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

  1. Perioperative pain management in hip arthroscopy; what options are there?

    PubMed Central

    Bech, N. H.; Hulst, A. H.; Spuijbroek, J. A.; van Leuken, L. L. A.; Haverkamp, D.

    2016-01-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

  2. Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology

    PubMed Central

    Bhonsle, Sachin; Mehta, Sonu

    2016-01-01

    Introduction Shoulder pain can cause significant pain, discomfort and reduce the ability to perform activities of daily living, thus making it the third most common cause of musculoskeletal consultation. The current gold standard diagnostic investigation is arthroscopy. MRI is a proved sensitive and accurate non-invasive tool in investigating shoulder pathology, but false and misleading results are equally reported. Aim The aim of the study is to compare the efficacy of MRI in diagnosing shoulder pathologies in comparison to arthroscopy, considering arthroscopy as the gold standard. Materials and Methods Thirty nine consecutive patients, between 18-80 years of age, presenting with chronic shoulder pain or instability of more than 6 weeks, or with clinical signs of impingement or tear were included in the study. MRI of the shoulder joint was done followed by shoulder arthroscopy. The data collected was analysed for the significant correlation between MRI of shoulder and arthroscopic findings by kappa statistics. Results Out of 39 patients, Rotator cuff (RC) tear was the most common pathology. MRI showed excellent sensitivity in the diagnosis of rotator cuff tears (0.91) and osteochondral defects (OCD), very good sensitivity for Bankart’s lesion (0.8) and had poor sensitivity to detect SLAP tear (0.15). MRI was specific for all shoulder pathologies. MRI detected RC tears with kappa score of 0.73, Bankart’s tear and OCD’s with kappa score of 0.83 and 1.0 respectively and SLAP lesion with kappa score of 0.14. The accuracy of MRI was highest in diagnosing OCD’s (1.0), followed by RC tear (0.9), Bankart’s tear (0.9) and accuracy was least in diagnosing SLAP lesion (0.7). False negative results were more than false positives. Conclusion The present study supports that MRI is effective in diagnosing rotator cuff tears, Bankart’s tear and ostechondral defects but was not found to be helpful in diagnosing SLAP lesions. MRI and arthroscopy have complimentary roles

  3. Can Chronic Ankle Instability be Prevented? Rethinking Management of Lateral Ankle Sprains.

    ERIC Educational Resources Information Center

    Denegar, Craig R.; Miller, Sayers J., III

    2002-01-01

    Investigates whether chronic ankle instability can be prevented, discussing: the relationship between mechanical and functional instability; normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics; and tissue healing, joint dysfunction, and acute lateral ankle sprain management. The paper describes a treatment model…

  4. Total ankle replacement or ankle fusion in painful advanced hemophilic arthropathy of the ankle.

    PubMed

    Rodriguez-Merchan, E Carlos

    2015-12-01

    In advanced painful hemophilic arthropathy of the ankle, the last resort is surgical treatment (ankle arthrodesis [AA] or total ankle replacement [TAR]). There is a controversy in the literature on which of the two procedures is more appropriate. A review of the literature was performed to clarify such a controversy. The first search engine was MedLine (keywords: total ankle replacement, ankle arthrodesis). Seventy articles were found in MedLine. Of these, only 16 were selected and reviewed because they were strictly focused on the topic of this article. The second search engine was the Cochrane Library, where only nine systematic reviews were found on the role of TAR and AA in non-hemophilia patients. TAR and AA provide pain relief and patient satisfaction in hemophilia patients in the short term. The available non-hemophilia literature is insufficient to conclude which treatment is superior. My current view is that AA may be preferable in most hemophilia patients.

  5. Reflections of Distraction in Memory: Transfer of Previous Distraction Improves Recall in Younger and Older Adults

    ERIC Educational Resources Information Center

    Thomas, Ruthann C.; Hasher, Lynn

    2012-01-01

    Three studies explored whether younger and older adults' free recall performance can benefit from prior exposure to distraction that becomes relevant in a memory task. Participants initially read stories that included distracting text. Later, they studied a list of words for free recall, with half of the list consisting of previously distracting…

  6. Pseudoaneurysm with Arteriovenous Fistula after Arthroscopic Procedure: A Rare Complication of Arthroscopy.

    PubMed

    Jin, Moran; Lee, Yang-Haeng; Yoon, Young Chul; Han, Il-Yong; Park, Kyung-Taek; Wi, Jin Hong

    2015-08-01

    Pseudoaneurysm with arteriovenous fistula is a rare complication of arthroscopy, and can be diagnosed by ultrasonography, computed tomography, magnetic resonance imaging, or angiography. This condition can be treated with open surgical repair or endovascular repair. We report our experience with the open surgical repair of a pseudoaneurysm with an arteriovenous fistula in a young male patient who underwent arthroscopy five months previously.

  7. Pseudoaneurysm with Arteriovenous Fistula after Arthroscopic Procedure: A Rare Complication of Arthroscopy

    PubMed Central

    Jin, Moran; Lee, Yang-Haeng; Yoon, Young Chul; Han, Il-Yong; Park, Kyung-Taek; Wi, Jin Hong

    2015-01-01

    Pseudoaneurysm with arteriovenous fistula is a rare complication of arthroscopy, and can be diagnosed by ultrasonography, computed tomography, magnetic resonance imaging, or angiography. This condition can be treated with open surgical repair or endovascular repair. We report our experience with the open surgical repair of a pseudoaneurysm with an arteriovenous fistula in a young male patient who underwent arthroscopy five months previously. PMID:26290846

  8. Arthroscopic Repair of Ankle Instability.

    PubMed

    Sorensen, Matthew D; Baca, John; Arbuckle, Keith

    2016-10-01

    Arthroscopic lateral ankle stabilization procedures have been described for many years. New technological advances and a deeper understanding of the pathobiomechanics involved in chronic lateral ankle instability have allowed an expansion of arthroscopic approaches to this common pathology. As experience is gained and outcomes within the patient profile are understood, the authors feel that the arthroscopic approach to lateral ankle stabilization may prove superior to traditional methods secondary to the risk and traditional complications that are mitigated within minimally invasive arthroscopic approaches. Additionally, the arthroscopic approach may allow a quicker return to ballistic sport and decrease time for rehabilitation. PMID:27599440

  9. Happiness increases distraction by auditory deviant stimuli.

    PubMed

    Pacheco-Unguetti, Antonia Pilar; Parmentier, Fabrice B R

    2016-08-01

    Rare and unexpected changes (deviants) in an otherwise repeated stream of task-irrelevant auditory distractors (standards) capture attention and impair behavioural performance in an ongoing visual task. Recent evidence indicates that this effect is increased by sadness in a task involving neutral stimuli. We tested the hypothesis that such effect may not be limited to negative emotions but reflect a general depletion of attentional resources by examining whether a positive emotion (happiness) would increase deviance distraction too. Prior to performing an auditory-visual oddball task, happiness or a neutral mood was induced in participants by means of the exposure to music and the recollection of an autobiographical event. Results from the oddball task showed significantly larger deviance distraction following the induction of happiness. Interestingly, the small amount of distraction typically observed on the standard trial following a deviant trial (post-deviance distraction) was not increased by happiness. We speculate that happiness might interfere with the disengagement of attention from the deviant sound back towards the target stimulus (through the depletion of cognitive resources and/or mind wandering) but help subsequent cognitive control to recover from distraction. PMID:26302716

  10. Happiness increases distraction by auditory deviant stimuli.

    PubMed

    Pacheco-Unguetti, Antonia Pilar; Parmentier, Fabrice B R

    2016-08-01

    Rare and unexpected changes (deviants) in an otherwise repeated stream of task-irrelevant auditory distractors (standards) capture attention and impair behavioural performance in an ongoing visual task. Recent evidence indicates that this effect is increased by sadness in a task involving neutral stimuli. We tested the hypothesis that such effect may not be limited to negative emotions but reflect a general depletion of attentional resources by examining whether a positive emotion (happiness) would increase deviance distraction too. Prior to performing an auditory-visual oddball task, happiness or a neutral mood was induced in participants by means of the exposure to music and the recollection of an autobiographical event. Results from the oddball task showed significantly larger deviance distraction following the induction of happiness. Interestingly, the small amount of distraction typically observed on the standard trial following a deviant trial (post-deviance distraction) was not increased by happiness. We speculate that happiness might interfere with the disengagement of attention from the deviant sound back towards the target stimulus (through the depletion of cognitive resources and/or mind wandering) but help subsequent cognitive control to recover from distraction.

  11. Ankle Fractures Often Not Diagnosed

    MedlinePlus

    ... side of the ankle. This condition often... Barefoot Running Barefoot running is running while barefoot, without wearing any shoes on the feet. Running in thin-soled, flexible shoes is related but ...

  12. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability

    PubMed Central

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-01-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability. PMID:26311206

  13. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability.

    PubMed

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-07-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability.

  14. Outcomes after hip arthroscopy in patients with workers' compensation claims.

    PubMed

    Salvo, John P; Hammoud, Sommer; Flato, Russell; Sgromolo, Nicole; Mendelsohn, Elliot S

    2015-02-01

    Patients with a workers' compensation claim have been shown to have inferior outcomes after various orthopedic procedures. In hip arthroscopy, good to excellent results have been shown in the athletic and prearthritic population in short-term and long-term follow-up. In the current study, the authors' hypothesis was that patients with a workers' compensation claim would have inferior outcomes after hip arthroscopy compared with patients without a workers' compensation claim. All patients with a workers' compensation claim who underwent hip arthroscopy over a 2-year period were studied. Postoperative functional outcomes were assessed with the Hip Outcome Score and modified Harris Hip Score. A cohort of 30 patients who did not have a workers' compensation claim was selected for comparison. Twenty-six patients were identified who had a workers' compensation claim and underwent hip arthroscopy performed by a single surgeon at the authors' institution with at least 6 months of follow-up. These patients were compared with 30 patients who did not have a workers' compensation claim. The workers' compensation group had a Hip Outcome Score of 66.5±28.8 and the non-workers' compensation group had a Hip Outcome Score of 89.4±12.0. This difference was statistically significant with Wilcoxon test (P=.003). The workers' compensation group had an average modified Harris Hip Score of 72.5±20.7 (mean±SD), and the non-workers' compensation group had a modified Harris Hip Score of 75.6±15.3. This difference was not significantly significant with Wilcoxon test (P=.9). At latest follow-up, 15 patients in the workers' compensation group (58%) were working. Patients returned to work an average of 6.8 months after surgery. The current study showed that postoperative functional outcomes in the workers' compensation group, as measured by Hip Outcome Score, were significantly inferior to those in the non-workers' compensation group. No statistical difference in postoperative modified

  15. CO2 laser arthroscopy-through the arthroscope

    NASA Astrophysics Data System (ADS)

    Garrick, James G.

    1990-06-01

    Orthopedists have been among the last of the specialists to utilize lasers in surgery. Even today, laser usage in orthopedics is almost exclusively limited to arthroscopy procedures. Although other types of lasers have been approved for use in orthopedics, nearly all laser-assisted arthroscopic procedures have involved the carbon dioxide laser in the knee. These techniques involve skills and problems not previously encountered. In an attempt to simplify the usage and circumvent some of the problems, we describe a means of laser energy delivery through the arthroscope.

  16. Hip arthroscopy and osteoarthritis: Where are the limits and indications?

    PubMed Central

    Mella, Claudio; Villalón, Ignacio E.; Núñez, Álvaro; Paccot, Daniel; Díaz-Ledezma, Claudio

    2015-01-01

    The use of hip arthroscopy, as a surgical technique, has increased significantly over the past ten years. The procedure has shown good and excellent results in symptom relief and function improvement for patients with femoro-acetabular impingement (FAI) and concurrent chondro-labral lesions. It is also a reliable method to correct the characteristic pathomorphologic alteration of FAI. However, surgical results are less successful among patients with advanced articular damage and secondary hip osteoarthritis. The aim of this article is to present some clinical and imagenological tools to discriminate the good candidates for arthroscopic FAI treatment from those who are not, due to extensive articular damage. PMID:27163082

  17. Distracted driving: prevalence, problems, and prevention.

    PubMed

    Overton, Tiffany L; Rives, Terry E; Hecht, Carrie; Shafi, Shahid; Gandhi, Rajesh R

    2015-01-01

    While the number of motor vehicle crashes has declined over the years, crashes resulting from distracted driving are increasing in the United States resulting in significant morbidity and mortality. The national public seems to be aware of the dangers associated with using technology while driving, but continues to engage in this dangerous behaviour, and may be unaware of or underestimate the impact of cell phone use on their own driving performance. Problems associated with distracted driving are not limited to novice or teenage drivers; multifaceted universal prevention efforts aimed at impacting large segments of the population may have the greatest impact. Legislation limiting drivers' cell phone use has had little impact, possibly due to low regulation and enforcement. Behaviour change programmes, improved vehicle safety, and public awareness campaigns have been developed as potential preventive efforts to reduce accidents caused by distracted drivers. PMID:24499372

  18. Percutaneous distraction osteogenesis for treatment of brachymetatarsia.

    PubMed

    Lamm, Bradley M

    2010-01-01

    Brachymetatarsia is not an unusual deformity and is often associated with functional and cosmetic issues that warrant surgical reconstruction. Lengthening of the affected metatarsal can be undertaken on an acute basis in a single operative procedure that involves the use of a bone graft or by means of gradual callus distraction. Because of the risk of metatarsophalangeal joint malalignment, it is important for the surgeon to take steps to stabilize the joint during the lengthening process. In this report, a percutaneous method of callus distraction for repair of brachymetatarsia and maintenance of metatarsophalangeal joint alignment is presented. PMID:20022524

  19. A Source of Distractions in the Classroom: The Teacher.

    ERIC Educational Resources Information Center

    Wong, Lily Y. S.

    This paper identifies distracting factors which take away pupils' attention from the lesson and focus it on the teacher. Distracting factors include teachers' irritating habits, improper attire, and mannerisms. Examples of distracting features of both males and females are listed in eight categories: (1) attire; (2) hair; (3) make-up; (4) personal…

  20. Distraction osteogenesis with pivot plate in the treatment of scaphocephaly.

    PubMed

    Nam, Seung Min; Kim, Yong Bae; Shin, Ho Seong; Park, Eun Soo; Jung, Sung Gyun

    2011-01-01

    In scaphocephaly, traditional distraction osteogenesis increases only the bitemporal width. We describe distraction osteogenesis with a pivot plate for scaphocephaly, which not only increases the bitemporal width but also decreases the anteroposterior length. Three patients with scaphocephaly were treated using distraction osteogenesis with a pivot plate between January 2005 and June 2006. These children underwent cranial reshaping by gradual distraction using an external distraction device and pivot plate. The distraction rate was 1 mm/d, and the latency period was 5 days. The follow-up period after distraction osteogenesis ranged from 16 to 24 months. No specific complications, such as accidental removal of the distraction devices, infection, or neurologic problems in any patient, occurred. The mean distraction was 45 mm. The mean cranial index was 73.6. Distraction osteogenesis for scaphocephaly is still in the development stage, but it is becoming accepted as a useful method because of its many advantages. Distraction osteogenesis with a pivot plate for scaphocephaly is better than other distraction osteogenesis techniques because it induces increased bitemporal width and decreased anteroposterior length synchronously.

  1. 77 FR 15398 - Attentive Driving: Countermeasures for Distraction Forum

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-15

    ... SAFETY BOARD Attentive Driving: Countermeasures for Distraction Forum The National Transportation Safety Board (NTSB) will convene a forum, Attentive Driving: Countermeasures for Distraction, which will begin... from the date of the event. Distracted driving is a serious safety risk on our highways, as...

  2. Arthroscopic-assisted fibular synthesis and syndesmotic stabilization of a complex unstable ankle injury.

    PubMed

    Salvi, Andrea Emilio; Metelli, Giovanni Pietro; Bettinsoli, Rosita; Hacking, Steven Adam

    2009-03-01

    Traditional treatment of complex ankle fracture consists of open reduction and internal fixation. Nevertheless, this treatment can delay fracture healing and cause prolonged oedema. The surgeon should consider necessity of early recovery when treating athletes, especially football players. In this light, it was decided to perform an arthroscopy-assisted percutaneous minimal osteosynthesis of a fibular fracture together with a syndesmotic disruption in order to permit the patient, a 24-year-old male, to resume quicker and easier full sport activities. The outcome was good and allowed patient to play soccer since 6 months following surgery. The complete and detailed articular evaluation provided by the arthroscope permitted to manage carefully a complex articular traumatism, avoiding the necessity of plating the fracture and improving a rapid full recovery of the joint function.

  3. Prilocaine in arthroscopy: clinical pharmacokinetics and rational use.

    PubMed

    Debruyne, D; Moulin, M; Thomassin, C; Locker, B; Tartiere, J; Bigot, M C; Besnard, M; Berthelin, C; Beguin, J

    1985-11-01

    Prilocaine pharmacokinetics were determined in 60 patients receiving the drug by two different routes of administration (intra-articular and subcutaneous) during arthroscopy under local anesthesia with controlled pressure irrigation. Resorption of prilocaine by subcutaneous tissues was slow and did not lead to high serum levels. On the contrary, prilocaine resorption by the synovium was fast and induced a sharp serum peak (265.8 +/- 163.5 ng/ml) in the hour after the end of the examination. The drug was completely eliminated from the blood after 24 hours, as the prilocaine t1/2 is about 5 hours. The first procedure was perfected to reduce the risk of methemoglobinemia, which occurred in four of 105 patients. Applied pressure was lowered to 100 mm Hg to prevent the escape of anesthetic solution into the soft tissue of the leg, the prilocaine concentration was reduced to 1 gm/L, and the arthroscope was only set up after a delay to allow the intra-articular anesthetic effect of prilocaine to become established. So far, 200 arthroscopies have been performed with this improved protocol without any problem.

  4. Plasma bupivacaine levels following single dose intraarticular instillation for arthroscopy.

    PubMed

    Meinig, R P; Holtgrewe, J L; Wiedel, J D; Christie, D B; Kestin, K J

    1988-01-01

    Arthroscopy of the knee was performed using 30 ml single dose intraarticular instillations of 0.5% or 0.25% solutions of bupivacaine (Marcaine). A total of 18 patients (mean age, 34 years), divided into two groups, participated in this study. Venous plasma levels were measured at 0, 10, 20, 30, 45, 60, 90, 120, and 240 minute intervals following a single instillation into the knee joint. All patients had suspected traumatic internal derangement of the knee. Electrocardiogram tracings, blood pressure, and neurologic assessment were monitored at each venous sampling interval or more often if clinically indicated. The type and amount of supplemental anesthesia were also recorded. None of our 18 patients required a general anesthetic because of pain although the following procedures were performed: meniscectomy, plica release, abrasion chondroplasty, loose body retrieval, and limited meniscal repair. A new methodology for the measurement of plasma bupivacaine using the gas chromatograph mass spectrometer is described. Monitoring specific molecular mass fragments allows the measurement of picogram per milliliter levels of bupivacaine. The highest peak plasma concentration occurred 20 minutes after instillation of 30 ml of 0.5% bupivacaine. The 625 +/- 225 ng/ml level was well below the 2,500 to 4,000 ng/ml reported to elicit early subjective CNS symptoms of bupivacaine toxicity. Thus, a single dose intraarticular instillation of 30 ml 0.5% or 0.25% bupivacaine is convenient, efficacious, and pharmacologically safe for routine clinical arthroscopy.

  5. Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?

    PubMed Central

    Bergkvist, Dan; Dahlberg, Leif E; Neuman, Paul; Englund, Martin

    2016-01-01

    Background and purpose Several randomized controlled trials have not shown any added benefit of arthroscopy over placebo surgery or physiotherapy in middle-aged patients with knee symptoms without trauma. We studied the characteristics of the knee arthroscopies performed in southern Sweden. Patients and methods From the orthopedic surgical records from 2007–2009 in the Skåne region of Sweden (with a population of 1.2 million), we retrieved ICD-10 diagnostic codes and selected all 4,096 arthroscopies that were diagnosed peroperatively with code M23.2 (derangement of meniscus due to old tear or injury) or code M17 (knee osteoarthritis). We extracted information on cartilage and meniscus status at arthroscopy, and we also randomly sampled 502 of these patients from the regional archive of radiology and analyzed the preoperative prevalence of radiographic or magnetic resonance imaging (MRI)-defined osteoarthritis. Results 2,165 (53%) of the 4,096 arthroscopies had the diagnostic code M23.2 or M17. In this subgroup, 1,375 cases (64%) had typical findings consistent with degenerative meniscal tear (i.e. that correspond to a degenerative meniscal tear in at least a third of all arthroscopies). Of the randomly sampled patients, the preoperative prevalence of radiological knee osteoarthritis was 46%. Interpretation There is a discrepancy between evidence-based medicine treatment guidelines and clinical practice regarding the amount of knee arthroscopies performed in patients with symptoms of degenerative knee disease. PMID:26012547

  6. The Neural Bases of Distraction and Reappraisal

    ERIC Educational Resources Information Center

    McRae, Kateri; Hughes, Brent; Chopra, Sita; Gabrieli, John D. E.; Gross, James J.; Ochsner, Kevin N.

    2010-01-01

    Distraction and reappraisal are two commonly used forms of cognitive emotion regulation. Functional neuroimaging studies have shown that each one depends upon interactions between pFC, interpreted as implementing cognitive control, and limbic regions, interpreted as mediating emotional responses. However, no study has directly compared distraction…

  7. Angiogenesis and mineralization during distraction osteogenesis.

    PubMed Central

    Choi, In Ho; Chung, Chin Youb; Cho, Tae-Joon; Yoo, Won Joon

    2002-01-01

    Distraction osteogenesis is currently a standard method of bone lengthening. It is a viable method for the treatment of short extremities as well as extensive bone defects, because large amounts of bone can be regenerated in the distraction gap. Mechanical stimulation by distraction induces biological responses of skeletal regeneration that is accomplished by a cascade of biologic processes that may include differentiation of pluripotential tissue, angiogenesis, mineralization, and remodeling. There are complex interactions between bone-forming osteoblasts and other cells present within the bone microenvironment, particularly vascular endothelial cells that may be pivotal members of a complex interactive communication network in bone. Regenerate bone forms by three modes of ossification, which include intramembranous, enchondral, and transchondroid ossifications, although intramembraneous bone formation is the predominant mechanism of ossification. In this review we discussed the coupling between angiogenesis and mineralization, the biological and mechanical factors affecting them, the cellular and molecular events occurring during distraction osteogenesis, and the emerging modalities to accelerate regenerate bone healing and remodeling. PMID:12172035

  8. Le Fort III distraction osteogenesis: modification of the intraoral splint in the rigid external distraction.

    PubMed

    Lim, Hyoseob; Ko, Ellen Wen-Ching; Lo, Lun-Jou

    2012-05-01

    Le Fort III distraction osteogenesis (DO) is a useful procedure for treating midface hypoplasia. The external distraction system has the advantage of allowing modification of the distraction vector during the activation period. This system needs an intraoral splint for the anchorage points. The intraoral splint has an important role in conducting the distraction force to the midface and in forming the advancement vector. The authors developed a modified type of splint to improve the outcome of Le Fort III DO.The intraoral splint is composed of a modified headgear face bow, molar bands, and a palatal acrylic plate without covering the teeth. Four suspension wires were applied to reinforce the stability. The zygomatic bones and the loops of the splint are selected as 4 anchorage points for Le Fort III DO. This procedure was applied to 2 patients.The midface had an advancement of more than 20 mm in both patients. The dental movement of the upper incisors and the upper first molar was minimal.The dental effect was nearly absent. The amount and vector of distraction could be decided under direct observation without blocking the dental occlusion. The vector of distraction could be adjusted during the activation period. The results of DO were satisfactory.

  9. The use of hip arthroscopy in the management of the pediatric hip

    PubMed Central

    Roy, Dennis R.

    2016-01-01

    Arthroscopy of the pediatric hip began in 1977 with a publication by Gross. Interest was relatively slow to develop in the 1980s and 1990s. Coupled with the success of hip arthroscopy in the adult, interest heightened in applying the procedure to a variety of pediatric hip disorders, given that the alternative was an open surgical hip dislocation. The success of this initial group of pediatric hip arthroscopist’s has further expanded the application of hip arthroscopy as the primary or adjunct procedure for the management of intra-articular problems of the pediatric hip. PMID:27583144

  10. The use of hip arthroscopy in the management of the pediatric hip.

    PubMed

    Roy, Dennis R

    2016-07-01

    Arthroscopy of the pediatric hip began in 1977 with a publication by Gross. Interest was relatively slow to develop in the 1980s and 1990s. Coupled with the success of hip arthroscopy in the adult, interest heightened in applying the procedure to a variety of pediatric hip disorders, given that the alternative was an open surgical hip dislocation. The success of this initial group of pediatric hip arthroscopist's has further expanded the application of hip arthroscopy as the primary or adjunct procedure for the management of intra-articular problems of the pediatric hip. PMID:27583144

  11. Dynamics of Driver Distraction: The process of engaging and disengaging.

    PubMed

    Lee, John D

    2014-01-01

    Driver distraction research has a long history, spanning nearly 50 years, but intensifying over the last decade. The dominant paradigm guiding this research defines distraction in terms of excessive workload and limited attentional resources. This approach largely ignores how drivers come to engage in these tasks and under what conditions they engage and disengage from driving-the dynamics of distraction. The dynamics of distraction identifies breakdowns of interruption management as an important contributor to distraction, leading to describe distraction in terms of failures of task timing, switching, and prioritization. The dynamics of distraction also identifies disengagement in driving (e.g., mind wandering) as a substantial challenge that secondary tasks might exacerbate or mitigate. Increasing vehicle automation accentuates the need to consider these dynamics of distraction. Automation offers drivers more opportunity to engage in distractions and disengage from driving, and can surprise drivers by unexpectedly requiring drivers to quickly re-engage in driving-placing greater importance of interruption management expertise. This review describes distraction in terms of breakdowns in interruption management and problems of engagement, and summarizes how contingency, conditioning, and consequence traps lead to problems of engaging and disengaging in driving and distractions.

  12. Dynamics of Driver Distraction: The process of engaging and disengaging

    PubMed Central

    Lee, John D.

    2014-01-01

    Driver distraction research has a long history, spanning nearly 50 years, but intensifying over the last decade. The dominant paradigm guiding this research defines distraction in terms of excessive workload and limited attentional resources. This approach largely ignores how drivers come to engage in these tasks and under what conditions they engage and disengage from driving—the dynamics of distraction. The dynamics of distraction identifies breakdowns of interruption management as an important contributor to distraction, leading to describe distraction in terms of failures of task timing, switching, and prioritization. The dynamics of distraction also identifies disengagement in driving (e.g., mind wandering) as a substantial challenge that secondary tasks might exacerbate or mitigate. Increasing vehicle automation accentuates the need to consider these dynamics of distraction. Automation offers drivers more opportunity to engage in distractions and disengage from driving, and can surprise drivers by unexpectedly requiring drivers to quickly re-engage in driving—placing greater importance of interruption management expertise. This review describes distraction in terms of breakdowns in interruption management and problems of engagement, and summarizes how contingency, conditioning, and consequence traps lead to problems of engaging and disengaging in driving and distractions. PMID:24776224

  13. Living dangerously: driver distraction at high speed.

    PubMed

    Johnson, Mark B; Voas, Robert B; Lacey, John H; McKnight, A Scott; Lange, James E

    2004-03-01

    Recent research indicates that cell phone use can distract drivers from safe vehicle operation. However, estimates of the prevalence of cell phone use while driving have been limited to daytime hours and low-speed roadways. This paper describes the results of a study to estimate rates of cell phone use and other distractions by examining approximately 40,000 high-quality digital photographs of vehicles and drivers on the New Jersey Turnpike. The photographs, which originally were collected as part of a separate study, were taken both during the day and during the night and at different locations across the span of the Turnpike. A radar gun linked to the camera recorded the speeds of vehicles as they passed. This provided us with the speeds of every vehicle photographed, and allowed us to determine population counts of vehicles. A panel of three trained coders examined each photograph and recorded the presence of cell phone use by the drivers or any other distracting behavior. Demographic information on the driver was obtained during previous examinations of the photographs for an unrelated study. A rating was considered reliable when two out of the three coders agreed. Population estimates (and confidence intervals) of cell phone use and other distractions were estimated by weighting the cases by the inverse probability of vehicle selection. Logistic regression was used to predict cell phone use from demographic and situational factors. The results indicated that the most frequent distraction was cell phone use: 1.5% of the drivers on the Turnpike were using cell phones compared to the 3 to 4% use rates reported in the National Occupant Protection Use Survey (NOPUS) surveys conducted during the daytime on lower speed roadways. The Turnpike survey indicated that cell phones were used less on weekends and at night, and when the driver was exceeding the speed limit or had a passenger in the car.

  14. Virtual Reality: A Distraction Intervention for Chemotherapy

    PubMed Central

    Schneider, Susan M.; Hood, Linda E.

    2007-01-01

    Purpose/Objectives To explore virtual reality (VR) as a distraction intervention to relieve symptom distress in adults receiving chemotherapy treatments for breast, colon, and lung cancer. Design Crossover design in which participants served as their own control. Setting Outpatient clinic at a comprehensive cancer center in the southeastern United States. Sample 123 adults receiving initial chemotherapy treatments. Methods Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and then received no intervention (control) during an alternate matched chemotherapy treatment. The Adapted Symptom Distress Scale–2, Revised Piper Fatigue Scale, and State Anxiety Inventory were used to measure symptom distress. The Presence Questionnaire and an open-ended questionnaire were used to evaluate the subjects’ VR experience. The influence of type of cancer, age, and gender on symptom outcomes was explored. Mixed models were used to test for differences in levels of symptom distress. Main Research Variables Virtual reality and symptom distress. Findings Patients had an altered perception of time (p < 0.001) when using VR, which validates the distracting capacity of the intervention. Evaluation of the intervention indicated that patients believed the head-mounted device was easy to use, they experienced no cybersickness, and 82% would use VR again. However, analysis demonstrated no significant differences in symptom distress immediately or two days following chemotherapy treatments. Conclusions Patients stated that using VR made the treatment seem shorter and that chemotherapy treatments with VR were better than treatments without the distraction intervention. However, positive experiences did not result in a decrease in symptom distress. The findings support the idea that using VR can help to make chemotherapy treatments more tolerable, but clinicians should not assume that use of VR will improve chemotherapy

  15. The origin of the ankle

    NASA Astrophysics Data System (ADS)

    Codino, Antonio; Plouin, Francois

    2007-03-01

    The differential intensity of cosmic radiation shows a sequence of depressions referred to as knees in a large energy band above 1015eV. The global depression entailed in the complete spectrum with respect to the extrapolated intensity based on low energy data, amounts to a maximum factor of 8, occurring at 5×10eV, where flux measurements exhibit a relative minimum, referred to as the ankle. It is demonstrated by a full simulation of cosmic ray trajectories in the Galaxy that the intensity minimum around the ankle energy is primarily due to the nuclear interactions of the cosmic ions with the interstellar matter and to the galactic magnetic field. Ankles signal the onset energies of the rectilinear propagation in the Milky Way at Earth, being for example, 4×10eV for helium and 6×10eV for iron. The ankle, in spite of its notable importance at Earth, is a local perturbation of the universal spectrum which, between the knee and the ankle, decreases by a round factor 109 regaining its unperturbed status above 1019eV.

  16. Posterior Ankle Structure Injury During Total Ankle Replacement.

    PubMed

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management. PMID:27291681

  17. Posterior Ankle Structure Injury During Total Ankle Replacement.

    PubMed

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management.

  18. Effects of ankle eversion taping using kinesiology tape in a patient with ankle inversion sprain.

    PubMed

    Lee, Sun-Min; Lee, Jung-Hoon

    2016-01-01

    [Purpose] The aim of this study was to report the effects of ankle eversion taping using kinesiology tape on ankle inversion sprain. [Subject] The subject was a 21-year-old woman with Grade 2 ankle inversion sprain. [Methods] Ankle eversion taping was applied to the sprained left ankle using kinesiology tape for 4 weeks (average, 15 h/day). [Results] Ankle instability and pain were reduced, and functional dynamic balance was improved after ankle eversion taping for 4 weeks. The Cumberland Ankle Instability Tool score and reach distances in the Y-Balance and lunge tests were increased. [Conclusion] Repeated ankle eversion taping may be an effective treatment intervention for ankle inversion sprain. PMID:27064668

  19. Effects of ankle eversion taping using kinesiology tape in a patient with ankle inversion sprain

    PubMed Central

    Lee, Sun-Min; Lee, Jung-Hoon

    2016-01-01

    [Purpose] The aim of this study was to report the effects of ankle eversion taping using kinesiology tape on ankle inversion sprain. [Subject] The subject was a 21-year-old woman with Grade 2 ankle inversion sprain. [Methods] Ankle eversion taping was applied to the sprained left ankle using kinesiology tape for 4 weeks (average, 15 h/day). [Results] Ankle instability and pain were reduced, and functional dynamic balance was improved after ankle eversion taping for 4 weeks. The Cumberland Ankle Instability Tool score and reach distances in the Y-Balance and lunge tests were increased. [Conclusion] Repeated ankle eversion taping may be an effective treatment intervention for ankle inversion sprain. PMID:27064668

  20. Effects of ankle eversion taping using kinesiology tape in a patient with ankle inversion sprain.

    PubMed

    Lee, Sun-Min; Lee, Jung-Hoon

    2016-01-01

    [Purpose] The aim of this study was to report the effects of ankle eversion taping using kinesiology tape on ankle inversion sprain. [Subject] The subject was a 21-year-old woman with Grade 2 ankle inversion sprain. [Methods] Ankle eversion taping was applied to the sprained left ankle using kinesiology tape for 4 weeks (average, 15 h/day). [Results] Ankle instability and pain were reduced, and functional dynamic balance was improved after ankle eversion taping for 4 weeks. The Cumberland Ankle Instability Tool score and reach distances in the Y-Balance and lunge tests were increased. [Conclusion] Repeated ankle eversion taping may be an effective treatment intervention for ankle inversion sprain.

  1. Subperiosteal Hematoma of the Ankle

    PubMed Central

    Hui, S H; Lui, T H

    2016-01-01

    Introduction: Periosteal reaction has a long list of differential diagnoses ranging from trauma, infection, metabolic disease to malignancy. The morphology of periosteal reaction shown in imaging studies helps to narrow down the list of differential diagnoses. Case report: A 25 year old gentleman had an inversion injury to his left ankle. He complained of lateral ankle and posterior heel pain and swelling after the injury. Radiograph of his left ankle revealed solid, smooth periosteal reaction at posterior aspect of left distal tibia. MRI showed periosteal reaction at the corresponding site, which was better demonstrated in CT scan. Follow up MRI and CT showed maturation of the new bone formation at the site of periosteal reaction. Findings were compatible with subperiosteal hematoma formation from injury, which ossified with time. Conclusion: Smooth, thick periosteal reaction favours benign process, while interrupted pattern is an alarming feature for more aggressive causes.

  2. Lateral ankle sprains and instability problems.

    PubMed

    Liu, S H; Jason, W J

    1994-10-01

    The lateral ankle complex is the most frequently injured single structure in athletes, consisting of 38% to 45% of all injuries. One-sixth of all sports injury loss time is from ankle sprains. In North America, ankle inversion sprains are considered "de rigeur" for basketball participation.

  3. The foot and ankle examination.

    PubMed

    Papaliodis, Dean N; Vanushkina, Maria A; Richardson, Nicholas G; DiPreta, John A

    2014-03-01

    Most foot and ankle disorders can be diagnosed after a proper history and clinical examination and can be effectively managed in a primary care setting. It is important to assess the entirety of patient disorders that present as they can be multifactorial in cause. A broad differential should include disorders of bones, joints, muscles, neurovasculature, and surrounding soft tissue structures. Physical examination should be thorough and focused on inspection, palpation, range of motion, and appropriate special tests when applicable. This article highlights some of the salient features of the foot and ankle examination and diagnostic considerations.

  4. [Diagnostic temporo-mandibular arthroscopy. Principle lesions, apropos of 50 case reports].

    PubMed

    Chossegros, C; Cheynet, F; Blanc, J L; Gola, R; Lachard, J

    1991-01-01

    Diagnostic arthroscopy is reserved to patients who suffer from internal temporo-mandibular joint derangements resisting to conservative treatments. This technique allows an acute diagnostic approach to the intra-articular lesions of the superior compartment.

  5. [Minimally invasive treatment of tibial plateau fracture under arthroscopy monitoring].

    PubMed

    Chen, Lixin; Ma, Shaoyun; Li, Xianpeng

    2014-05-01

    Twenty six patients with fracture of tibial plateau was under arthroscopy assisted reduction, the joint surface of bone graft, and USES the steel plate fixation treatment. Average surgery time was 65 min (70-120 min), average fracture healing time was 15 weeks (12-17 weeks), joint surface anatomical reattachment rate was 92.9%. Using break knee function criteria evaluation of curative effect: 18 cases great 6 cases wed, 2 cases ok, fine rate was 92.3%. No infection, deep venous thrombosis and small leg fascia chamber syndrome and other complications. Conclusion is that treatment of tibial plateau fractures under arthroscope has advantages of small trauma, check intuitively and reset accurately, functional recovery of patients are satisfied, the treatment has certain clinical application value.

  6. Elbow arthroscopy: a new setup to avoid visual paradox and improve triangulation.

    PubMed

    Sinha, Apurv; Pydah, Satya Kanth V; Webb, Mark

    2013-05-01

    Elbow arthroscopy is a useful diagnostic and therapeutic tool for various conditions. Conventional arthroscopy with the patient in the prone or lateral position where the screen is placed on the opposite side makes it difficult to interpret the image, results in visual paradox, and is associated with difficult triangulation. We present a modified setup for the operating room to help eliminate these problems and improve triangulation.

  7. [Rupture of the quadriceps tendon after lateral retinaculum release by arthroscopy].

    PubMed

    Trobisch, P D; Baumann, M; Weise, K; Fischer, R

    2010-06-01

    Complications after arthroscopic surgery of the knee joint are infrequent. Quadriceps tendon ruptures after knee arthroscopy are rarities. Only two cases have been published in the medical literature. This article presents a case of a quadriceps tendon rupture that occurred in a 19-year-old patient 5 weeks after lateral release of the retinaculum by arthroscopy. The late occurrence differentiates this case from the other previously published cases.

  8. Combined Hip Arthroscopy and Periacetabular Osteotomy: Indications, Advantages, Technique, and Complications

    PubMed Central

    Domb, Benjamin; LaReau, Justin; Redmond, John M.

    2014-01-01

    Evaluation and treatment of concomitant intra-articular pathology may be beneficial before periacetabular osteotomy (PAO) is performed. Hip arthroscopy before PAO allows the surgeon to perform full inspection of the hip joint and can be used to treat hip pathology before osteotomy. The indications for hip arthroscopy before PAO are presented in this article. The combined surgical procedure is described, along with potential complications. The advantages and disadvantages of this technique are outlined. PMID:24843847

  9. [Distraction osteogenesis of deficient alveolar bone prior to dental rehabilitation].

    PubMed

    Shilo, D; Emodi, O; Aizenbud, D; Rachmiel, A

    2015-07-01

    Implant supported rehabilitation has become very common in treatment plans nowadays, yet many patients lack the vertical and horizontal bone dimensions required for endosseous implant insertion. Distraction osteogenesis is a technique in which bone is generated by progressive elongation of two bone fragments following an osteotomy or corticotomy. Distraction osteogenesis of the alveolar ridge as a treatment modality in implant dentistry is a very useful technique that allows for adequate bone formation suitable for implant insertion. Alveolar distraction can be unidirectional, bidirectional, multidirectional or horizontal. Alveolar distraction osteogenesis can be performed by using intraosseous distraction devices, intraosseous distraction implants or by extraosseous devices which are the most prevalent today. Distraction osteogenesis has many advantages such as gradual lengthening of the bone with no need for an autogenous bone graft and lack of the associated donor site morbidity as well as distraction of the surrounding soft tissue together with the transported bone. One of the major challenges when using alveolar distraction osteogenesis is controlling the vector of distraction, this problem should be further addressed in future researches. We describe different methods for alveolar distraction osteogenesis, including the surgical procedure, latency period, lengthening and consolidation period. We also discuss the advantages, disadvantages and complications of the method. In this manuscript a case of mandibular alveolar deficiency following mandibular fracture and loss of teeth and the alveolar bone is presented. This patient was treated by alveolar distraction osteogenesis with excellent results. This patient was later rehabilitated . using endosseous implants as demonstrated by radiographs. Alveolar distraction osteogenesis provides a method to regain both hard tissue and soft tissue without additional grafting and is an efficient modality in cases of medium

  10. Foot and ankle problems in dancers.

    PubMed

    Kadel, Nancy

    2014-11-01

    The dancer's foot and ankle are subjected to high forces and unusual stresses in training and performance. Injuries are common in dancers, and the foot and ankle are particularly vulnerable. Ankle sprains, ankle impingement syndromes, flexor hallucis longus tendonitis, cuboid subluxation, stress fractures, midfoot injuries, heel pain, and first metatarsophalangeal joint problems including hallux valgus, hallux rigidus, and sesamoid injuries will be reviewed. This article will discuss these common foot and ankle problems in dancers and give typical clinical presentation and diagnostic and treatment recommendations.

  11. What are the current indications for use of radiofrequency devices in hip arthroscopy? A systematic review

    PubMed Central

    Suarez-Ahedo, Carlos; Pavan Vemula, S.; Stake, Christine E.; Finley, Zachary A.; Martin, Timothy J.; Gui, Chengcheng; Domb, Benjamin G.

    2015-01-01

    The role of radiofrequency energy (RFE) devices has been minimally studied in hip arthroscopy. The purpose of this study was to determine the role of RFE devices in hip arthroscopy through a systematic review of the literature. We searched the PubMed database using the following Medical Subject Heading terms: hip arthroscopy, hip radiofrequency, thermal capsulorrhaphy, thermal chondroplasty and radiofrequency debridement. Two authors independently reviewed the literature and included articles based on predetermined inclusion criteria. We excluded review, technique and experimental articles. After title and abstract review, we selected 293 articles for full-text review. Ten articles met the inclusion and exclusion criteria. For the included articles, a total of 305 hips underwent arthroscopy with concomitant RFE treatment at a mean age of 25.7 years. Eight articles presented patient-reported outcome (PRO) instruments, one study did not report an outcome instrument but utilized an evaluation of postoperative range of motion (ROM) and 1 year magnetic resonance image (MRI) and computed tomography (CT) imaging. The remaining article measured only the ROM pre- and postoperatively. Only one of the articles reviewed reported complications. Current evidence on the safety and indications for use of RFE devices in hip arthroscopy is insufficient. The literature shows mixed results regarding its use in hip arthroscopy. Although the use of thermal energy is not without risk, if used judiciously and appropriate precautions are taken to avoid damage to adjacent tissues, those devices can be useful for the treatment of certain intra-articular hip pathologies arthroscopically. PMID:27011856

  12. Biomechanical patterns of text-message distraction.

    PubMed

    Le, Peter; Hwang, Jaejin; Grawe, Sarah; Li, Jing; Snyder, Alison; Lee, Christina; Marras, William S

    2015-01-01

    The objective of this study was to identify biomechanical measures that can distinguish texting distraction in a laboratory-simulated driving environment. The goal would be to use this information to provide an intervention for risky driving behaviour. Sixteen subjects participated in this study. Three independent variables were tested: task (texting, visual targeting, weighted and non-weighted movements), task direction (front and side) and task distance (close and far). Dependent variables consisted of biomechanical moments, head displacement and the length of time to complete each task. Results revealed that the time to complete each task was higher for texting compared to other tasks. Peak moments during texting were only distinguishable from visual targeting. Peak head displacement and cumulative biomechanical exposure measures indicated that texting can be distinguished from other tasks. Therefore, it may be useful to take into account both temporal and biomechanical measures when considering warning systems to detect texting distraction. PMID:25867196

  13. Anatomy of the ankle ligaments: a pictorial essay.

    PubMed

    Golanó, Pau; Vega, Jordi; de Leeuw, Peter A J; Malagelada, Francesc; Manzanares, M Cristina; Götzens, Víctor; van Dijk, C Niek

    2016-04-01

    Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.

  14. Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player

    PubMed Central

    Lee, Sun-Min; Lee, Jung-Hoon

    2015-01-01

    [Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the Star Excursion Balance Test, and the weight-bearing ankle dorsiflexion were increased. [Conclusion] This study showed that ankle inversion taping using kinesiology tape may be an effective therapy for a patient with a medial ankle sprain. PMID:26311991

  15. Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player.

    PubMed

    Lee, Sun-Min; Lee, Jung-Hoon

    2015-07-01

    [Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the Star Excursion Balance Test, and the weight-bearing ankle dorsiflexion were increased. [Conclusion] This study showed that ankle inversion taping using kinesiology tape may be an effective therapy for a patient with a medial ankle sprain.

  16. The distraction osteogenesis in midfacial hypoplasia.

    PubMed

    Lucchese, Alessandra; Gherlone, Enrico F; Asperio, Paolo; Baena, Ruggero Rodriguez y

    2014-05-01

    Distraction osteogenesis (DO) can generate new bone in a gap between 2 vascularized bone surfaces in response to application of graduated tensile stress across the bone gap. The authors present the clinical result in a cleft patient with severe maxillary deficiency treated by a rigid external distraction (RED) device. A boy complained of both masticatory and psychological problems because of cleft with severe midfacial retrusion. The treatment aimed to create a well-balanced facial profile, increase maxillary incisal display, create proper overjet and overbite, and align his dentition. By the RED system, the traction is applied to the maxilla through the dentition by an intraoral splint. A complete Le Fort I osteotomy was performed, including pterygomaxillary and septal disjunction, with mobilization. Once osteotomy was completed, the halo portion of the RED device was adjusted for the width of the neurocranium and was rigidly fixed around the head with 2 scalp screws on each side. A well-balanced facial profile and a good alignment of the dentition were obtained. The patients had considerable improvement in his self-esteem. Clinical reports have suggested that maxillary advancements achieved by distraction are more stable than those achieved with orthognathic surgery with a minimal influence on velopharyngeal competence.

  17. Treatment of brachymetatarsia by callus distraction (callotasis).

    PubMed

    Kawashima, T; Yamada, A; Ueda, K; Harii, K

    1994-02-01

    Callus distraction (callotasis) has already become a popular procedure in the lengthening of limbs. With the development of a small device, it can also be applied to the hand or foot, thus providing benefits in the treatment of brachymetatarsia. Four toes of 3 patients with brachymetatarsia of the fourth toe were treated by this method, and excellent elongation of from 17.50 to 32.55 mm (average, 23.71 mm) was acquired. The treatment period ranged from 78 to 141 days (average, 112.5 days). More time was required in the earlier cases, but the most recent took only 11 weeks. The optimal distraction rate is considered to be 0.35 mm per half-day. Reshortening after treatment ranged from 3.6 to 5.5 mm (average, 4.7 mm), or from 15% to 26% (average, 20.5%) of the distracted length. About 90% of the resorption was observed within 1 month, except in a case that involved a postoperative fracture, and no resorption was seen after 2 surgical months. Regarding complications, subluxation of joints was seen in 2 patients and a postoperative fracture in 1 patient. Subluxation was caused by tendons resisting elongation. The procedure is described, representative cases are illustrated, and problems encountered are discussed. PMID:8192371

  18. Preliminary studies of mineralization during distraction osteogenesis.

    PubMed

    Aronson, J; Good, B; Stewart, C; Harrison, B; Harp, J

    1990-01-01

    Distraction osteogenesis by the Ilizarov method was performed on 20 dogs. Mineralization at the site of the left tibial metaphyseal lengthening was measured by weekly quantitative computer tomography (QCT) using the contralateral tibia as a control. Four dogs each were killed on Days 7, 14, 21, and 28 of distraction in order to correlate QCT with microradiology, nondecalcified histology, quantitative calcium analysis, and scanning electron microscopy. It was consistently found that intramembranous ossification proceeded centripetally from each corticotomy surface toward the central fibrous interzone. Bone columns crystallized along longitudinally oriented collagen bundles, expanding circumferentially to surrounding bundles. As the distraction gap increased, the bone columns increased in length and in diameter, while the fibrous interzone remained about 4 mm long. Histologically, the bone columns resembled stalagmites and stalactites, as seen by microradiography and scanning electron microscopy, that projected from each corticotomy surface toward the center. These cones reached maximum diameters of 150-200 mu at the corticotomy surfaces. Radiodensity (QCT) increased gradually from the central fibrous interzone toward each corticotomy surface. Mineral density, as determined by calcium quantification, reflected the microscopic geometry and radiographic polarity.

  19. [An experimental study of a new bidirectional distraction appliance].

    PubMed

    Lucas, R; Gounot, N; Cresseaux, P; Breton, P; Freidel, M; Ferez, C; Roger, T; Genevois, J P

    1998-07-01

    The goals of mandibular distraction are to restore a normal length but also a normal shape to the hypoplastic mandible. These two goals are related to the elongation vector which is itself related to the location of the cortictomy and of the device. Other factors influence this elongation vector. So it is impossible to precisely predict the elongation vector. With the monodirectional distraction device no modification can be made during the distraction time. With a bidirectional distraction device offering the possibility to modulate the angulation between the two elongation rods it is possible to adjust the elongation vector during distraction. Precise distraction gap modeling is possible. This is particularly important to correct anterior open-bite. This device was tested on animals (pigs). PMID:9697234

  20. [An experimental study of a new bidirectional distraction appliance].

    PubMed

    Lucas, R; Gounot, N; Cresseaux, P; Breton, P; Freidel, M; Ferez, C; Roger, T; Genevois, J P

    1998-07-01

    The goals of mandibular distraction are to restore a normal length but also a normal shape to the hypoplastic mandible. These two goals are related to the elongation vector which is itself related to the location of the cortictomy and of the device. Other factors influence this elongation vector. So it is impossible to precisely predict the elongation vector. With the monodirectional distraction device no modification can be made during the distraction time. With a bidirectional distraction device offering the possibility to modulate the angulation between the two elongation rods it is possible to adjust the elongation vector during distraction. Precise distraction gap modeling is possible. This is particularly important to correct anterior open-bite. This device was tested on animals (pigs).

  1. Quality and Quantity of the Elbow Arthroscopy Literature: A Systematic Review and Meta-Analysis.

    PubMed

    Erickson, Brandon J; Chalmers, Peter N; Cvetanovich, Gregory L; Frank, Rachel M; Romeo, Anthony A; Harris, Joshua D

    2016-01-01

    The purpose of this article is to perform a systematic review and meta-analysis of elbow arthroscopy literature to answer the following questions: "Across the world, what demographic of patients are undergoing elbow arthroscopy, what are the most common indications for elbow arthroscopy, and how good is the evidence?" The authors hypothesized that patients who undergo elbow arthroscopy will be chiefly age <40 years, the most common indication for elbow arthroscopy will be a release/débridement, and the evidence regarding elbow arthroscopy will be poor. Also, no significant differences will exist in elbow arthroscopy publications, subjects, outcomes, and techniques based on continent/country of publication. A systematic review was registered with the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) and performed with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using 3 publicly available databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using 1-way analysis of variance (ANOVA) to compare between continents and Pearson's correlation coefficients to evaluate changes over time. In total, 112 studies were included (3093 subjects; 3168 elbows; 64% male; mean 34.9 ± 14.68 years. Mean 33.4 ± 26.02 months follow-up. Most studies were level IV evidence (94.6%) and had a low Modified Coleman Methodology Score (MCMS) (mean 28.1 ± 8.06). From 1985 through 2013, the number of publications significantly increased with time (P = .004) in all continents. The 3 most common indications for elbow arthroscopy were osteochondritis dissecans (OCD), lateral epicondylitis, and release and débridement. The number of reported cases for the 3 most common indications significantly

  2. ALCOHOL AND DISTRACTION INTERACT TO IMPAIR DRIVING PERFORMANCE

    PubMed Central

    Harrison, Emily L. R.; Fillmore, Mark T.

    2011-01-01

    Background Recognition of the risks associated with alcohol intoxication and driver distraction has led to a wealth of simulated driving research aimed at studying the adverse effects of each of these factors. Research on driving has moved beyond the individual, separate examination of these factors to the examination of potential interactions between alcohol intoxication and driver distraction. In many driving situations, distractions are commonplace and might have little or no disruptive influence on primary driving functions. Yet, such distractions might become disruptive to a driver who is intoxicated. Methods The present study examined the interactive impairing effects of alcohol intoxication and driver distraction on simulated driving performance in 40 young adult drivers using a divided attention task as a distracter activity. The interactive influence of alcohol and distraction was tested by having drivers perform the driving task under four different conditions: 0.65 g/kg alcohol; 0.65 g/kg alcohol + divided attention; placebo; and placebo + divided attention. Results As hypothesized, divided attention had no impairing effect on driving performance in sober drivers. However, under alcohol, divided attention exacerbated the impairing effects of alcohol on driving precision. Conclusions Alcohol and distraction continue to be appropriate targets for research into ways to reduce the rates of driving-related fatalities and injuries. Greater consideration of how alcohol and distraction interact to impair aspects of driving performance can further efforts to create prevention and intervention measures to protect drivers, particularly young adults. PMID:21277119

  3. [Autologous tissue engineering by means of distraction osteogenesis: Biomechanical considerations].

    PubMed

    Schouman, T; Raoul, G; Dubois, G

    2011-09-01

    Tissue engineering consists in producing functional replacement tissue. Distraction osteogenesis is a tissue engineering technique that uses the mechanical environment of cells to induce tissue regeneration, without need for exogenous biochemical factors. A better understanding of the optimal mechanical conditions of distraction callus stretching may reduce the duration, discomfort, and even social impact of distraction protocols, and complications and failures. We present the current state of knowledge in this field by addressing the fundamentals of elongating bone tissue biomechanics, the influence of rhythm and rate of distraction, and that of vectors and stability. Finally, we present the innovations currently studied, which may modify our clinical protocol in the short term.

  4. Subtractive fuzzy classifier based driver distraction levels classification using EEG.

    PubMed

    Wali, Mousa Kadhim; Murugappan, Murugappan; Ahmad, Badlishah

    2013-09-01

    [Purpose] In earlier studies of driver distraction, researchers classified distraction into two levels (not distracted, and distracted). This study classified four levels of distraction (neutral, low, medium, high). [Subjects and Methods] Fifty Asian subjects (n=50, 43 males, 7 females), age range 20-35 years, who were free from any disease, participated in this study. Wireless EEG signals were recorded by 14 electrodes during four types of distraction stimuli (Global Position Systems (GPS), music player, short message service (SMS), and mental tasks). We derived the amplitude spectrum of three different frequency bands, theta, alpha, and beta of EEG. Then, based on fusion of discrete wavelet packet transforms and fast fourier transform yield, we extracted two features (power spectral density, spectral centroid frequency) of different wavelets (db4, db8, sym8, and coif5). Mean ± SD was calculated and analysis of variance (ANOVA) was performed. A fuzzy inference system classifier was applied to different wavelets using the two extracted features. [Results] The results indicate that the two features of sym8 posses highly significant discrimination across the four levels of distraction, and the best average accuracy achieved by the subtractive fuzzy classifier was 79.21% using the power spectral density feature extracted using the sym8 wavelet. [Conclusion] These findings suggest that EEG signals can be used to monitor distraction level intensity in order to alert drivers to high levels of distraction.

  5. A systematic review on ankle injury and ankle sprain in sports.

    PubMed

    Fong, Daniel Tik-Pui; Hong, Youlian; Chan, Lap-Ki; Yung, Patrick Shu-Hang; Chan, Kai-Ming

    2007-01-01

    This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports. PMID:17190537

  6. A systematic review on ankle injury and ankle sprain in sports.

    PubMed

    Fong, Daniel Tik-Pui; Hong, Youlian; Chan, Lap-Ki; Yung, Patrick Shu-Hang; Chan, Kai-Ming

    2007-01-01

    This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

  7. Arthroscopy of the hip for patients with mild to moderate developmental dysplasia of the hip and femoroacetabular impingement: Outcomes following hip arthroscopy for treatment of chondrolabral damage.

    PubMed

    Fukui, K; Trindade, C A C; Briggs, K K; Philippon, M J

    2015-10-01

    The purpose of this study was to determine patient-reported outcomes of patients with mild to moderate developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) undergoing arthroscopy of the hip in the treatment of chondrolabral pathology. A total of 28 patients with a centre-edge angle between 15° and 19° were identified from an institutional database. Their mean age was 34 years (18 to 53), with 12 female and 16 male patients. All underwent labral treatment and concomitant correction of FAI. There were nine reoperations, with two patients requiring revision arthroscopy, two requiring periacetabular osteotomy and five needing total hip arthroplasty. Patients who required further major surgery were more likely to be older, male, and to have more severe DDH with a larger alpha angle and decreased joint space. At a mean follow-up of 42 months (24 to 89), the mean modified Harris hip score improved from 59 (20 to 98) to 82 (45 to 100; p < 0.001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 30 (1 to 61) to 16 (0 to 43; p < 0.001). Median patient satisfaction was 9.0/10 (1 to 10). Patients reported excellent improvement in function following arthroscopy of the hip. This study shows that with proper patient selection, arthroscopy of the hip can be successful in the young patient with mild to moderate DDH and FAI. PMID:26430004

  8. Distraction 'on the buses': a novel framework of ergonomics methods for identifying sources and effects of bus driver distraction.

    PubMed

    Salmon, Paul M; Young, Kristie L; Regan, Michael A

    2011-05-01

    Driver distraction represents a significant problem in the public transport sector. Various methods exist for investigating distraction; however, the majority are difficult to apply within the context of naturalistic bus driving. This article investigates the nature of bus driver distraction at a major Australian public transport company, including the sources of distraction present, and their effects on driver performance, through the application of a novel framework of ergonomics methods. The framework represents a novel approach for assessing distraction in a real world context. The findings suggest that there are a number of sources of distraction that could potentially distract bus drivers while driving, including those that derive from the driving task itself, and those that derive from the additional requirements associated with bus operation, such as passenger and ticketing-related distractions. A taxonomy of the sources of bus driver distraction identified is presented, along with a discussion of proposed countermeasures designed to remove the sources identified or mitigate their effects on driver performance.

  9. Long-term outcome after supination-external rotation type-4 fractures of the ankle.

    PubMed

    Stufkens, S A S; Knupp, M; Lampert, C; van Dijk, C N; Hintermann, B

    2009-12-01

    We have compared the results at a mean follow-up of 13 years (11 to 14) of two groups of supination-external rotation type-4 fractures of the ankle, in one of which there was a fracture of the medial malleolus and in the other the medial deltoid ligament had been partially or completely ruptured. Of 66 patients treated operatively between 1993 and 1997, 36 were available for follow-up. Arthroscopy had been performed in all patients pre-operatively to assess the extent of the intra-articular lesions. The American Orthopaedic Foot and Ankle Society hind-foot score was used for clinical evaluation and showed a significant difference in both the total and the functional scores (p < 0.05), but not in those for pain or alignment, in favour of the group with a damaged deltoid ligament (p < 0.05). The only significant difference between the groups on the short-form 36 quality-of-life score was for bodily pain, again in favour of the group with a damaged deltoid ligament. There was no significant difference between the groups in the subjective visual analogue scores or in the modified Kannus radiological score. Arthroscopically, there was a significant difference with an increased risk of loose bodies in the group with an intact deltoid ligament (p < 0.005), although there was no significant increased risk of deep cartilage lesions in the two groups. At a mean follow-up of 13 years after operative treatment of a supination-external rotation type-4 ankle fracture patients with partial or complete rupture of the medial deltoid ligament tended to have a better result than those with a medial malleolar fracture.

  10. Predictors of Length of Career Following Hip Arthroscopy for Femoroacetabular Impingement in Professional Hockey Players

    PubMed Central

    Menge, Travis; Briggs, Karen K.; Philippon, Marc J.

    2016-01-01

    Objectives: Previous studies have shown that professional hockey players return to sport at a high rate following hip arthroscopy. The average length of a National Hockey League (NHL) career has been reported to be 5.5 years, and it is unknown how long players continue to play after hip arthroscopy. The purpose of this study was 1) to determine predictors of length of career in players following hip arthroscopy for treatment of symptomatic femoroacetabular impingement (FAI), and 2) investigate the rate of those who continue to play professional hockey a minimum of 5 years after hip arthroscopy. Methods: Seventy professional hockey players underwent hip arthroscopy for FAI between 2005 and 2010 by a single surgeon. Data was retrieved from NHL.com regarding the duration of each player’s professional career. In addition, position played, draft position, age at time of surgery, and surgical details were also used in data analysis. Results: Our cohort included thirteen players that were centers, 15 defensemen, 20 goalies, and 22 wings. The average overall draft number was 57 (range 1 to 228), and average age at surgery was 27 years (range 17 to 38). Forty of the 70 athletes (57%) continued to play professionally a minimum of 5 years after hip arthroscopy. As of the most recent 2015 season, the average NHL length of career was 13 years (range 8 to 23 years), with an average of 6.9 years played following hip arthroscopy. Therre was no different in length of career and years played when goalies were compared to other players(p=0.760). Length of career and years played after arthroscopy correlated with age at surgery (r=0.799 and r=-0.408). Players who played 5 or more years after arthroscopy were significantly younger than those who did not (25 vs. 30 years, p=0.001). Sixty-five players (93%) had labral repair and 5 (7%) had labral reconstruction. There were no differences in length of career or years played after arthroscopy based on type of labral treatment (p=0

  11. Muscle computer interfaces for driver distraction reduction.

    PubMed

    Khushaba, Rami N; Kodagoda, Sarath; Liu, Diaki; Dissanayake, Gamini

    2013-05-01

    Driver distraction is regarded as a significant contributor to motor-vehicle crashes. One of the important factors contributing to driver distraction was reported to be the handling and reaching of in-car electronic equipment and controls that usually requires taking the drivers' hands off the wheel and eyes off the road. To minimize the amount of such distraction, we present a new control scheme that senses and decodes the human muscles signals, denoted as Electromyogram (EMG), associated with different fingers postures/pressures, and map that to different commands to control external equipment, without taking hands off the wheel. To facilitate such a scheme, the most significant step is the extraction of a set of highly discriminative feature set that can well separate between the different EMG-based actions and to do so in a computationally efficient manner. In this paper, an accurate and efficient method based on Fuzzy Neighborhood Discriminant Analysis (FNDA), is proposed for discriminant feature extraction and then extended to the channel selection problem. Unlike existing methods, the objective of the proposed FNDA is to preserve the local geometrical and discriminant structures, while taking into account the contribution of the samples to the different classes. The method also aims to efficiently overcome the singularity problems of classical LDA by employing the QR-decomposition. Practical real-time experiments with eight EMG sensors attached on the human forearm of eight subjects indicated that up to fourteen classes of fingers postures/pressures can be classified with <7% error on average, proving the significance of the proposed method.

  12. ARTHROSCOPY FOR TREATMENT OF REFRACTORY CALCIFIC TENDONITIS OF THE SHOULDER

    PubMed Central

    Fernandes, Marcos Rassi; Fernandes, Rui José

    2015-01-01

    Objective: To evaluate the results from arthroscopic treatment in patients with calcific tendonitis of the shoulder. Methods: Between September 2001 and June 2006, 55 patients with calcific tendonitis of the shoulder that was resistant to conservative treatment were evaluated, with follow-up of 12 to 70 months. The mean age was 42 years, ranging from 30 to 64 years; 44 patients were female (80%). There were 37 right shoulders, and 63.63% of the cases were on the dominant side. Pain was the main symptom, and the mean time between onset of symptoms and arthroscopy was 38 months (range: five to 120 months). The tendon affected was the supraspinatus in 42 cases, the infraspinatus in 11 cases and an association between these in two cases. Acromioplasty was carried out in 12 patients (21.82%) and subacromial bursectomy was performed in all cases. Results: According to the UCLA criteria, 46 cases were excellent and six were good, making a total of 52 satisfactory results (94.54%). Conclusion: Arthroscopic treatment of calcific tendonitis of the shoulder appears to be an effective method, with high rates of satisfactory results. Associated acromioplasty is not necessary. PMID:27019839

  13. The Mayo Table Technique in Hip Arthroscopy.

    PubMed

    Salas, Antonio Porthos; González-Campos, Mauricio; Salas-Pérez, Alfredo D'Artagnan; Aurelio González-Bazaldua, Jose Luis

    2016-06-01

    Hip distractor devices or hip fracture tables (HFTs) are vital to perform a reliable hip arthroscopy (HA) for the treatment of femoroacetabular impingement, especially when labral tears, chondral-labral delaminations, ligamentum teres tears, and other intraarticular disorders are present. Adequate hip distractors were not available in the early days of HA; most of HFTs being used those days were rigid, cumbersome, and did not allow us to properly perform an arthroscopic dynamic impingement test to evaluate and assess the femoral head and its site of impingement. The mayo table technique was developed because of the lack of appropriate hip instrumentation and an HFT when the author (A.P.S.) started to perform HA. This easy technique allows the surgeon to control hip maximal range of motion and also to assess completely the cam deformity in the posterolateral, superolateral, anterior, and anteroinferior aspects. It also allows the surgeon to revise where the cam is impinging and afterward perform a complete bony resection and decompression. We strongly believe that with the mayo table technique HA can be performed simply and reliably in old rigid and cumbersome HFTs and also hip distractors that do not allow an adequate dynamic assessment of the hip with maximal range of motion. PMID:27656362

  14. Find an Orthopaedic Foot and Ankle MD/DO

    MedlinePlus

    ... AOFAS / FootCareMD / Find a Surgeon Find an Orthopaedic Foot & Ankle Surgeon Page Content The Orthopaedic Distinction Who are Orthopaedic Foot & Ankle Surgeons? Orthopaedic foot and ankle surgeons are ...

  15. Outcomes of temporomandibular joint arthroscopy in patients with painful but otherwise normal joints.

    PubMed

    Dimitroulis, George

    2015-07-01

    The aim of this retrospective clinical study was to assess the clinical outcomes of temporomandibular joint (TMJ) arthroscopy in patients who presented with category 1 normal joints. The null hypothesis being tested was that patients with normal joints do not respond to TMJ arthroscopy. The clinical records of 116 patients who had undergone TMJ arthroscopy by the author from 2010 to 2013 were retrieved and individually analysed for inclusion in this retrospective, cohort clinical study. The inclusion criteria used to select patients for this study were those who had arthroscopically proven category 1 normal joints, free of intra-articular pathology. Of the 14 patients who were found to have normal joints, only 10 could be contacted for a follow-up survey. Despite the fact that all patients were informed that no joint pathology was found, six out of the 10 patients reported improvement in their temporomandibular disorder (TMD) symptoms that lasted for more than 6 months following TMJ arthroscopy. The results of this investigation indicate that we can reject the null hypothesis, and that patients with normal TMJs do indeed respond to TMJ arthroscopy. What this limited study has highlighted is the pervasive effects of the placebo that all surgeons need to keep in mind when formulating treatment plans for patients with TMD.

  16. Which ankle fractures require syndesmotic stabilization?

    PubMed

    van den Bekerom, Michel P J; Lamme, Bas; Hogervorst, Mike; Bolhuis, Hugo W

    2007-01-01

    Syndesmotic ruptures associated with ankle fractures are most commonly caused by external rotation of the foot, eversion of the talus within the ankle mortise, and excessive dorsiflexion. The distal tibiofibular syndesmosis consists of the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and interosseous ligament, and it is essential for stability of the ankle mortise. Despite the numerous biomechanical and clinical studies pertaining to ankle fractures, there are no uniform recommendations regarding the use of the syndesmotic screw for specific injury patterns and fracture types. The objective of this review was to formulate recommendations for clinical practice related to the use of syndesmotic screw placement. PMID:17980843

  17. Total Ankle Arthroplasty: An Imaging Overview

    PubMed Central

    Kim, Da-Rae; Potter, Hollis G.; Li, Angela E.; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice. PMID:27134529

  18. Total Ankle Arthroplasty: An Imaging Overview.

    PubMed

    Kim, Da-Rae; Choi, Yun Sun; Potter, Hollis G; Li, Angela E; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  19. Nonoperative management of athletic ankle injuries.

    PubMed

    Vegso, J J; Harmon, L E

    1982-03-01

    Few injuries in sports are more ubiquitous than those involving the ankle. Athletes in some endeavors, notably football and basketball, routinely have their ankles prophylactically taped at a cost of hundreds of thousands of dollars and, probably, millions of man hours. Other sports, such as skiing, involve encasement of the foot, ankle and lower leg in plastic and foam to the extent of almost complete exclusion of motion. In spite of these rather heroic measures, ankle injuries continue to constitute a significant threat to athletes in these and most other activities.

  20. Neuronal Effects of Auditory Distraction on Visual Attention

    ERIC Educational Resources Information Center

    Smucny, Jason; Rojas, Donald C.; Eichman, Lindsay C.; Tregellas, Jason R.

    2013-01-01

    Selective attention in the presence of distraction is a key aspect of healthy cognition. The underlying neurobiological processes, have not, however, been functionally well characterized. In the present study, we used functional magnetic resonance imaging to determine how ecologically relevant distracting noise affects cortical activity in 27…

  1. Implementation Intentions and Test Anxiety: Shielding Academic Performance from Distraction

    ERIC Educational Resources Information Center

    Parks-Stamm, Elizabeth J.; Gollwitzer, Peter M.; Oettingen, Gabriele

    2010-01-01

    College students whose test anxiety was measured completed a working memory-intensive math exam with televised distractions. Students were provided with implementation intentions (if-then plans; Gollwitzer, 1999) designed to either help them ignore the distractions (i.e., temptation-inhibiting plans) or focus more intently on the math exam (i.e.,…

  2. Rapid maxillary canine retraction by dental distraction: A clinical study

    PubMed Central

    Koteswara Prasad, N. K.; Chitharanjan, Arun; Kailasam, Vignesh

    2014-01-01

    Aim: The aim of this clinical study was to perform rapid maxillary canine retraction through distraction of the periodontal ligament and investigate the rate and amount of canine retraction, amount of anchor loss, the nature of tooth movement achieved, and radiographic changes in the periodontal ligament region during and after canine distraction. Materials and Methods: This study was conducted on 10 distractions ranging in age from 14 years to 25 years who needed canine retraction and first premolar extraction in the maxillary arch. Ten canine distractions were carried out with custom-made, tooth-borne intra-oral distraction device. Results: The results indicate that the periodontal ligament can be distracted just like the mid-palatal suture in rapid palatal expansion and the maxillary canines are retracted rapidly into the first premolar extraction space at the rate of about 2.53 mm/week. Conclusion: Though this study indicates that the periodontal ligament can be distracted to elicit rapid tooth movement, the long-term effects of canine distraction are not well known and need close monitoring. PMID:25298710

  3. Interference by Process, Not Content, Determines Semantic Auditory Distraction

    ERIC Educational Resources Information Center

    Marsh, John E.; Hughes, Robert W.; Jones, Dylan M.

    2009-01-01

    Distraction by irrelevant background sound of visually-based cognitive tasks illustrates the vulnerability of attentional selectivity across modalities. Four experiments centred on auditory distraction during tests of memory for visually-presented semantic information. Meaningful irrelevant speech disrupted the free recall of semantic…

  4. Periodontal ligament distraction: A simplified approach for rapid canine retraction

    PubMed Central

    Prabhat, K. C.; Maheshwari, Sandhya; Gupta, N. D.; Verma, Sanjeev K.; Goyal, Lata

    2012-01-01

    Distraction osteogenesis is a method of inducing new bone formation by applying mechanical strains on preexisting bone. The process of osteogenesis in the periodontal ligament during orthodontic tooth movement is similar to the osteogenesis in the midpalatal suture during rapid palatal expansion. A new concept of “distracting the periodontal ligament” is proposed to elicit rapid canine retraction in two weeks. At the time of first premolar extraction, the interseptal bone distal to the canine was undermined with a bone bur, grooving vertically inside the extraction socket along the buccal and lingual sides and extending obliquely toward the socket base. Then, a tooth-borne, custom-made, intraoral distraction device was placed to distract the canine distally into the extraction space. It was activated 0.5 mm/day, immediately after the extraction. Canine was distracted 6.5 mm into the extraction space within two weeks. PMID:22628978

  5. Clinical Use of Deferoxamine in Distraction Osteogenesis of Irradiated Bone.

    PubMed

    Momeni, Arash; Rapp, Scott; Donneys, Alexis; Buchman, Steven R; Wan, Derrick C

    2016-06-01

    The deleterious effects of radiotherapy, including hypovascularity and hypocellularity, have made distraction of irradiated bones challenging. Animal studies, however, have demonstrated adjunctive measures such as the administration of deferoxamine to significantly improve bone regeneration across irradiated distraction gaps. In this report, the authors demonstrate, for the first time, enhanced bone formation following deferoxamine application in a patient following distraction of a previously irradiated maxilla. Computed tomography imaging of the pterygomaxillary buttress on the side of administration revealed significantly increased bone area and density relative to the contralateral buttress. This is the first presentation of clinical deferoxamine use to promote bone formation following irradiated bone distraction and highlights the promise for this adjunctive measure to make outcomes after distraction of irradiated bone more reliable. PMID:27171947

  6. The shoulder distraction force in cricket fast bowling.

    PubMed

    Stuelcken, Max C; Ferdinands, René E D; Ginn, Karen A; Sinclair, Peter J

    2010-08-01

    This preliminary study aimed to quantify the magnitude of the peak shoulder distraction force during the bowling action of female cricket fast bowlers. An eight camera Vicon motion analysis system operating at 120 Hz recorded the fast bowling actions of 18 Australian female fast bowlers. A three segment inverse solution model of the bowling arm was used to calculate the shoulder distraction force. A large peak shoulder distraction force was recorded during the early stages of the follow-through of the bowling action. When normalized for body weight, the distraction force was within the range of values reported for baseball and softball pitchers, who are considered to be at high risk of shoulder injury. Therefore, the relative importance of the peak shoulder distraction force in the fast bowling action for the development of shoulder pain in female cricket fast bowlers warrants further investigation. PMID:20841630

  7. The shoulder distraction force in cricket fast bowling.

    PubMed

    Stuelcken, Max C; Ferdinands, René E D; Ginn, Karen A; Sinclair, Peter J

    2010-08-01

    This preliminary study aimed to quantify the magnitude of the peak shoulder distraction force during the bowling action of female cricket fast bowlers. An eight camera Vicon motion analysis system operating at 120 Hz recorded the fast bowling actions of 18 Australian female fast bowlers. A three segment inverse solution model of the bowling arm was used to calculate the shoulder distraction force. A large peak shoulder distraction force was recorded during the early stages of the follow-through of the bowling action. When normalized for body weight, the distraction force was within the range of values reported for baseball and softball pitchers, who are considered to be at high risk of shoulder injury. Therefore, the relative importance of the peak shoulder distraction force in the fast bowling action for the development of shoulder pain in female cricket fast bowlers warrants further investigation.

  8. Paracelsus to parascience: the environmental cancer distraction.

    PubMed

    Ames, B N; Gold, L S

    2000-01-17

    Entering a new millennium seems a good time to challenge some old ideas, which in our view are implausible, have little supportive evidence, and might best be left behind. In this essay, we summarize a decade of work, raising four issues that involve toxicology, nutrition, public health, and government regulatory policy. (a) Paracelsus or parascience: the dose (trace) makes the poison. Half of all chemicals, whether natural or synthetic, are positive in high-dose rodent cancer tests. These results are unlikely to be relevant at the low doses of human exposure. (b) Even Rachel Carson was made of chemicals: natural vs. synthetic chemicals. Human exposure to naturally occurring rodent carcinogens is ubiquitous, and dwarfs the general public's exposure to synthetic rodent carcinogens. (c) Errors of omission: micronutrient inadequacy is genotoxic. The major causes of cancer (other than smoking) do not involve exogenous carcinogenic chemicals: dietary imbalances, hormonal factors, infection and inflammation, and genetic factors. Insufficiency of many micronutrients, which appears to mimic radiation, is a preventable source of DNA damage. (d) Damage by distraction: regulating low hypothetical risks. Putting huge amounts of money into minuscule hypothetical risks damages public health by diverting resources and distracting the public from major risks.

  9. Metatarsal lengthening by callus distraction for brachymetatarsia.

    PubMed

    Wada, Akifusa; Bensahel, Henri; Takamura, Kazuyuki; Fujii, Toshio; Yanagida, Haruhisa; Nakamura, Tomoyuki

    2004-05-01

    Twelve metatarsal lengthening procedures by callus distraction were performed in seven patients with brachymetatarsia. The mean age at the time of the surgery was 12.0 years (range, 11.1-14.5 years). The mean duration of follow-up was 5.2 years (range, 1.2-13.5 years). The bones were lengthened at a rate of 0.7 mm/day by a mean of 20 mm (range, 15-30 mm), which was 45% of their original length (range, 37-61%). The mean healing index was 73 days/cm (range, 41-98 days/cm). Corrective shortening osteotomy was performed in one case in which the metatarsophalangeal joint was dislocated due to excessive lengthening. In 10 of the remaining 11 cases, joint stiffness, narrowing of the joint space and some degree of plantar subluxation of the metatarsophalangeal joint were observed during distraction, but these were gradually resolved without either elongation of the tendon or metatarsophalangeal joint fixation with Kirschner wire. PMID:15083123

  10. [Factors affecting bone regeneration in Ilizarov callus distraction].

    PubMed

    Fink, B; Krieger, M; Schneider, T; Menkhaus, S; Fischer, J; Rüther, W

    1995-12-01

    We evaluated the X-rays of 36 patients who underwent 50 callus distractions. With the aid of a computerized digitalisation system for analogue films, the relative X-ray density of the distraction area was calculated for each X-ray. These relative X-ray densities were figured graphically for the duration of treatment for each patient. In the consolidation phase, the graph of each patient had a logarithmic relationship. The gradients of the logarithmic density curves were considered an indicator of the quantity of new bone formation. These gradients were correlated to the following clinical parameters: age of the patient, beginning of distraction after corticotomy, average speed of distraction, average weight bearing during the distraction and consolidation phase, location of corticotomy (distal femur versus proximal tibia) and diclofenac medication. Except for the location of the corticotomy and diclofenac, all parameters had an influence on osteoneogenesis by callus distraction. The parameters affecting new bone formation the most were the age of the patient and weight bearing. Patients aged under 18 years (p = 0.005), beginning of distraction later than 8 days (p = 0.109), an average distraction speed below 1 mm/day (p = 0.079), and average weight bearing of more than 30 kg (p = 0.068 for the distraction phase and p = 0.089 for the consolidation phase) showed a quantitatively higher rate of new bone formation by callus distraction than the patients in the other groups. Patients with a shorter leg due to poliomyelitis and one patient with an amniotic leg tie showed a slower increase in X-ray density graphs than the other patients. PMID:8584945

  11. Development and validation of a computer-based learning module for wrist arthroscopy.

    PubMed

    Obdeijn, M C; Alewijnse, J V; Mathoulin, C; Liverneaux, P; Tuijthof, G J M; Schijven, M P

    2014-04-01

    The objective of this study was to develop and validate a computer-based module for wrist arthroscopy to which a group of experts could consent. The need for such a module was assessed with members of the European Wrist Arthroscopy Society (EWAS). The computer-based module was developed through several rounds of consulting experts on the content. The module's learning enhancement was tested in a randomized controlled trial with 28 medical students who were assigned to the computer-based module group or lecture group. The design process led to a useful tool, which is supported by a panel of experts. Although the computer based module did not enhance learning, the participants did find the module more pleasant to use. Developing learning tools such as this computer-based module can improve the teaching of wrist arthroscopy skills.

  12. Balance assessments for predicting functional ankle instability and stable ankles.

    PubMed

    Ross, Scott E; Linens, Shelley W; Wright, Cynthia J; Arnold, Brent L

    2011-10-01

    A number of instrumented and non-instrumented measures are used to detect balance deficits associated with functional ankle instability (FAI). Determining outcome measures that detect balance deficits associated with FAI might assist clinicians in identifying impairments that may otherwise go undetected with less responsive balance measures. Thus, our objective was to determine the balance measure that best predicted ankle group membership (FAI or stable ankle). Participants included 17 subjects without a history of ankle sprains (168±9 cm, 66±14 kg, 24±5 yr) and 17 subjects with FAI (172±9 cm, 71±11 kg, 22±3 yr). Balance trials were performed without vision and subjects stood on a single leg as motionless as possible for 20s. Balance was quantified with center-of-pressure measures (velocity, area) and error score. Measures were positively correlated with each other (r range: 0.60-0.76). The multifactorial model with all three measures best predicted group membership (F((3,30))=7.20, P=0.001; R(2)=0.42; percent classified correctly=77%), and was followed by the multifactorial model with resultant center-of-pressure velocity and error score (F((2,31))=8.73, P=0.001; R(2)=0.36; percent classified correctly=74%). The resultant center-of-pressure velocity (F((1,32))=13.46, P=0.001; R(2)=0.30; percent classified correctly=74%; unique variance=12.7%) and error score (F((1,32))=12.51, P=0.001; R(2)=0.28; percent classified correctly=71%; unique variance=12.0%) predicted group membership; however, 95th percentile center-of-pressure area ellipse did not (F((1,32))=4.16, P=0.05; R(2)=0.12; percent classified correctly=65%; unique variance=5.8%). A multifactorial single leg balance assessment is best for predicting group membership. COPV is the best single predictor of group membership, but clinicians may use error score to identify deficits associated with FAI if force plates are not available. PMID:21868225

  13. Arthroscopy of the temporomandibular joint. Examination of 2 patients with suspected disk derangement.

    PubMed

    Hellsing, G; Holmlund, A; Nordenram, A; Wredmark, T

    1984-02-01

    2 patients with a history of reciprocal temporomandibular joint (TMJ) clicking were visually examined with arthroscopy of their right side TMJs. Clinical and radiographic examination revealed no signs of arthrosis deformans. One patient with significantly reduced opening ability combined with occasional disappearance of TMJ clicks showed advanced arthrotic changes of cartilage which were not visible radiographically. The other patient with unimpaired function also had a severe arthrotic lesion in the clicking joint. In neither case did the disk appear to be displaced. It is concluded that arthroscopy yields additional information for TMJ diagnosis which cannot be achieved by clinical and radiographic examination alone.

  14. Editorial Commentary: Role of Synovial Biomarkers in Patient Outcomes After Knee Arthroscopy.

    PubMed

    Brand, Jefferson C

    2016-03-01

    Humans are notably poor at predicting event outcomes. In "Correlation of Synovial Fluid Biomarkers With Cartilage Pathology and Associated Outcomes in Knee Arthroscopy," Cuellar, Cuellar, Kirsch, and Strauss show that some synovial fluid biomarkers (20 were sampled for the investigation) may predict operative findings at the time of arthroscopy and patient-reported outcome measures at follow-up. Further research will clarify the role of synovial biomarkers in knee pathology and, hopefully, narrow the choices to one or two pertinent markers that can be used to improve our ability to predict outcomes from arthroscopic knee surgery.

  15. Basic Hip Arthroscopy: Anatomic Establishment of Arthroscopic Portals Without Fluoroscopic Guidance.

    PubMed

    Howse, Elizabeth A; Botros, Daniel B; Mannava, Sandeep; Stone, Austin V; Stubbs, Allston J

    2016-04-01

    Hip arthroscopy has gained popularity in recent years for diagnostic and therapeutic hip preservation management. This article details the establishment of arthroscopic portals of the hip, specifically the anterolateral and modified anterior portals without fluoroscopic guidance. The anterolateral portal is established anatomically, and the modified anterior portal is then established under arthroscopic guidance. A through understanding of the hip anatomy allows for these portals to be made both safely and reliably for hip arthroscopies in the modified supine positioned patient. The reduced use of fluoroscopy with this technique lowers the risk of ionizing radiation exposure to the patient and surgeon.

  16. Diagnosis and treatment of chronic ankle pain.

    PubMed

    Wukich, Dane K; Tuason, Dominick A

    2011-01-01

    The differential diagnosis for chronic ankle pain is quite broad. Ankle pain can be caused by intra-articular or extra-articular pathology and may be a result of a traumatic or nontraumatic event. A detailed patient history and physical examination, coupled with judicious selection of the appropriate imaging modalities, are vital in making an accurate diagnosis and providing effective treatment. Chronic ankle pain can affect all age groups, ranging from young athletes to elderly patients with degenerative joint and soft-tissue disorders. It has been estimated that 23,000 ankle sprains occur each day in the United States, representing approximately 1 sprain per 10,000 people per day. Because nearly one in five ankle injuries result in chronic symptoms, orthopaedic surgeons are likely to see patients with chronic ankle pain. Many patients with chronic ankle pain do not recall any history of trauma. Reviewing the management of the various disorders that can cause chronic ankle pain will help orthopaedic surgeons provide the best treatment for their patients. PMID:21553785

  17. Ankle and Other Signatures in Uhecr

    NASA Astrophysics Data System (ADS)

    Berezinsky, Veniamin

    2015-03-01

    The interaction signatures of UHE protons propagating through CMB are discussed. Much attention is given to ankle, which starting from 1963 is usually interpreted as a feature of transition from galactic to extragalactic cosmic rays. We argue here that this interpretation is now excluded. It gives more credit to alternative explanation of the ankle as an intrinsic part of the pair-production dip.

  18. Basketball injuries of the foot and ankle.

    PubMed

    McDermott, E P

    1993-04-01

    Foot and ankle injuries in basketball are discussed in three unrelated categories in this article. This includes a practical differential diagnosis of ankle sprains, acute conditions of the mid and hindfoot, overuse syndromes of nerve entrapment, fascial strain, synovitis, joint subluxation, and inflammation resulting from repetitive stress. The diagnosis and treatment of tendon inflammation of the extrinsic foot musculature is also reviewed.

  19. Current concepts review: ankle fractures.

    PubMed

    Arastu, M H; Demcoe, R; Buckley, R E

    2012-01-01

    Ankle fractures are common injuries that require meticulous technique in order to optimise outcome. The Lauge-Hansen and Danis-Weber classifications in addition to careful evaluation of the injury mechanism can help guide treatment but surgeons must be aware that there are injury patterns that will not always fit the afore mentioned patterns. The principles of atraumatic soft tissue handling, rigid internal fixation and early range of motion exercises are critical for successfully treating these injuries. There are still areas of treatment uncertainty and future directed research is needed in order to address some of these questions.

  20. Tumours of the foot and ankle.

    PubMed

    Khan, Zeeshan; Hussain, Shakir; Carter, Simon R

    2015-09-01

    Sarcomas are rare tumours and particularly rarer in the foot and ankle region. The complex anatomy of the foot and ankle makes it unique and hence poses a challenge to the surgeon for limb salvage surgery. Other lesions found in the foot and ankle region are benign bone and soft tissue tumours, metastasis and infection. The purpose of this article is to discuss the relevance of the complex anatomy of the foot and ankle in relation to tumours, clinical features, their general management principles and further discussion about some of the more common bone and soft tissue lesions. Discussion of every single bone and soft tissue lesion in the foot and ankle region is beyond the scope of this article.

  1. Backward distraction osteogenesis in a patient with severe mandibular micrognathia.

    PubMed

    Mitsukawa, Nobuyuki; Morishita, Tadashi; Saiga, Atsuomi; Akita, Shinsuke; Kubota, Yoshitaka; Satoh, Kaneshige

    2013-09-01

    Maxillary skeletal prognathism can involve severe mandibular micrognathia with marked mandibular retrognathism or hypoplasia. For patients with such a condition, a conventional treatment is mandibular advancement by sagittal split ramus osteotomy (SSRO). This procedure has problems such as insufficient advancement, instability of jaw position, and postoperative relapse. Thus, in recent years, mandibular distraction osteogenesis has been used in some patients. Mandibular distraction has many advantages, but an ideal occlusion is difficult to achieve using this procedure. That is, 3-dimensional control cannot be attained using an internal device that is unidirectional. This report describes a case of severe mandibular micrognathia in a 14-year-old girl treated using backward distraction osteogenesis. This procedure was first reported by Ishii et al (Jpn J Jaw Deform 2004; 14:49) and involves a combination of SSRO and ramus distraction osteogenesis. In the present study, intermaxillary fixation in centric occlusion was performed after osteotomy, and proximal bone segments were distracted in a posterosuperior direction. This procedure is a superior surgical technique that avoids the drawbacks of SSRO and conventional mandibular distraction. However, it applies a large load to the temporomandibular joints and requires thorough management. Thus, careful evaluation needs to be made of the indication for backward distraction osteogenesis.

  2. Vector control in internal midface distraction using temporary anchorage devices.

    PubMed

    Francis, Cameron; Rommer, Elizabeth; Mancho, Salim; Carey, Joseph; Hammoudeh, Jeffrey A; Urata, Mark M

    2012-11-01

    Le Fort III and monobloc distraction osteogenesis serve as the primary surgical treatment for children with severe midface hypoplasia. The orbital retrusion and class III malocclusion of patients with midface hypoplasia is best addressed with bodily advancement of the midface segment parallel to the cephalometric Frankfort horizontal plane. Use of internal distraction devices allows for advancement of the midface without extensive external hardware but comes at the cost of less vectorial control, resulting in a distraction vector that can cause a clockwise rotation of the entire midface or frontofacial component creating hollow appearing orbits. To counteract this clockwise rotation, we have developed a technique using orthodontic microimplants to anchor interarch class III relationship elastics. We report our experiences with this technique on a cadaveric model and as a case series of 17 patients who underwent midface distraction. A Le Fort III distraction procedure was carried out on a cadaver, and the orbital height was measured at 0-, 10-, and 20-mm distraction advancement with and without elastics in a class III relationship. Improvement of both subjective hollow appearance of the orbits and objective measurement of the orbital height with class III relationship elastics demonstrated the efficacy of class III relationship elastics in counteracting the clockwise rotation of the midface segment. A review of 17 patients with midface or frontofacial hypoplasia treated with Le Fort III or monobloc distraction with simultaneous microimplant anchored class III relationship elastics revealed correction of malocclusion and improved midface projection without significant increase in vertical height of the orbits.

  3. Versatility of Distraction Osteogenesis for the Craniofacial Skeleton.

    PubMed

    Klement, Kristen A; Black, Jonathan S; Denny, Arlen D

    2016-05-01

    Malformations of the craniofacial skeleton are common. Restoration of anatomic shape, size, and position has been traditionally accomplished using autologous bone grafting to fill gaps created by surgery and segmental movement. The authors present their practice using distraction in many different ages and settings over 20 years. A retrospective review was performed of all craniofacial patients treated using distraction osteogenesis for mandible, midface, and calvarium. The authors identified 205 patient. Mandible: 112 patients were treated at an average age of 3.4 years. 18.8% of patients required repeat distraction. There was no difference in the neonatal versus older group (P = 0.71). There were significantly higher reoperation rates in syndromic children (P < 0.01). Midface: 58 patients underwent Lefort III distraction at an average age of 13.6 years. One (1.7%) required repeat distraction (Miller syndrome). Five (8.6%) patients underwent subsequent Lefort I advancement for occlusal changes. Calvarium: 33 patients were treated at an average age of 4.7 years. No repeat distractions were performed. One patient required an additional advancement procedure. Distraction demonstrates successful long-term correction of defects in the craniofacial skeleton with the versatility and control needed to treat the wide spectrum of deformity.

  4. The causes and consequences of distraction in everyday driving.

    PubMed

    Stutts, Jane; Feaganes, John; Rodgman, Eric; Hamlett, Charles; Reinfurt, Donald; Gish, Kenneth; Mercadante, Michael; Staplin, Loren

    2003-01-01

    To document drivers' exposure to potential distractions and the effects of these distractions on driving performance, inconspicuous video camera units were mounted in the vehicles of 70 volunteer subjects. The camera units automatically recorded a closeup view of the driver's face, a broader view of the interior of the vehicle, and the roadway immediately ahead of the vehicle whenever it was powered on. Three hours of randomly selected data per subject were coded based on a taxonomy of driver distractions (talking on cell phone, eating, tuning radio, etc.), contextual variables (whether vehicle stopped or moving, road type, traffic level, etc.) and observable measures of driver performance (eyes directed inside or outside vehicle, hands on or off steering wheel, and vehicle position in travel lane). Results were analyzed descriptively and using nonparametric bootstrap analysis techniques. The most common distractions in terms of overall event durations were eating and drinking (including preparations to eat or drink), distractions inside the vehicle (reaching or looking for an object, manipulating vehicle controls, etc.), and distractions outside the vehicle (often unidentified). Although many of the distractions were also associated with negative driving performance outcomes, further research is needed to clarify their impact on driving safety.

  5. Systemic administration of lithium improves distracted bone regeneration in rats.

    PubMed

    Wang, Xuemei; Zhu, Songsong; Jiang, Xiaowen; Li, Yunfeng; Song, Donghui; Hu, Jing

    2015-06-01

    Lithium, popular in psychology field, has been recognized as an activator component of the canonical Wnt signaling pathway. The effect of lithium on osteogenesis or on the human fracture risk has been widely reported. However, little is known on its role in distraction osteogenesis to date. In this study, the effect of systematic administrated lithium on distraction osteogenesis in a rat model was investigated. The osteotomy was performed on the right tibia in 40 adult male Sprague-Dawley rats. Then they were randomly assigned into two equal groups (n = 20/group), which underwent Lithium or saline treatment through gastric gavage until the day they were killed. One week after the osteotomy, the tibias were distracted for 14 days (rate 0.6 mm/day). Following 8 weeks consolidation period, the distracted tibias in both groups were harvested and examined by X-ray plain radiography, histology, dual-energy X-ray absorptiometry, Micro-CT, and biomechanical tests. The results showed that lithium group possessed higher bone mineral density, more mature new bone tissue, and better regenerated bone mass continuity in the distraction gaps without any local or systemic adverse effects was encountered. This study suggested lithium could increase bony callus ossification volume and accelerate distracted tissue mineralization to facilitate bone regeneration in distraction gap.

  6. Management of post midface distraction occlusal discrepancy using temporary anchorage devices in a cleft patient

    PubMed Central

    Koteswara Prasad, N. K.; Hussain, Syed Altaf; Chitharanjan, Arun B.; Murthy, Jyotsna

    2015-01-01

    Open bite deformity following a successful midface advancement by distraction osteogenesis is a common complication. Temporary anchorage devices can be deployed during the distraction and post-distraction settling phases for restoring the occlusion even in severe cases. The following report describes the management of severe anterior open bite following maxillary distraction. PMID:25991895

  7. Continuous mandibular distraction osteogenesis using superelastic shape memory alloy (SMA).

    PubMed

    Idelsohn, S; Peña, J; Lacroix, D; Planell, J A; Gil, F J; Arcas, A

    2004-04-01

    Distraction osteogenesis is a well-established method of endogenous tissue engineering. It is a biological process of bone neo-formation between segments subjected to tension. The concept of this study was to investigate the distraction osteogenesis with a device capable of creating a permanent and constant force during the whole process as if a very large number of small elongations were applied constantly. The mechanical testing of the device used to produce the constant force and the in vivo analysis of the bone growth after it was implanted in rabbits are presented on this work. The device consists of a NiTi coil spring, superelastic at body temperature, in order to have a stress plateau during the austenitic retransformation during the unloading. The in vivo analysis was made on six female rabbits of 12 months old. A segmental mandibulectomy at the horizontal arm of the mandible and a corticotomy at 5mm distant from the gap were made. Next, following a latency period of five days, the SMA springs were implanted to induce the bone neo-formation. The displacement at the unloading plateau shows that it is necessary to have longer springs or to use several (available commercially) in series in order to fulfil the requirements of a human distraction. The temperature variations induced changes in the spring force. However, when the temperature returns to 37 degrees C the distraction force recovers near the initial level and does so completely when the distraction process continues. For the in vivo study, all six rabbits successfully completed the distraction. The radiographies showed the gap as distraction advanced. A continuity in the newly formed bone with similar transversal and horizontal dimensions than the original bone can be observed on the histologies. In conclusion, the application of a constant force on distraction osteogenesis, using SMA springs, may be a successful alternative to the conventional gradual distraction.

  8. Treatment of brachymetatarsia by distraction osteogenesis.

    PubMed

    Shim, Jong Sup; Park, Seung Jun

    2006-01-01

    Metatarsal lengthening by distraction osteogenesis was performed on 17 brachymetatarsia patients with 39 metatarsal bones. To lengthen the first metatarsal in an attempt to prevent development of varus deformity of the hindfoot after lengthening, horizontal lengthening in the anterior direction was performed rather than lengthening through the anatomical axis. In addition, care was taken to ensure that the fourth metatarsal bone screw did not interpose with the fifth extensor tendon during the fourth metatarsal lengthening. Lengthening was successful except in 1 case with mean lengthening of 19.5 mm (48.8%) for the first metatarsal and 17.1 mm (36.2%) for the fourth metatarsal. Because of joint stiffness, plantar capsulotomy was performed on 7 cases, 6 of which had been previously operated on bilaterally. Varus deformity of the hindfoot after the first metatarsal lengthening and entrapment of the fifth extensor tendon after the fourth metatarsal lengthening was not detected in any case. PMID:16557144

  9. The role of ankle bracing for prevention of ankle sprain injuries.

    PubMed

    Gross, Michael T; Liu, Hsin-Yi

    2003-10-01

    Lateral ankle sprains are one of the most common injuries incurred in recreational and competitive athletics. These injuries have a significant impact in terms of cost, athletic participation, and activities of daily living. Prophylactic ankle braces are often used to reduce the risk of injury recurrence when individuals return to athletic participation. The purpose of this clinical commentary is to review the literature and provide our own experience relative to the use of prophylactic ankle bracing. Relatively high incidence rates of ankle sprain injury have been reported for basketball and soccer athletes, military trainees, and individuals with a previous history of ankle sprain injury. Semirigid and laced ankle braces have significantly reduced the incidence of initial and recurrent ankle sprain injuries in athletic and military samples. With few exceptions, these braces do not appear to affect functional performance adversely. The prophylactic use of semirigid ankle braces appears warranted to reduce the incidence of initial and, in particular, recurrent ankle sprain injuries for individuals who participate in activities that have the highest risk for these injuries. Additional research is needed to evaluate the many new braces that are available and in use and their influence on the incidence of ankle sprain injury and functional performance.

  10. Footwear and ankle stability in the basketball player.

    PubMed

    Petrov, O; Blocher, K; Bradbury, R L; Saxena, A; Toy, M L

    1988-04-01

    Ankle stability in basketball players is affected by footwear. Athletic shoe manufacturers have introduced specialized lacing systems and high-top performance shoes to improve ankle stability. These performance shoes not only aid in preventing ankle injuries, but also protect injured ankles.

  11. Sutural distraction osteogenesis (SDO) versus osteotomy distraction osteogenesis (ODO) for midfacial advancement: a new technique and primary clinical report.

    PubMed

    Liu, Chunming; Hou, Min; Liang, Limin; Huang, Xuming; Zhang, Tong; Zhang, Haizhong; Ma, Xiao; Song, Ruyao

    2005-07-01

    A new technique of osteotomy distraction osteogenesis (ODO) and sutural distraction osteogenesis (SDO) by the use of bone-borne traction hooks is presented. The technique of osteotomy plus distraction osteogenesis is suitable for adult patients. The technique of sutural distraction osteogenesis is suitable for young patients, ages 6 through 12 years. The distraction system consists of a face-bow, orthodontic elastics, and bone-borne traction hooks. The bone-borne traction hooks are made of titanium, with two traction hooks running laterally or downwardly. When a Le Fort III osteotomy is needed, bone-borne traction hooks are inserted through the nostrils into a bone hole drilled at the lateral-inferior pyriform aperture. When no osteotomy is needed, only the bone-borne traction hooks are placed. Heavy elastics were used in the technique of osteotomy distraction osteogenesis for Le Fort III osteotomy adult patients, whereas light forces and thus light elastics were used for younger patients. Three adult patients and four children were treated by osteotomy distraction and sutural distraction, respectively. All seven patients with midfacial hypoplasia established a harmonious facial profile and normal occlusal relationships. Radiographic examination showed balanced advancement of the midfacial skeleton. It is suggested that the treatment of midfacial hypoplasia in children by the technique of sutural distraction osteogenesis is to be preferred because of its simplicity and relative noninvasiveness. Thus, the authors suggest that midfacial hypoplasia should be treated at a younger age by this technique, potentially eliminating the need for a Le Fort III osteotomy at an older age.

  12. Sacral Emphysematous Osteomyelitis Caused by Escherichia coli after Arthroscopy of the Knee

    PubMed Central

    Hockertz, Thomas

    2016-01-01

    Emphysematous osteomyelitis is a rare but serious condition which is often associated with a fatal outcome. The typical appearances of emphysematous osteomyelitis are clusters of small gas bubbles within the medullary cavity. We report a case of a 62-year-old male who presented with emphysematous osteomyelitis due to hematogenous spread of Escherichia coli from the knee after arthroscopy.

  13. Ultrasound arthroscopy of human knee cartilage and subchondral bone in vivo.

    PubMed

    Liukkonen, Jukka; Lehenkari, Petri; Hirvasniemi, Jukka; Joukainen, Antti; Virén, Tuomas; Saarakkala, Simo; Nieminen, Miika T; Jurvelin, Jukka S; Töyräs, Juha

    2014-09-01

    Arthroscopic ultrasound imaging enables quantitative evaluation of articular cartilage. However, the potential of this technique for evaluation of subchondral bone has not been investigated in vivo. In this study, we address this issue in clinical arthroscopy of the human knee (n = 11) by determining quantitative ultrasound (9 MHz) reflection and backscattering parameters for cartilage and subchondral bone. Furthermore, in each knee, seven anatomical sites were graded using the International Cartilage Repair Society (ICRS) system based on (i) conventional arthroscopy and (ii) ultrasound images acquired in arthroscopy with a miniature transducer. Ultrasound enabled visualization of articular cartilage and subchondral bone. ICRS grades based on ultrasound images were higher (p < 0.05) than those based on conventional arthroscopy. The higher ultrasound-based ICRS grades were expected as ultrasound reveals additional information on, for example, the relative depth of the lesion. In line with previous literature, ultrasound reflection and scattering in cartilage varied significantly (p < 0.05) along the ICRS scale. However, no significant correlation between ultrasound parameters and structure or density of subchondral bone could be demonstrated. To conclude, arthroscopic ultrasound imaging had a significant effect on clinical grading of cartilage, and it was found to provide quantitative information on cartilage. The lack of correlation between the ultrasound parameters and bone properties may be related to lesser bone change or excessive attenuation in overlying cartilage and insufficient power of the applied miniature transducer. PMID:25023111

  14. Sacral Emphysematous Osteomyelitis Caused by Escherichia coli after Arthroscopy of the Knee.

    PubMed

    Velickovic, Mirko; Hockertz, Thomas

    2016-01-01

    Emphysematous osteomyelitis is a rare but serious condition which is often associated with a fatal outcome. The typical appearances of emphysematous osteomyelitis are clusters of small gas bubbles within the medullary cavity. We report a case of a 62-year-old male who presented with emphysematous osteomyelitis due to hematogenous spread of Escherichia coli from the knee after arthroscopy. PMID:27651965

  15. Ultrasound arthroscopy of human knee cartilage and subchondral bone in vivo.

    PubMed

    Liukkonen, Jukka; Lehenkari, Petri; Hirvasniemi, Jukka; Joukainen, Antti; Virén, Tuomas; Saarakkala, Simo; Nieminen, Miika T; Jurvelin, Jukka S; Töyräs, Juha

    2014-09-01

    Arthroscopic ultrasound imaging enables quantitative evaluation of articular cartilage. However, the potential of this technique for evaluation of subchondral bone has not been investigated in vivo. In this study, we address this issue in clinical arthroscopy of the human knee (n = 11) by determining quantitative ultrasound (9 MHz) reflection and backscattering parameters for cartilage and subchondral bone. Furthermore, in each knee, seven anatomical sites were graded using the International Cartilage Repair Society (ICRS) system based on (i) conventional arthroscopy and (ii) ultrasound images acquired in arthroscopy with a miniature transducer. Ultrasound enabled visualization of articular cartilage and subchondral bone. ICRS grades based on ultrasound images were higher (p < 0.05) than those based on conventional arthroscopy. The higher ultrasound-based ICRS grades were expected as ultrasound reveals additional information on, for example, the relative depth of the lesion. In line with previous literature, ultrasound reflection and scattering in cartilage varied significantly (p < 0.05) along the ICRS scale. However, no significant correlation between ultrasound parameters and structure or density of subchondral bone could be demonstrated. To conclude, arthroscopic ultrasound imaging had a significant effect on clinical grading of cartilage, and it was found to provide quantitative information on cartilage. The lack of correlation between the ultrasound parameters and bone properties may be related to lesser bone change or excessive attenuation in overlying cartilage and insufficient power of the applied miniature transducer.

  16. Sacral Emphysematous Osteomyelitis Caused by Escherichia coli after Arthroscopy of the Knee

    PubMed Central

    Hockertz, Thomas

    2016-01-01

    Emphysematous osteomyelitis is a rare but serious condition which is often associated with a fatal outcome. The typical appearances of emphysematous osteomyelitis are clusters of small gas bubbles within the medullary cavity. We report a case of a 62-year-old male who presented with emphysematous osteomyelitis due to hematogenous spread of Escherichia coli from the knee after arthroscopy. PMID:27651965

  17. Editorial Commentary: Shoulder Arthroscopy With Epinephrine Diluted Saline-Irrigation Fluid.

    PubMed

    Moezzi, Darius

    2016-03-01

    The addition of epinephrine to irrigation fluid aims to improve visual clarity during shoulder arthroscopy. A potential benefit is shorter operative time. Intra-articular procedures received the greatest benefit, although bleeding within the subacromial space is typically more problematic for shoulder arthroscopists. PMID:26945950

  18. Survivorship of Primary Hip Arthroscopy in New York State - A Population-Based Study

    PubMed Central

    Nawabi, Danyal H.; Degen, Ryan; Pan, Ting; Ranawat, Anil S.; Kelly, Bryan T.; Lyman, Stephen

    2016-01-01

    Objectives: Hip arthroscopy utilization has significantly increased over the past decade, with annual rates increasing as much as 300-600% in that time period. While large sample data demonstrates significant improvement in clinical outcomes out to two years post-operatively, with low rates of associated post-operative complications, there is little information on the long-term survival of primary hip arthroscopy procedures. The purpose of this study is to report on the rates of revision hip arthroscopy and conversion to resurfacing or total hip arthroplasty (THA) following hip arthroscopy in the State of New York. We will also report on prognostic variables that may contribute to the need for repeat surgery. Methods: The Statewide Planning and Research Cooperative System (SPARCS) database, a census of all hospital admissions and ambulatory surgery in New York State, was used to identify cases of outpatient primary hip arthroscopy. Demographic information was collected for these patients. After case identification, unique identifiers were utilized to identify those patients that underwent revision hip arthroscopy or subsequent ipsilateral hip resurfacing or THA. The risks of each of these outcomes were modeled with use of age, sex, socio-economic status, hospital and surgeon volume as potential risk factors. Patients were also tracked for 30-day and 90-day complications requiring re-admission. Results: We identified 8,267 hip arthroscopy cases from 1998-2012 performed by 295 surgeons in 137 different surgical centers. Demographics revealed that 46.1% of patients were male, with 80.2% carrying private insurance. Annual hip arthroscopy rates increased 88-fold over the observation period, with a 750% increase over the last 10 years. Revision surgery (scope or arthroplasty) was required in 1,087 cases (13.1%) at a mean of 622 ± 603 days. More specifically, revision hip arthroscopy was required in 310 cases (3.8%) at a mean of 649 ± 586 days after the index procedure

  19. Individual differences in distractibility: An update and a model

    PubMed Central

    Sörqvist, Patrik; Rönnberg, Jerker

    2014-01-01

    This paper reviews the current literature on individual differences in susceptibility to the effects of background sound on visual-verbal task performance. A large body of evidence suggests that individual differences in working memory capacity (WMC) underpin individual differences in susceptibility to auditory distraction in most tasks and contexts. Specifically, high WMC is associated with a more steadfast locus of attention (thus overruling the call for attention that background noise may evoke) and a more constrained auditory-sensory gating (i.e., less processing of the background sound). The relation between WMC and distractibility is a general framework that may also explain distractibility differences between populations that differ along variables that covary with WMC (such as age, developmental disorders, and personality traits). A neurocognitive task-engagement/distraction trade-off (TEDTOFF) model that summarizes current knowledge is outlined and directions for future research are proposed. PMID:25632345

  20. Position versus force control: using the 2-DOF robotic ankle trainer to assess ankle's motor control.

    PubMed

    Farjadian, Amir B; Nabian, Mohsen; Hartman, Amber; Corsino, Johnathan; Mavroidis, Constantinos; Holden, Maureen K

    2014-01-01

    An estimated of 2,000,000 acute ankle sprains occur annually in the United States. Furthermore, ankle disabilities are caused by neurological impairments such as traumatic brain injury, cerebral palsy and stroke. The virtually interfaced robotic ankle and balance trainer (vi-RABT) was introduced as a cost-effective platform-based rehabilitation robot to improve overall ankle/balance strength, mobility and control. The system is equipped with 2 degrees of freedom (2-DOF) controlled actuation along with complete means of angle and torque measurement mechanisms. Vi-RABT was used to assess ankle strength, flexibility and motor control in healthy human subjects, while playing interactive virtual reality games on the screen. The results suggest that in the task with 2-DOF, subjects have better control over ankle's position vs. force.

  1. Conversion of ankle autofusion to total ankle replacement using the Salto XT revision prosthesis.

    PubMed

    Williamson, Emilie R C; Demetracopoulos, Constantine A; Ellis, Scott J

    2016-09-01

    Few reports in the literature have described the conversion of a surgically fused ankle to a total ankle replacement. The takedown of an autofusion and conversion to a prosthesis has not been described. We report the case of a patient with severe rheumatoid arthritis with an ankle autofusion fixed in equinus and severe talonavicular arthritis that was converted to ankle replacement using the Salto XT revision system. We describe the reasons why the decision was made to perform total ankle arthroplasty while concomitantly fusing the talonavicular joint, and discuss the rationale of the various surgical treatment options considered. We describe the clinical and radiographic outcomes achieved in this case. At 12 months post-operatively the patient reported significant reduction of pain, increased FAOS scores and had increased ankle range of motion.

  2. Risk factors for the need of hip arthroscopy following periacetabular osteotomy

    PubMed Central

    Hartig-Andreasen, Charlotte; Troelsen, Anders; Thillemann, Theis M.; Gelineck, John; Søballe, Kjeld

    2015-01-01

    Despite the frequency of labral tears in symptomatic developmental dysplasia of the hip, no consensus exists regarding the treatment of coexisting dysplasia of the hip and tearing of the acetabular labrum. The purpose of this prospective, MR arthrography (MRA) based 2-year follow-up study was to identify risk factors predicting the need for a hip arthroscopy (HA) after periacetabular osteotomy (PAO). Ninety-nine patients (104 hips) scheduled for PAO were evaluated preoperatively and at 2-year follow-up. MRA was performed in all patients prior to PAO. At follow-up, patients were divided into a non-arthroscopy and arthroscopy group. The two groups were compared clinical and radiological, and risk factors for HA after PAO were calculated. Patient reported outcome measures (WOMAC, Oxford Hip and SF36) were filled out before PAO and at follow-up. Ninety-five hips (91.3%) were evaluated. Twenty-six hips (27%) required an arthroscopy within 2 years of the PAO. Risk factors were preoperative borderline dysplasia, acetabular retroversion and complete labral detachment. Labral tearing, degeneration or hypertrophy did not negatively affect the outcome of PAO. Patients not requiring an arthroscopy had a statistically significant better outcome measured by patients reported outcome measures. After PAO, 27% of the hips needed intra-articular assessment. Conventional radiographs and MRA analysis can be used to identify predictors for patients requiring HA after PAO. At 2-year follow-up, the clinical outcome improved in all patients. However, those patients who had no need of a HA after their PAO had superior results. PMID:27011862

  3. Risk of nerve injury during arthroscopy portal placement in the elbow joint: A cadaveric study

    PubMed Central

    Chaware, Prashant N; Santoshi, John A; Pakhare, Abhijit P; Rathinam, Bertha A D

    2016-01-01

    Background: Elbow arthroscopy has become a routine procedure now. However, placing portals is fraught with dangers of injuring the neurovascular structures around elbow. There are not enough data documenting the same amongst the Indians. We aimed to determine the relative distances of nerves around the elbow to the arthroscopy portals and risk of injury in different positions of the elbow. Materials and Methods: Six standard elbow arthroscopy portals were established in 12 cadaveric upper limbs after joint distension. Then using standard dissection techniques all the nerves around the elbow were exposed, and their distances from relevant portals were measured using digital vernier caliper in 90° elbow flexion and 0° extension. Descriptive statistical analysis was used for describing distance of the nerves from relevant portal. Wilcoxon-signed rank test and Friedman's test were used for comparison. Results: There was no major nerve injury at all the portals studied in both positions of the elbow. The total incidence of cutaneous nerve injury was 8.3% (12/144); medial cutaneous nerve of forearm 10/48 and posterior cutaneous nerve of forearm 2/24. No significant changes were observed in the distance of a nerve to an individual portal at 90° flexion or 0° extension position of the elbow. Conclusion: This study demonstrates the risk of injury to different nerves at the standard portals of elbow arthroscopy. In practice, the actual incidence of nerve injury may still be lower. We conclude that elbow arthroscopy is a safe procedure when all precautions as described are duly followed. PMID:26952128

  4. Needle arthroscopy of the knee with synovial biopsy sampling: technical experience in 150 patients.

    PubMed

    Baeten, D; Van den Bosch, F; Elewaut, D; Stuer, A; Veys, E M; De Keyser, F

    1999-01-01

    Needle arthroscopy is an office-based technique allowing direct visualisation of the knee cavity and selective sampling of the synovial membrane. We performed needle arthroscopy in 150 patients with synovitis of the knee (1) to evaluate the diagnostic potential in early arthritis, (2) to perform therapeutic lavage in persistent inflammatory synovitis and (3) to assess the balance between technical feasibility, safety and patient comfort on the one hand, and the relevance of the obtained macro- and microscopic information for diagnosis and research purposes on the other. After disinfection of the leg and local anaesthesia of the skin and joint, a 1.8-2.7 mm needle arthroscope was introduced into the knee. Synovial fluid was aspirated and lavage of the joint cavity was performed to allow macroscopic evaluation of hyperaemia and hypertrophy of the synovial membrane. Biopsies were taken at inflamed sites, followed by another lavage to remove blood and debris. Needle arthroscopy of the knee is a simple and easy to perform technique made particularly attractive by the local anaesthesia and the ambulatory setting. It allows good macroscopic evaluation of synovial inflammation and selective sampling of the synovial membrane. Biopsies are suitable for RNA and DNA extraction, bacterial or lymphocyte culture, and cell isolation. Because samples were sometimes too small for representative histology, we switched from a 1.8 mm to a 2.7 mm biopsy forceps with good results. In nearly all cases the arthroscopy was well tolerated. Moreover, some patients reported relief of symptoms and even improvement of mobility after lavage of the inflamed joint. No major complications were noted. It was concluded that needle arthroscopy of the knee is a simple, safe and well-tolerated technique, with promising perspectives as a diagnostic, scientific and possibly therapeutic tool in rheumatic diseases. PMID:10638766

  5. Identifying cognitive distraction using steering wheel reversal rates.

    PubMed

    Kountouriotis, Georgios K; Spyridakos, Panagiotis; Carsten, Oliver M J; Merat, Natasha

    2016-11-01

    The influence of driver distraction on driving performance is not yet well understood, but it can have detrimental effects on road safety. In this study, we examined the effects of visual and non-visual distractions during driving, using a high-fidelity driving simulator. The visual task was presented either at an offset angle on an in-vehicle screen, or on the back of a moving lead vehicle. Similar to results from previous studies in this area, non-visual (cognitive) distraction resulted in improved lane keeping performance and increased gaze concentration towards the centre of the road, compared to baseline driving, and further examination of the steering control metrics indicated an increase in steering wheel reversal rates, steering wheel acceleration, and steering entropy. We show, for the first time, that when the visual task is presented centrally, drivers' lane deviation reduces (similar to non-visual distraction), whilst measures of steering control, overall, indicated more steering activity, compared to baseline. When using a visual task that required the diversion of gaze to an in-vehicle display, but without a manual element, lane keeping performance was similar to baseline driving. Steering wheel reversal rates were found to adequately tease apart the effects of non-visual distraction (increase of 0.5° reversals) and visual distraction with offset gaze direction (increase of 2.5° reversals). These findings are discussed in terms of steering control during different types of in-vehicle distraction, and the possible role of manual interference by distracting secondary tasks.

  6. Foot and Ankle Injuries in Runners.

    PubMed

    Tenforde, Adam S; Yin, Amy; Hunt, Kenneth J

    2016-02-01

    Foot and ankle injuries account for nearly one-third of running injuries. Achilles tendinopathy, plantar fasciopathy, and ankle sprains are 3 of the most common types of injuries sustained during training. Other common injuries include other tendinopathies of the foot and ankle, bone stress injuries, nerve conditions including neuromas, and joint disease including osteoarthritis. This review provides an evidence-based framework for the evaluation and optimal management of these conditions to ensure safe return to running participation and reduce risk for future injury. PMID:26616180

  7. Distractibility in dieters and nondieters: an alternative view of "externality".

    PubMed

    Herman, C P; Polivy, J; Pliner, P; Threlkeld, J; Munic, D

    1978-05-01

    Two experiments were performed in an investigation of the effects of distraction and emotional arousal on the proofreading performance of dieting female subjects. In Experiment 1, it was found that distraction initially impaired the performance of dieters and facilitated the performance of nondieters, a pattern previously shown by Rodin to apply to obese and normal weight subjects, respectively, and interpreted as evidence of greater externality in the obese. Subsequent retesting of the same subjects in succeeding months, however, revealed a complete reversal of the original results. In Experiment 2, the reaction to distraction found in the first phase of Experiment 1 was obtained when subjects were in a situation of minimal threat. In a situation of high threat, the relative distractibility of dieters was reversed, as in the latter phases of Experiment 1. An explanation is offered for these data in terms of the greater emotionality of dieters, the susceptibility of cognitive performance to arousal (distraction, anxiety) manipulations, and the potentially competing effects of distraction and anxiety. Implications for the prevailing "trait" view of externality (stimulus binding) are discussed.

  8. An isogenic model of murine mandibular distraction osteogenesis.

    PubMed

    Deshpande, Sagar S; Weiss, Daniela M; Donneys, Alexis; Gallagher, Katherine K; Tchanque-Fossuo, Catherine N; Sarhaddi, Deniz; Buchman, Steven R

    2013-03-01

    The advent of stem cell-based therapies makes current models of mandibular distraction osteogenesis unwieldy. We thereby designed an isogenic model of distraction osteogenesis whose purpose was to allow for the free transfer of cells and components between rats. As immune response plays a significant role in healing and prevention of infection, an immune-competent mode is desirable rather than an athymic rat/xenograft model. The purposes of this study were as follows: (1) to replicate established models of distraction osteogenesis in a rodent model using an isogenic rat strain, and (2) to characterize the differences between inbred, isogenic rats and outbred rats in mandibular distraction osteogenesis via radiomorphometry and biomechanical response analysis. We demonstrated successful distraction osteogenesis to 5.1 mm in all Lewis (isogenic) rat mandibles as well as all Sprague-Dawley (outbred) rat mandibles, with no significant difference in volume-normalized radiomorphometrics, trending difference in non-volume-normalized radiomorphometrics and significant differences in biomechanical response parameters. We attribute the differences demonstrated to the decreased size of the Lewis rat mandible in comparison to Sprague-Dawley mandibles. We also provide information with caring with the additional needs of the Lewis rat. Given these differences, we find that Lewis rats function as an excellent model for isogenic mandibular distraction osteogenesis, but data procured may not be comparable between isogenic and nonisogenic models.

  9. How to avoid complications of distraction osteogenesis for first brachymetatarsia

    PubMed Central

    Yang, Hyun-Kee; Chung, Jae-Yoon; Moon, Eun-Sun; Jung, Sung-Taek

    2009-01-01

    Background and purpose Distraction osteogenesis may be used for the treatment of brachymetatarsia. However, few reports have been published on first metatarsal lengthening by this method. We evaluated the complications of distraction osteogenesis for first brachymetatarsia and here we provide a solution. Patients and methods 16 patients (27 feet) underwent distraction osteogenesis for first brachymetatarsia. Mean age at time of surgery was 20 (12–34) years and mean duration of postoperative follow-up was 5 (2–13) years. A unilateral external fixator was fixed at the medial aspect of the metatarsus. The distraction axis was parallel to the plantar surface of the foot in the sagittal plane and to the second metatarsal axis in the transversal plane. Results First metatarsal length expressed as a proportion of second metatarsal length was 60% (55–64). Average degree of metatarsal lengthening was 42% (34–54), and the average lengthening index was 64 (39–93) days/cm. The most common complication was stiffness of the metatarsophalangeal joint (12 feet). Deformities that included cavus foot and hallux valgus occurred in 3 feet each, and callus fractures occurred in 3 feet. The other complications were pin breakage and pin tract infection in 2 feet each. Interpretation Distraction osteogenesis for first brachymetatarsia can give satisfactory cosmetic and functional results. However, several complications are commonly encountered. This report on complications and their solutions may help those attempting distraction osteogenesis for first brachymetatarsia. PMID:19404807

  10. The neural bases of distracter-resistant working memory

    PubMed Central

    Wager, Tor D.; Spicer, Julie; Insler, Rachel; Smith, Edward E.

    2014-01-01

    A major difference between humans and other animals is our capacity to maintain information in working memory (WM) while performing secondary tasks, which enables sustained, complex cognition. A common assumption is that the lateral prefrontal cortex (PFC) is critical for WM performance in the presence of distracters, but direct evidence is scarce. We assessed the relationship between fMRI activity and WM performance within-subjects, with performance matched across Distracter and No-distracter conditions. Activity in ventrolateral PFC during WM encoding and maintenance positively predicted performance in both conditions, whereas activity in the pre-supplementary motor area (pre-SMA) predicted performance only under distraction. Other parts of dorsolateral and ventrolateral PFC predicted performance only in the No-distracter condition. These findings challenge a lateral PFC-centered view of distracter-resistance, and suggest that the lateral PFC supports a type of WM representation that is efficient for dealing with task-irrelevant input but is nonetheless easily disrupted by dual-task demands. PMID:24366656

  11. Initial Experience With a New Intraoral Midface Distraction Device

    PubMed Central

    Burstein, Fernando; Soldanska, Magdalena; Granger, Michael; Berhane, ChiChi; Schoemann, Mark

    2015-01-01

    Abstract Maxillary hypoplasia that necessitates surgical advancement affects approximately 25% of patients born with cleft lip and palate. Syndromic conditions such as Crouzon may also be accompanied by significant maxillary hypoplasia. Severe maxillary hypoplasia can result in airway obstruction, malocclusion, proptosis, and facial disfigurement. For optimal stability, severe hypoplasia is best addressed with maxillary distraction osteogenesis. Twenty-two patients (15 boys, 7 girls, ages 6–16 years, mean age 10 years) with severe midface hypoplasia underwent midface distraction with new internal maxillary distraction (IMD) device at our institution. Total distraction distances ranged from 15 to 30 mm. There were no major complications, and all of them had improvement in functional and aesthetic parameters. There were 2 minor complications and 2 patients failed to distract the full distance because of converging vectors. Early maxillary distraction in patients with severe midface hypoplasia is a useful technique to provide interval correction of severe maxillary hypoplasia before skeletal maturity and definitive orthognathic surgery is contemplated, and it is a good tool to improve occlusion, aesthetics, and self-perception in younger patients. PMID:26080162

  12. [Biomechanics of the ankle joint].

    PubMed

    Zwipp, H

    1989-03-01

    According to Fick, the tree-dimensional patterns of foot motion are best characterized as jawlike movement. Anatomically and biomechanically, this process represents conjoined, synchronous motion within the three mobile segments of the hindfoot: the ankle joint, the posterior subtalar joint, and the anterior subtalar joint. Foot kinematics can be described more completely if the anterior subtalar joint is defined not only as the talocalcaneal navicular joint, but as including the calcaneocuboid joint, thus representing the transverse joint of the tarsus, i.e., the Chopart joint. The axes of these three joints can be defined precisely. In some parts they represent a screwlike motion, clockwise or counter-clockwise, around the central ligamentous structures (fibulotibial ligament, talocalcaneal interosseous ligament, bifurcate ligament). The individual anatomy and structure of these ligaments provide variations in the degree and direction of foot motion. A precise knowledge of foot kinematics is important in surgical ligament and joint reconstruction and in selective foot arthrodeses.

  13. Sonographic anatomy of the ankle.

    PubMed

    Precerutti, M; Bonardi, M; Ferrozzi, G; Draghi, F

    2014-06-01

    Ankle sonography is one of the most commonly ordered examinations in the field of osteoarticular imaging, and it requires intimate knowledge of the anatomic structures that make up the joint. For practical purposes, the examination can be divided into four compartments, which are analyzed in this pictorial essay: the anterior compartment, which includes the tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons; the accessory peroneus tertius tendon; and the extensor retinaculum; the medial compartment (tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons; the flexor retinaculum; the medial collateral-or deltoid-ligament, and the neurovascular bundle); the lateral compartment (peroneus longus, peroneus brevis, and peroneus quartus tendons; superior and inferior peroneal retinacula, lateral collateral ligament); and the posterior compartment (Achilles tendon, plantaris tendon, Kagar's triangle, superficial, and deep retrocalcaneal bursae). Scanning techniques are briefly described to ensure optimal visualization of the various anatomic structures.

  14. Sonographic anatomy of the ankle.

    PubMed

    Precerutti, M; Bonardi, M; Ferrozzi, G; Draghi, F

    2014-06-01

    Ankle sonography is one of the most commonly ordered examinations in the field of osteoarticular imaging, and it requires intimate knowledge of the anatomic structures that make up the joint. For practical purposes, the examination can be divided into four compartments, which are analyzed in this pictorial essay: the anterior compartment, which includes the tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons; the accessory peroneus tertius tendon; and the extensor retinaculum; the medial compartment (tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons; the flexor retinaculum; the medial collateral-or deltoid-ligament, and the neurovascular bundle); the lateral compartment (peroneus longus, peroneus brevis, and peroneus quartus tendons; superior and inferior peroneal retinacula, lateral collateral ligament); and the posterior compartment (Achilles tendon, plantaris tendon, Kagar's triangle, superficial, and deep retrocalcaneal bursae). Scanning techniques are briefly described to ensure optimal visualization of the various anatomic structures. PMID:24883130

  15. Lichen simplex chronicus on the ankle (image)

    MedlinePlus

    Lichen simplex chronicus on the ankle: Lichen simplex chronicus is also known as neurodermatitis. A minor itch may encourage scratching which increases the irritation, leading to more scratching. This ...

  16. Sports Injuries to the Foot and Ankle

    MedlinePlus

    ... Field Hockey Football Injuries Golf Injuries Lacrosse Rugby Running Soccer Softball Tennis Volleyball Find an ACFAS Physician ... Foot and Ankle Although golf does not involve running or jumping, injuries can occur to the foot ...

  17. Better Way to Treat Seniors' Ankle Fractures?

    MedlinePlus

    ... quality of life can suffer as they lose mobility," added Willett. He is a professor of orthopedics, ... two groups in terms of pain, ankle motion, mobility or quality of life, the study found. Patients ...

  18. Fibular osteochondroma presenting as chronic ankle sprain.

    PubMed

    Montella, B J; O'Farrell, D A; Furr, W S; Harrelson, J M

    1995-04-01

    A 19-year-old baseball player was referred for assessment of recurrent sprains of the right ankle. This was found to be secondary to a palsy of the common peroneal nerve that was compressed by an osteochondroma of the fibular neck. The lesion was resected from the fibula and the patient made a complete recovery. We present this case as an example of a rare underlying problem in a patient who was initially diagnosed as having a sports-related ankle injury.

  19. Endoscopic Ankle Lateral Ligament Graft Anatomic Reconstruction.

    PubMed

    Michels, Frederick; Cordier, Guillaume; Guillo, Stéphane; Stockmans, Filip

    2016-09-01

    Chronic instability is a common complication of lateral ankle sprains. If nonoperative treatment fails, a surgical repair or reconstruction may be indicated. Today, endoscopic techniques to treat ankle instability are becoming more popular. This article describes an endoscopic technique, using a step-by-step approach, to reconstruct the ATFL and CFL with a gracilis graft. The endoscopic technique is reproducible and safe with regard to the surrounding anatomic structures. Short and midterm results confirm the benefits of this technique. PMID:27524711

  20. Salvage arthrodesis for failed total ankle arthroplasty

    PubMed Central

    Zürcher, Arthur W

    2010-01-01

    Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease. Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction. Results Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles. Interpretation Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good. PMID:20175648

  1. Ankle flexibility and injury patterns in dancers.

    PubMed

    Wiesler, E R; Hunter, D M; Martin, D F; Curl, W W; Hoen, H

    1996-01-01

    Lower-extremity injuries are common among dancers and cause significant absences from rehearsals and performances. For this study of lower-extremity injuries in 101 ballet and 47 modern dance students, injuries requiring medical attention sustained over 1 academic year were associated with the following data obtained at the beginning of the school year: ankle flexibility, sex, dance discipline, previous injury, body mass index, and years of training. Eighty-three of the 148 students (age range, 12 to 28 years) reported prior lower-limb injuries, the most common being ankle sprains (28% of all dancers). Previous leg injuries correlated significantly with lower dorsiflexion measurements and with more new injuries. Female students had greater ankle and first metatarsophalangeal flexibility. Modern dancers had greater ankle inversion. Ninety-four students sustained 177 injuries during the study, including 75 sprains or strains and 71 cases of tendinitis. Thirty-nine percent (N = 69) were ankle injuries; 18% (N = 33) were knee injuries; 23% (N = 40) were foot injuries; and 20% (N = 35) were either hip or thigh injuries. Sixty-seven percent (N = 78) of the injured students were ballet dancers. Age, years of training, body mass index, sex, and ankle range of motion measurement had no predictive value for injury; previous injury and dance discipline both correlated with increased risk of injury. PMID:8947396

  2. Complex ankle arthrodesis: Review of the literature

    PubMed Central

    Rabinovich, Remy V; Haleem, Amgad M; Rozbruch, S Robert

    2015-01-01

    Complex ankle arthrodesis is defined as an ankle fusion that is at high risk of delayed and nonunion secondary to patient comorbidities and/or local ankle/hindfoot factors. Risk factors that contribute to defining this group of patients can be divided into systemic factors and local factors pertaining to co-existing ankle or hindfoot pathology. Orthopaedic surgeons should be aware of these risk factors and their association with patients’ outcomes after complex ankle fusions. Both external and internal fixations have demonstrated positive outcomes with regards to achieving stable fixation and minimizing infection. Recent innovations in the application of biophysical agents and devices have shown promising results as adjuncts for healing. Both osteoconductive and osteoinductive agents have been effectively utilized as biological adjuncts for bone healing with low complication rates. Devices such as pulsed electromagnetic field bone stimulators, internal direct current stimulators and low-intensity pulsed ultrasound bone stimulators have been associated with faster bone healing and improved outcomes scores when compared with controls. The aim of this review article is to present a comprehensive approach to the management of complex ankle fusions, including the use of biophysical adjuncts for healing and a proposed algorithm for their treatment. PMID:26396936

  3. Total ankle replacement for posttraumatic arthritis

    PubMed Central

    Weme, Rebecca A Nieuwe; van Solinge, Guido; N Doornberg, Job; Sierevelt, Inger; Haverkamp, Daniël; Doets, H Cornelis

    2015-01-01

    Background and purpose Most studies on total ankle replacement (TAR) have used a case mix of patients. We evaluated the outcome of TAR performed for end-stage arthritis either because of fracture or ligamentous injury. Patients and methods We prospectively followed 88 consecutive patients (50 postfracture ankles and 40 ankles with instability arthritis (2 bilateral)) who underwent TAR between 2001 and 2009. Mean follow-up for both groups was 5 years. Results Preoperative varus deformity of 10° or more was present in 23 ankles in the instability group. At 6 years, survival with revision or salvage fusion as an endpoint was 87% (95% CI: 74–99) in the postfracture group and 79% (95% CI: 63–94) in the instability group. Progressive periprosthetic osteolysis was seen in 23 ankles, and required salvage fusion in 6. The number of reoperations was similar in both groups. Clinical outcome, as assessed with 2 ankle scores and 2 questionnaires, showed good results and was similar at the latest follow-up. Interpretation The outcome was similar in the postfracture and instability groups and also similar to that reported in series including a case mix of patients. In contrast to earlier reports, preoperative frontal plane deformity in this series was not identified as a risk factor for failure. PMID:25772269

  4. TOTAL ANKLE REPLACEMENT: WHY, WHEN AND HOW?

    PubMed Central

    Bonasia, Davide Edoardo; Dettoni, Federico; Femino, John E; Phisitkul, Phinit; Germano, Margherita; Amendola, Annunziato

    2010-01-01

    Total ankle replacement (TAR) was first attempted in the 1970s, but poor results led to its being considered inferior to ankle fusion until the late 1980s and early 1990s. By that time, newer designs which more closely replicated the natural anatomy of the ankle, showed improved clinical outcomes.1 Currently, even though controversy still exists about the effectiveness of TAR compared to ankle fusion, TAR has shown promising mid-term results and should no longer be considered an experimental procedure. Factors related to improved TAR outcomes include: 1) better patient selection, 2) more precise knowledge and replication of ankle biomechanics, 3) the introduction of less-constrained designs with reduced bone resection and no need for cementation, and 4) greater awareness of soft-tissue balance and component alignment. When TAR is performed, a thorough knowledge of ankle anatomy, pathologic anatomy and biomechanics is needed along with a careful pre-operative plan. These are fundamental in obtaining durable and predictable outcomes. The aim of this paper is to outline these aspects through a literature review. PMID:21045984

  5. Morphofunctional and clinical study on mandibular alveolar distraction osteogenesis.

    PubMed

    Zaffe, Davide; Bertoldi, Carlo; Palumbo, Carla; Consolo, Ugo

    2002-10-01

    Alveolar Distraction Osteogenesis (ADO) is a process which forms new alveolar bone to correct alveolar deformities in ridge height and width. This work aims (a). to verify the predictability of the augmentation of height of atrophic alveolar ridges using an extra-alveolar distraction device and (b). to study the bone processes in order to optimize implanto-prosthetic rehabilitation. ADO was performed on 10 patients with ridge deformities to obtain the required ridge augmentation. Clinical and radiological (OPT and CT with densitometric assay) evaluations were carried out during the following 12 weeks, before implant insertion. Biopsies at 40, 60 and 88 days were studied after general, specific and histochemical staining of slides; microradiographs were analyzed to evaluate the Trabecular Bone Volume. Forty days after the end of distraction, soft callus indicated the start of ossification. Sixty days after the end of distraction, the soft callus was largely converted into a network of trabecular woven bone; osteogenic activity was high and TBV was about 50%. Eighty-eight days after the end of distraction, the amount of bone appeared reduced, with a more ordered structure; bone formation activity and TBV also diminished, whereas osteoclast erosion was active. The densitometric assay shows values increasing from the end of distraction, particularly after implant insertion. Histological results show a regression in bone deposition processes 88 days after the end of distraction culminating in a virtual steady-state after a certain time. The results suggest that early implant insertion may be desirable to avoid bone loss due to mechanical unloading.

  6. Impact of distracted driving on safety and traffic flow.

    PubMed

    Stavrinos, Despina; Jones, Jennifer L; Garner, Annie A; Griffin, Russell; Franklin, Crystal A; Ball, David; Welburn, Sharon C; Ball, Karlene K; Sisiopiku, Virginia P; Fine, Philip R

    2013-12-01

    Studies have documented a link between distracted driving and diminished safety; however, an association between distracted driving and traffic congestion has not been investigated in depth. The present study examined the behavior of teens and young adults operating a driving simulator while engaged in various distractions (i.e., cell phone, texting, and undistracted) and driving conditions (i.e., free flow, stable flow, and oversaturation). Seventy five participants 16-25 years of age (split into 2 groups: novice drivers and young adults) drove a STISIM simulator three times, each time with one of three randomly presented distractions. Each drive was designed to represent daytime scenery on a 4 lane divided roadway and included three equal roadway portions representing Levels of Service (LOS) A, C, and E as defined in the 2000 Highway Capacity Manual. Participants also completed questionnaires documenting demographics and driving history. Both safety and traffic flow related driving outcomes were considered. A Repeated Measures Multivariate Analysis of Variance was employed to analyze continuous outcome variables and a Generalized Estimate Equation (GEE) Poisson model was used to analyze count variables. Results revealed that, in general more lane deviations and crashes occurred during texting. Distraction (in most cases, text messaging) had a significantly negative impact on traffic flow, such that participants exhibited greater fluctuation in speed, changed lanes significantly fewer times, and took longer to complete the scenario. In turn, more simulated vehicles passed the participant drivers while they were texting or talking on a cell phone than while undistracted. The results indicate that distracted driving, particularly texting, may lead to reduced safety and traffic flow, thus having a negative impact on traffic operations. No significant differences were detected between age groups, suggesting that all drivers, regardless of age, may drive in a manner

  7. Effect of treadmill walking with ankle stretching orthosis on ankle flexibility and gait

    PubMed Central

    Cho, Young-ki; Kim, Si-hyun; Jeon, In-cheol; Ahn, Sun-hee; Kwon, Oh-yun

    2015-01-01

    [Purpose] The purpose of this study was to evaluate the kinematics of the ankle in the lunge to estabilish effectiveness of an ankle stretching orthosis (ASO) on the ankle dorsiflexion range of motion (ROM) of individuals with limited dorsiflexion ROM. [Subjects and Methods] Forty ankles with decreased dorsiflexion ROM of 20 participants were evaluated in this study. After wearing the ASO, participants walked on a treadmill for 15 minutes. Participants walked on the treadmill at a self-selected comfortable speed. Ankle dorsiflexion ROM, maximum dorsiflexion ROM before heel-off, and time to heel-off during the stance phase of gait were measured before and after 15 minutes of treadmill walking with the ASO. The differences in all variables between before and after treadmill walking with ASO were analyzed using the paired t-test. [Results] Ankle active and passive ROM, and dorsiflexion ROM during lunge increased significantly after treadmill walking with ASO. Treadmill walking with the ASO significantly increased the angle of maximal dorsiflexion before heel-off and time to heel-off during the stance phase. [Conclusion] The results of this study show that treadmill walking with the ASO effectively improved ankle flexibility and restored the normal gait pattern of the ankle joint by increasing dorsiflexion ROM, maximal angle of dorsiflexion, and time to heel-off in the stance phase. PMID:25995601

  8. Arthroscopic Management of Complications Following Total Ankle Replacement.

    PubMed

    Lui, Tun Hing; Roukis, Thomas S

    2015-10-01

    There is great potential of managing the complications of total ankle replacement arthroscopically and endoscopically, and these procedures can be summarized into 3 groups. Group 1 includes procedures of the ankle joint proper with close proximity to the articular components of the total ankle replacement. Group 2 includes procedures of the tibia and talus with close proximity to the nonarticular parts of the total ankle replacement. Group 3 includes procedures that are away from the total ankle replacement. However, these remain master arthroscopist procedures and should be performed by foot and ankle surgeons who perform them with regularity.

  9. The Effects of Interactive and Passive Distraction on Cold Pressor Pain in Preschool-aged Children

    PubMed Central

    Dahlquist, Lynnda M.; Wohlheiter, Karen

    2011-01-01

    Objective Using a mixed model design, this study examined the effects of interactive versus passive distraction on healthy preschool-aged children’s cold pressor pain tolerance. Methods Sixty-one children aged 3–5 years were randomly assigned to one of the following: interactive distraction, passive distraction, or no distraction control. Participants underwent a baseline cold pressor trial followed by interactive distraction trial, passive distraction trial, or second baseline trial. One or two additional trials followed. Children originally assigned to distraction received the alternate distraction intervention. Controls participated in both interactive and passive distraction trials in counterbalanced order. Results Participants showed significantly higher pain tolerance during both interactive and passive distraction relative to baseline. The two distraction conditions did not differ. Conclusions Interactive and passive video game distraction appear to be effective for preschool-aged children during laboratory pain exposure. Future studies should examine whether more extensive training would enhance effects of interactive video game distraction. PMID:21278378

  10. Miniature osmotic actuators for controlled maxillofacial distraction osteogenesis

    NASA Astrophysics Data System (ADS)

    Li, Yu-Hsien; Su, Yu-Chuan

    2010-06-01

    We have successfully demonstrated miniature actuators that are capable of converting chemical potential directly into steady mechanical movements for maxillofacial distraction osteogenesis. Pistons and diaphragms powered by osmosis are employed to provide the desired linear and volumetric displacements for bone distraction and potentially the release of bone morphogenetic proteins, respectively. The cylindrical-shaped miniature actuators are composed of polymeric materials and fabricated by molding and assembly processes. In the prototype demonstration, vapor-permeable thermoplastic polyurethane was employed as the semi-permeable material. 3 cm long actuators with piston and diaphragm radii of 1 mm and 500 µm, respectively, were fabricated and characterized. The maximum distraction force from the piston-type actuator is found to be 6 N while the piston travels at a constant velocity of 32 µm h-1 (or 0.77 mm/day) for about 1 week. Meanwhile, the release rate from the diaphragm-type actuator is measured to be constant, 0.15 µl h-1 (or 3.6 µl/day), throughout the experiment. Moreover, the sizes and output characteristics of the self-regulating actuators could readily be tailored to realize optimal distraction rate, rhythm and osteogenic activity. As such, the demonstrated miniature osmotic actuators could potentially serve as versatile apparatuses for maxillofacial distraction osteogenesis and fulfill the needs of a variety of implantable and biomedical applications.

  11. Treatment of brachymetatarsia by the callus distraction method.

    PubMed

    Fox, I M

    1998-01-01

    Brachymetatarsia is not an uncommon congenital foot disorder that is due to a premature closure of the ephiphyseal plate. The literature has numerous surgical procedures for the correction of this problem. In recent years, the callus distraction technique described by ilizarov has been utilized for this problem. This is a retrospective study of the use of the callus distraction technique for the correction of congenitally short metatarsal. This series included six feet in six female patients, all with a short fourth metatarsal. Preoperative complaints were metatarsalgia and/or cosmesis. A noncircular, uniplanar axial fixation device was utilized for fixation and distraction. The fixator was put in place prior to the metatarsal osteotomy. Static fixation was for a period of 5-7 days before distraction was begun. The metatarsal was lengthened 0.5 mm two times a day, or 1 mm per day. The time to end point ranged from 45 to 70 days, followed by another 6-8 weeks of static immobilization. The preoperative metatarsal length ranged from 3.5 to 4.2 cm. The end stage metatarsal length ranged from 4.7 to 6.3 cm, with an average increase in length of 1.68 cm. As compared to other techniques described in the medical literature, the callus distraction technique has its own unique set of advantages and disadvantages. PMID:9798170

  12. Alveolar ridge augmentation using distraction osteogenesis: a clinical trial

    PubMed Central

    Shukla, Anand; Singh, Saumyendra V; Kumar, Sumit; Mehrotra, Divya; Mohammad, S; Singh, Stuti

    2012-01-01

    Background Severely resorbed ridges present a great challenge to prosthodontic rehabilitation. Available reconstructive options include autologous/alloplastic augmentation with questionable results, or regeneration of new bone under gradual and controlled tension using distraction osteogenesis. This study focused on use of distraction osteogenesis for the treatment of vertically deficient alveolar ridges to assess its feasibility and outcome. Materials and Methods Alveolar distraction osteogenesis (ADO) was studied at 10 different intra-oral, partial or complete edentulous sites. After a latency period of 5 days, distraction was carried out for 6–7 days at the rate of 0.5 mm every 12 hours (1 mm/day). Distractor was removed after a consolidation period of 12 weeks. Results The mean height gained at the 10 intra-oral sites was 4.8 mm with standard deviation of ± 0.056. The mean follow-up period was 2 years. Complications of therapy included hardware failure, wound gape and extra-oral scar. The overall complication rate was 10%. Conclusion Distraction osteogenesis is a promising option to aid uneventful prosthodontic rehabilitation of severe vertically resorbed alveolar ridges. PMID:25756028

  13. Evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee.

    PubMed

    Dearing, Jonathan; Nutton, Richard W

    2008-06-01

    Arthroscopy continues to be widely used in the management of knee osteoarthritis despite concerns regarding its effectiveness. The Scottish Arthroplasty Project has demonstrated a three-fold variation in rates of arthroscopy for osteoarthritis of the knee across different regions of Scotland. This has clear ramifications for the utilisation of finite health care resources. In light of such variations in national clinical practice this review identifies the evidence based factors which permit identification of patients who will obtain sustained benefit from arthroscopic treatment of knee osteoarthritis. Such a patient should have symptoms of short duration affecting the medial compartment of the knee, have localised tenderness at the medial joint line, mechanical symptoms and positive findings on meniscal stress testing. There should be neither significant mechanical malalignment nor flexion contracture, there should be preservation of the joint space on radiographs and the patient should not be obese. If these criteria are fulfilled the likelihood for long lasting reduction in symptoms is increased. PMID:18378147

  14. Dry arthroscopy with a retraction system for matrix-aided cartilage repair of patellar lesions.

    PubMed

    Sadlik, Boguslaw; Wiewiorski, Martin

    2014-02-01

    Several commercially available cartilage repair techniques use a natural or synthetic matrix to aid cartilage regeneration (e.g., autologous matrix-induced chondrogenesis or matrix-induced cartilage implantation). However, the use of matrix-aided techniques during conventional knee joint arthroscopy under continuous irrigation is challenging. Insertion and fixation of the matrix can be complicated by the presence of fluid and the confined patellofemoral joint space with limited access to the lesion. To overcome these issues, we developed a novel arthroscopic approach for matrix-aided cartilage repair of patellar lesions. This technical note describes the use of dry arthroscopy assisted by a minimally invasive retraction system. An autologous matrix-induced chondrogenesis procedure is used to illustrate this novel approach.

  15. Cartilage Status at Time of Arthroscopy Predicts Failure in Patients With Hip Dysplasia.

    PubMed

    Dwyer, Maureen K; Lee, Jo-Ann; McCarthy, Joseph C

    2015-09-01

    The purpose of our study was to determine whether chondral damage at the time of arthroscopy predicted conversion to THA in patients with dysplasia. We identified 166 patients with dysplasia who underwent hip arthroscopy. Forty-seven went on to receive THA. The articular cartilage of three regions of the acetabulum and femoral head were assessed for signs of chondral damage (absent, mild, or severe]). A stepwise multivariable logistic regression analysis revealed mild damage on the posterior femoral head (P=0.001) and severe damage on the anterior acetabulum (P=0.007) made a significant contribution to the predictor. The presence of mild posterior femoral head chondral changes was indicative of more global cartilage damage in this series of patients. Our findings show that chondral damage on the posterior femoral head and anterior acetabulum is a strong predictor of ultimate conversion to THA in dysplastic patients. PMID:26059500

  16. Arthroscopy of the shoulder joint--a cadaver and clinical study. Part 2: Clinical study.

    PubMed

    Rojvanit, V

    1984-10-01

    Shoulder arthroscopy was carried out 56 times on 50 patients. Different types of arthroscopes were employed. Anterior and posterior approaches were used. Diagnoses were 21 cases of glenohumeral instability including 17 of recurrent anterior dislocation and subluxation; 2 of voluntary anterior subluxation and 2 of habitual posterior dislocation, 13 of rotator cuff tear, 6 of chronic subacromial bursitis, 2 of fracture-dislocation, 2 of frozen shoulder, 2 of baseball shoulder, one of rheumatoid arthritis, and 3 miscellaneous. The arthroscopic findings in the instability group and rotator cuff tear group were verified. Bankart lesion and Hill-Sachs lesion were identified arthroscopically. The indications for shoulder arthroscopy are outlined. There was no significant morbidity with this procedure.

  17. Danish Hip Arthroscopy Registry: an epidemiologic and perioperative description of the first 2000 procedures

    PubMed Central

    Mygind-Klavsen, Bjarne; Grønbech Nielsen, Torsten; Maagaard, Niels; Kraemer, Otto; Hölmich, Per; Winge, Søren; Lund, Bent; Lind, Martin

    2016-01-01

    Danish Hip Arthroscopy Registry (DHAR) was initiated in 2012 as a web-based prospective registry. The purpose of this study was to evaluate and report the epidemiologic and perioperative data of the first 2000 procedures in a Danish hip arthroscopy population and to describe the development of DHAR. We describe the use of various Patient Related Outcome Measures related to non-arthritic hip patients. The 2000 procedures consisted of 56% females and 44% males. Mean age 37.5 years, mean surgical time was 86.5 min and mean traction time 50.5 min. The most frequently performed procedure was CAM and Pincer resection in 93.5% of the cases. Labral refixation or repair was done in 70.3% of the cases. The most common type of acetabular chondral damage was grade II lesions (36.6%). Grade III and IV changes were seen in 36.1% of the cases. The preoperative iHOT12 was 45 (mean) based on all 12 items. EQ-5D was 0.65 and HAGOS sub-scores were 51 (pain), 49 (symptoms), 53 (ADL), 35 (sport), 20 (physical activity) and 29, respectively. We conclude that patients undergoing hip arthroscopy report considerable pain, loss of function, reduced level of activity and reduced quality-of-life prior to surgery. The problems with development and maintaining a large clinical registry are described and further studies are needed to validate data completeness. We consider the development of a national clinical registry for hip arthroscopy as a successful way of developing and maintaining a valuable clinical and scientific tool. PMID:27583150

  18. Horizontal and Vertical Stabilization of Acute Unstable Acromioclavicular Joint Injuries Arthroscopy-Assisted

    PubMed Central

    Cisneros, Luis Natera; Sarasquete Reiriz, Juan; Besalduch, Marina; Petrica, Alexandru; Escolà, Ana; Rodriguez, Joaquim; Fallone, Jan Carlo

    2015-01-01

    We describe the technical aspects of an arthroscopy-assisted procedure indicated for the management of acute unstable acromioclavicular joint injuries, consisting of a synthetic augmentation of both the coracoclavicular and acromioclavicular ligaments, that anatomically reproduces the coracoclavicular biomechanics and offers fixation that keeps the torn ends of the ligaments facing one another, thus allowing healing of the native structures without the need for a second surgical procedure for metal hardware removal. PMID:26870653

  19. Danish Hip Arthroscopy Registry: an epidemiologic and perioperative description of the first 2000 procedures.

    PubMed

    Mygind-Klavsen, Bjarne; Grønbech Nielsen, Torsten; Maagaard, Niels; Kraemer, Otto; Hölmich, Per; Winge, Søren; Lund, Bent; Lind, Martin

    2016-07-01

    Danish Hip Arthroscopy Registry (DHAR) was initiated in 2012 as a web-based prospective registry. The purpose of this study was to evaluate and report the epidemiologic and perioperative data of the first 2000 procedures in a Danish hip arthroscopy population and to describe the development of DHAR. We describe the use of various Patient Related Outcome Measures related to non-arthritic hip patients. The 2000 procedures consisted of 56% females and 44% males. Mean age 37.5 years, mean surgical time was 86.5 min and mean traction time 50.5 min. The most frequently performed procedure was CAM and Pincer resection in 93.5% of the cases. Labral refixation or repair was done in 70.3% of the cases. The most common type of acetabular chondral damage was grade II lesions (36.6%). Grade III and IV changes were seen in 36.1% of the cases. The preoperative iHOT12 was 45 (mean) based on all 12 items. EQ-5D was 0.65 and HAGOS sub-scores were 51 (pain), 49 (symptoms), 53 (ADL), 35 (sport), 20 (physical activity) and 29, respectively. We conclude that patients undergoing hip arthroscopy report considerable pain, loss of function, reduced level of activity and reduced quality-of-life prior to surgery. The problems with development and maintaining a large clinical registry are described and further studies are needed to validate data completeness. We consider the development of a national clinical registry for hip arthroscopy as a successful way of developing and maintaining a valuable clinical and scientific tool. PMID:27583150

  20. Cytokines as a predictor of clinical response following hip arthroscopy: minimum 2-year follow-up.

    PubMed

    Shapiro, Lauren M; Safran, Marc R; Maloney, William J; Goodman, Stuart B; Huddleston, James I; Bellino, Michael J; Scuderi, Gaetano J; Abrams, Geoffrey D

    2016-08-01

    Hip arthroscopy in patients with osteoarthritis has been shown to have suboptimal outcomes. Elevated cytokine concentrations in hip synovial fluid have previously been shown to be associated with cartilage pathology. The purpose of this study was to determine whether a relationship exists between hip synovial fluid cytokine concentration and clinical outcomes at a minimum of 2 years following hip arthroscopy. Seventeen patients without radiographic evidence of osteoarthritis had synovial fluid aspirated at time of portal establishment during hip arthroscopy. Analytes included fibronectin-aggrecan complex as well as a multiplex cytokine array. Patients completed the modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index and the International Hip Outcomes Tool pre-operatively and at a minimum of 2 years following surgery. Pre and post-operative scores were compared with a paired t-test, and the association between cytokine values and clinical outcome scores was performed with Pearson's correlation coefficient with an alpha value of 0.05 set as significant. Sixteen of seventeen patients completed 2-year follow-up questionnaires (94%). There was a significant increase in pre-operative to post-operative score for each clinical outcome measure. No statistically significant correlation was seen between any of the intra-operative cytokine values and either the 2-year follow-up scores or the change from pre-operative to final follow-up outcome values. No statistically significant associations were seen between hip synovial fluid cytokine concentrations and 2-year follow-up clinical outcome assessment scores for those undergoing hip arthroscopy.

  1. Cytokines as a predictor of clinical response following hip arthroscopy: minimum 2-year follow-up

    PubMed Central

    Shapiro, Lauren M.; Safran, Marc R.; Maloney, William J.; Goodman, Stuart B.; Huddleston, James I.; Bellino, Michael J.; Scuderi, Gaetano J.; Abrams, Geoffrey D.

    2016-01-01

    Hip arthroscopy in patients with osteoarthritis has been shown to have suboptimal outcomes. Elevated cytokine concentrations in hip synovial fluid have previously been shown to be associated with cartilage pathology. The purpose of this study was to determine whether a relationship exists between hip synovial fluid cytokine concentration and clinical outcomes at a minimum of 2 years following hip arthroscopy. Seventeen patients without radiographic evidence of osteoarthritis had synovial fluid aspirated at time of portal establishment during hip arthroscopy. Analytes included fibronectin–aggrecan complex as well as a multiplex cytokine array. Patients completed the modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index and the International Hip Outcomes Tool pre-operatively and at a minimum of 2 years following surgery. Pre and post-operative scores were compared with a paired t-test, and the association between cytokine values and clinical outcome scores was performed with Pearson’s correlation coefficient with an alpha value of 0.05 set as significant. Sixteen of seventeen patients completed 2-year follow-up questionnaires (94%). There was a significant increase in pre-operative to post-operative score for each clinical outcome measure. No statistically significant correlation was seen between any of the intra-operative cytokine values and either the 2-year follow-up scores or the change from pre-operative to final follow-up outcome values. No statistically significant associations were seen between hip synovial fluid cytokine concentrations and 2-year follow-up clinical outcome assessment scores for those undergoing hip arthroscopy. PMID:27583163

  2. Cytokines as a predictor of clinical response following hip arthroscopy: minimum 2-year follow-up.

    PubMed

    Shapiro, Lauren M; Safran, Marc R; Maloney, William J; Goodman, Stuart B; Huddleston, James I; Bellino, Michael J; Scuderi, Gaetano J; Abrams, Geoffrey D

    2016-08-01

    Hip arthroscopy in patients with osteoarthritis has been shown to have suboptimal outcomes. Elevated cytokine concentrations in hip synovial fluid have previously been shown to be associated with cartilage pathology. The purpose of this study was to determine whether a relationship exists between hip synovial fluid cytokine concentration and clinical outcomes at a minimum of 2 years following hip arthroscopy. Seventeen patients without radiographic evidence of osteoarthritis had synovial fluid aspirated at time of portal establishment during hip arthroscopy. Analytes included fibronectin-aggrecan complex as well as a multiplex cytokine array. Patients completed the modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index and the International Hip Outcomes Tool pre-operatively and at a minimum of 2 years following surgery. Pre and post-operative scores were compared with a paired t-test, and the association between cytokine values and clinical outcome scores was performed with Pearson's correlation coefficient with an alpha value of 0.05 set as significant. Sixteen of seventeen patients completed 2-year follow-up questionnaires (94%). There was a significant increase in pre-operative to post-operative score for each clinical outcome measure. No statistically significant correlation was seen between any of the intra-operative cytokine values and either the 2-year follow-up scores or the change from pre-operative to final follow-up outcome values. No statistically significant associations were seen between hip synovial fluid cytokine concentrations and 2-year follow-up clinical outcome assessment scores for those undergoing hip arthroscopy. PMID:27583163

  3. Randomized clinical trial of musical distraction with and without headphones for adolescents' immunization pain.

    PubMed

    Kristjánsdóttir, Ólöf; Kristjánsdóttir, Guðrún

    2011-03-01

    Distraction has shown to be a helpful pain intervention for children; however, few investigations have studied the effectiveness of this method with adolescents. The aim of this study was to evaluate the usefulness of an easy and practical musical distraction in reducing adolescents' immunization pain. Furthermore, to examine whether musical distraction techniques (with or without headphones) used influenced the pain outcome. Hundred and eighteen 14-year-old adolescents, scheduled for polio immunization, participated. Adolescents were randomly assigned to one of three research groups; musical distraction with headphones (n=38), musical distraction without headphones (n=41) and standard care control (n=39). Results showed adolescents receiving musical distraction were less likely to report pain compared to the control group, controlling for covariates. Comparing musical distraction techniques, eliminating headphone emerged as a significant predictor of no pain. Results suggest that an easy and practical musical distraction intervention, implemented without headphones, can give some pain relief to adolescents during routine vaccination.

  4. Use of internal callus distraction in the treatment of congenital brachymetatarsia.

    PubMed

    Yamada, Naoto; Yasuda, Yoshihiro; Hashimoto, Nobuko; Iwashiro, Hironobu; Uchinuma, Eiju

    2005-10-01

    Congenital bilateral brachymetatarsia of the fourth metatarsal bone was treated by osteotomy and bone lengthening using the internal distraction technique. The patient was cosmetically improved. This technique has some advantages over the method of external distraction. PMID:16039626

  5. The disruptive - and beneficial - effects of distraction on older adults' cognitive performance.

    PubMed

    Weeks, Jennifer C; Hasher, Lynn

    2014-01-01

    Older adults' decreased ability to inhibit irrelevant information makes them especially susceptible to the negative effects of simultaneously occurring distraction. For example, older adults are more likely than young adults to process distraction presented during a task, which can result in delayed response times, decreased reading comprehension, disrupted problem solving, and reduced memory for target information. However, there is also some evidence that the tendency to process distraction can actually facilitate older adults' performance when the distraction is congruent with the target information. For example, congruent distraction can speed response times, increase reading comprehension, benefit problem solving, and reduce forgetting in older adults. We review data showing that incongruent distraction can harm older adults' performance, as well as evidence suggesting that congruent distraction can play a supportive role for older adults by facilitating processing of target information. Potential applications of distraction processing are also discussed.

  6. A review of intra-articular knee injuries in racquet sports diagnosed by arthroscopy.

    PubMed

    Marans, H J; Kennedy, D K; Kavanagh, T G; Wright, T A

    1988-05-01

    Because of the recent rapid increase in the number of knee injuries related to racquet sports, the authors undertook a retrospective study of such injuries seen over a 5-year period at the Toronto Western Hospital Sports Medicine Institute. The 121 patients who presented over the study period with a racquet-sports-related knee injury requiring arthroscopy represented 30% of all racquet-sports related injuries seen during that period. The mean age at presentation was 32.8 years and two-thirds of the patients were men. All the major racquet sports were represented. In all, 213 lesions (7 bilateral) were seen at 128 arthroscopies, and 165 arthroscopic procedures were performed. The most common lesion was meniscal followed by chondromalacia patellae, anterior cruciate ligament tears, chondral lesions and pathologic plicae. Over 90% of the patients returned to their chosen racquet sport within 3 months of the arthroscopy and most were playing at a similar performance level to that before the initial injury.

  7. Le fort I maxillary advancement using distraction osteogenesis.

    PubMed

    Combs, Patrick D; Harshbarger, Raymond J

    2014-11-01

    Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hypoplasia in cleft, syndromic, and noncleft patients. In this article, the authors provide a review of current data and recommendations concerning Le Fort I advancement with distraction osteogenesis. In addition, they outline their technique for treating severe maxillary hypoplasia with distraction osteogenesis using internal devices.

  8. Driver distraction and driver inattention: definition, relationship and taxonomy.

    PubMed

    Regan, Michael A; Hallett, Charlene; Gordon, Craig P

    2011-09-01

    There is accumulating evidence that driver distraction and driver inattention are leading causes of vehicle crashes and incidents. However, as applied psychological constructs, they have been inconsistently defined and the relationship between them remains unclear. In this paper, driver distraction and driver inattention are defined and a taxonomy is presented in which driver distraction is distinguished from other forms of driver inattention. The taxonomy and the definitions provided are intended (a) to provide a common framework for coding different forms of driver inattention as contributing factors in crashes and incidents, so that comparable estimates of their role as contributing factors can be made across different studies, and (b) to make it possible to more accurately interpret and compare, across studies, the research findings for a given form of driver inattention.

  9. Video surveillance for monitoring driver's fatigue and distraction

    NASA Astrophysics Data System (ADS)

    Jiménez-Moreno, R.; Orjuela, S. A.; Van Hese, P.; Prieto, F. A.; Grisales, V. H.; Philips, W.

    2012-06-01

    Fatigue and distraction effects in drivers represent a great risk for road safety. For both types of driver behavior problems, image analysis of eyes, mouth and head movements gives valuable information. We present in this paper a system for monitoring fatigue and distraction in drivers by evaluating their performance using image processing. We extract visual features related to nod, yawn, eye closure and opening, and mouth movements to detect fatigue as well as to identify diversion of attention from the road. We achieve an average of 98.3% and 98.8% in terms of sensitivity and specificity for detection of driver's fatigue, and 97.3% and 99.2% for detection of driver's distraction when evaluating four video sequences with different drivers.

  10. A new device for microincremental automatic distraction osteogenesis.

    PubMed

    Ayoub, A F; Richardson, W

    2001-10-01

    We have invented a distraction device that can be placed intraorally and provides autodistraction. The device consists of two units: an implantable component that is applied directly on the bone, and an external component that is distant from the surgical site. The external component is mounted on a standard, battery-driven portable syringe driver or infusion pump. A fine flexible non-compressible tube connects the two. The compression of the bellows in the external component causes fluid to be forced through the connecting tube into the distraction component. The combination of the sealed system and incompressible fluid guarantees expansion of the bellows of the distraction component and gradually separates the bone segments. PMID:11601815

  11. Brief report: faces cause less distraction in autism.

    PubMed

    Riby, Deborah M; Brown, Philippa H; Jones, Nicola; Hanley, Mary

    2012-04-01

    Individuals with autism have difficulties interpreting face cues that contribute to deficits of social communication. When faces need to be processed for meaning they fail to capture and hold the attention of individuals with autism. In the current study we illustrate that faces fail to capture attention in a typical manner even when they are non-functional to task completion. In a visual search task with a present butterfly target an irrelevant face distracter significantly slows performance of typical individuals. However, participants with autism (n = 28; mean 10 years 4 months) of comparable non-verbal ability are not distracted by the faces. Interestingly, there is a significant relationship between level of functioning on the autism spectrum and degree of face capture or distraction.

  12. Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

    PubMed Central

    Young, Ki Won; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

    2015-01-01

    Background We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Methods Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. Results The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Conclusions Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were

  13. Unsupported standing with minimized ankle muscle fatigue.

    PubMed

    Mihelj, Matjaz; Munih, Marko

    2004-08-01

    In the past, limited unsupported standing has been restored in patients with thoracic spinal cord injury through open-loop functional electrical stimulation of paralyzed knee extensor muscles and the support of intact arm musculature. Here an optimal control system for paralyzed ankle muscles was designed that enables the subject to stand without hand support in a sagittal plane. The paraplegic subject was conceptualized as an underactuated double inverted pendulum structure with an active degree of freedom in the upper trunk and a passive degree of freedom in the paralyzed ankle joints. Control system design is based on the minimization of a cost function that estimates the effort of ankle joint muscles via observation of the ground reaction force position, relative to ankle joint axis. Furthermore, such a control system integrates voluntary upper trunk activity and artificial control of ankle joint muscles, resulting in a robust standing posture. Figures are shown for the initial simulation study, followed by disturbance tests on an intact volunteer and several laboratory trials with a paraplegic person. Benefits of the presented methodology are prolonged standing sessions and in the fact that the subject is able to maintain voluntary control over upper body orientation in space, enabling simple functional standing. PMID:15311817

  14. Unsupported standing with minimized ankle muscle fatigue.

    PubMed

    Mihelj, Matjaz; Munih, Marko

    2004-08-01

    In the past, limited unsupported standing has been restored in patients with thoracic spinal cord injury through open-loop functional electrical stimulation of paralyzed knee extensor muscles and the support of intact arm musculature. Here an optimal control system for paralyzed ankle muscles was designed that enables the subject to stand without hand support in a sagittal plane. The paraplegic subject was conceptualized as an underactuated double inverted pendulum structure with an active degree of freedom in the upper trunk and a passive degree of freedom in the paralyzed ankle joints. Control system design is based on the minimization of a cost function that estimates the effort of ankle joint muscles via observation of the ground reaction force position, relative to ankle joint axis. Furthermore, such a control system integrates voluntary upper trunk activity and artificial control of ankle joint muscles, resulting in a robust standing posture. Figures are shown for the initial simulation study, followed by disturbance tests on an intact volunteer and several laboratory trials with a paraplegic person. Benefits of the presented methodology are prolonged standing sessions and in the fact that the subject is able to maintain voluntary control over upper body orientation in space, enabling simple functional standing.

  15. [Chronic ankle instability in sports -- a review for sports physicians].

    PubMed

    Valderrabano, V; Leumann, A; Pagenstert, G; Frigg, A; Ebneter, L; Hintermann, B

    2006-12-01

    Chronic ankle instability represents a typical sports injury which can mostly be seen in basketball, soccer, orienteering and other high risk sports. 20 to 40 % of the acute ankle sprains develop into chronic ankle instability. From a sports orthopaedic point of view, chronic ankle instability can be subdivided into a lateral, medial or a combination of both so called rotational ankle instability. From a pathophysiological point of view, chronic ankle instability can be either mechanical with a structural ligament lesion or functional with loss of the neuromuscular control. For the sports physician, the chronic ankle instability is a difficult entity as the diagnosis is usually complex and the therapy usually surgical. This review on chronic ankle instability addresses pathomechanism, diagnostics, indications for conservative and surgical treatments, and possible long-term sequelae, as ligamentous osteoarthritis.

  16. Distracted driving and implications for injury prevention in adults.

    PubMed

    Hoff, Jane; Grell, Jennifer; Lohrman, Nicole; Stehly, Christy; Stoltzfus, Jill; Wainwright, Gail; Hoff, William S

    2013-01-01

    Distracted driving, a significant public safety issue, is typically categorized as cell phone use and texting. The increase of distracted driving behavior (DDB) has resulted in an increase in injury and death. The purpose of this study was to identify the frequency and perception of DDB in adults. A 7-question SurveyMonkey questionnaire was distributed to a convenience sample of adults. Standard demographics included age, gender, and highest levels of education. Primary outcome questions were related to frequency of DDB, and overall perceptions specific to distracted driving. Results were compared on the basis of demographics. Chi-square testing and the Kruskal-Wallis analysis of variance were applied, with statistical significance defined as P ≤ .05. There were 1857 respondents to the survey: 1721 were aged 23-64 years (93%); 1511 were women (81%); 1461 had high school education or greater (79%). A total of 168 respondents (9%) reported being involved in a car accident while distracted. The highest reported frequency of DDB included cell phone use (69%), eating/drinking (67%), and reaching for an object in the care (49%). Younger age (18-34 years) and higher level of education (bachelor's degree or greater) were statistically associated with these DDB; gender demonstrated no statistical significance. Text messaging was reported by 538 respondents (29%), with a statistically significant association with age (18-34 years), higher education (bachelor's degree or greater), and gender (males). A total of 1143 respondents (63%) believed that they could drive safely while distracted. This study demonstrates that DDB in adults is not restricted to reading and sending text messages. Moreover, these results indicated that people fail to perceive the dangers inherent in distracted driving. Prevention and outreach education should not be limited to texting and cell phone use but should target all forms of DDB. The age group 18-34 years should be the primary target in the

  17. Distracted driving and implications for injury prevention in adults.

    PubMed

    Hoff, Jane; Grell, Jennifer; Lohrman, Nicole; Stehly, Christy; Stoltzfus, Jill; Wainwright, Gail; Hoff, William S

    2013-01-01

    Distracted driving, a significant public safety issue, is typically categorized as cell phone use and texting. The increase of distracted driving behavior (DDB) has resulted in an increase in injury and death. The purpose of this study was to identify the frequency and perception of DDB in adults. A 7-question SurveyMonkey questionnaire was distributed to a convenience sample of adults. Standard demographics included age, gender, and highest levels of education. Primary outcome questions were related to frequency of DDB, and overall perceptions specific to distracted driving. Results were compared on the basis of demographics. Chi-square testing and the Kruskal-Wallis analysis of variance were applied, with statistical significance defined as P ≤ .05. There were 1857 respondents to the survey: 1721 were aged 23-64 years (93%); 1511 were women (81%); 1461 had high school education or greater (79%). A total of 168 respondents (9%) reported being involved in a car accident while distracted. The highest reported frequency of DDB included cell phone use (69%), eating/drinking (67%), and reaching for an object in the care (49%). Younger age (18-34 years) and higher level of education (bachelor's degree or greater) were statistically associated with these DDB; gender demonstrated no statistical significance. Text messaging was reported by 538 respondents (29%), with a statistically significant association with age (18-34 years), higher education (bachelor's degree or greater), and gender (males). A total of 1143 respondents (63%) believed that they could drive safely while distracted. This study demonstrates that DDB in adults is not restricted to reading and sending text messages. Moreover, these results indicated that people fail to perceive the dangers inherent in distracted driving. Prevention and outreach education should not be limited to texting and cell phone use but should target all forms of DDB. The age group 18-34 years should be the primary target in the

  18. The prevalence of distraction among passenger vehicle drivers: a roadside observational approach

    PubMed Central

    Huisingh, Carrie; Griffin, Russell; McGwin, Gerald

    2015-01-01

    Objective Distracted driving contributes to a large proportion of motor vehicle crashes, yet little is known about the prevalence of distracted driving and the specific types of distracting behaviors. The objective of this study was to estimate the prevalence of driver distraction using a roadside observational study design. Methods A cross-sectional survey involving direct roadside observation was conducted at 11 selected intersections. Trained investigators observed a sample of passenger vehicles and recorded distraction-related behaviors, driver characteristics, and contextual factors such as vehicle speed and traffic flow. Results Of the 3,265 drivers observed, the prevalence of distracted driving was 32.7%. Among those involved in a distracting activity, the most frequently observed distractions included interacting with another passenger (53.2%, where passengers were present), talking on the phone (31.4%), external-vehicle distractions (20.4%), and texting/dialing a phone (16.6%). The prevalence of talking on the phone was higher among females than males (38.6% vs. 24.3%), whereas external vehicle distractions were higher among males than females (25.8% vs. 24.3%). Drivers <30 years were observed being engaged in any distracting activity, interacting with other passengers and texting/dialing more frequently than drivers aged 30–50 and >50 years. Drivers were engaged in distracting behaviors more frequently when the car was stopped. Conclusions When using similar methodology, roadside observational studies generate comparable prevalence estimates of driver distraction as naturalistic driving studies. Driver distraction is a common problem among passenger vehicle drivers. Despite the increased awareness on the dangers of texting and cell phone use while driving, these specific activities were two of the most frequently observed distractions. There is a continued need for road safety education about the dangers of distracted driving, especially for younger

  19. Analytics For Distracted Driver Behavior Modeling in Dilemma Zone

    SciTech Connect

    Li, Jan-Mou; Malikopoulos, Andreas; Thakur, Gautam; Vatsavai, Raju

    2014-01-01

    In this paper, we present the results obtained and insights gained through the analysis of TRB contest data. We used exploratory analysis, regression, and clustering models for gaining insights into the driver behavior in a dilemma zone while driving under distraction. While simple exploratory analysis showed the distinguishing driver behavior patterns among different popu- lation groups in the dilemma zone, regression analysis showed statically signification relationships between groups of variables. In addition to analyzing the contest data, we have also looked into the possible impact of distracted driving on the fuel economy.

  20. Dynamic Distraction External Fixation for Contracture of the Metacarpophalangeal Joint.

    PubMed

    Seigerman, Daniel A; Tan, Virak

    2015-12-01

    Metacarpophalangeal (MP) joint contractures are common after traumatic injury, and can be difficult to manage. After surgical capsulectomy, it remains challenging to maintain motion that was obtained at the time of surgery. Our group uses a novel, prefabricated digital external fixator to provide both distraction, and motion therapy across the MP joint after surgical treatment of MP contracture. The purpose of this technique is to demonstrate the effectiveness of an adjunctive dynamic distraction external fixator for the maintenance of joint motion after surgical treatment of MP contractures of the border digits. PMID:26280472

  1. Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

    PubMed Central

    Roy, Anindo; Bever, Christopher T.; Forrester, Larry W.; Macko, Richard F.; Hogan, Neville

    2011-01-01

    Our objective in this study was to assess passive mechanical stiffness in the ankle of chronic hemiparetic stroke survivors and to compare it with those of healthy young and older (age-matched) individuals. Given the importance of the ankle during locomotion, an accurate estimate of passive ankle stiffness would be valuable for locomotor rehabilitation, potentially providing a measure of recovery and a quantitative basis to design treatment protocols. Using a novel ankle robot, we characterized passive ankle stiffness both in sagittal and in frontal planes by applying perturbations to the ankle joint over the entire range of motion with subjects in a relaxed state. We found that passive stiffness of the affected ankle joint was significantly higher in chronic stroke survivors than in healthy adults of a similar cohort, both in the sagittal as well as frontal plane of movement, in three out of four directions tested with indistinguishable stiffness values in plantarflexion direction. Our findings are comparable to the literature, thus indicating its plausibility, and, to our knowledge, report for the first time passive stiffness in the frontal plane for persons with chronic stroke and older healthy adults. PMID:21346215

  2. Arthrometric Measurement of Ankle-Complex Motion: Normative Values

    PubMed Central

    Schwarz, Neil A.; Kovaleski, John E.; Heitman, Robert J.; Gurchiek, Larry R.; Gubler-Hanna, Coral

    2011-01-01

    Abstract Context: Valid and reliable measurements of ankle-complex motion have been reported using the Hollis Ankle Arthrometer. No published normative data of ankle-complex motion obtained from ankle arthrometry are available for use as a reference for clinical decision making. Objective: To describe the distribution variables of ankle-complex motion in uninjured ankles and to establish normative reference values for use in research and to assist in clinical decision making. Design: Descriptive laboratory study. Setting: University research laboratory. Patients or Other Participants: Both ankles of 50 men and 50 women (age = 21.78 ± 2.0 years [range, 19–25 years]) were tested. Intervention(s): Each ankle underwent anteroposterior (AP) and inversion-eversion (I-E) loading using an ankle arthrometer. Main Outcome Measure(s): Recorded anterior, posterior, and total AP displacement (millimeters) at 125 N and inversion, eversion, and total I-E rotation (degrees) at 4 Nm. Results: Women had greater ankle-complex motion for all variables except for posterior displacement. Total AP displacement of the ankle complex was 18.79 ± 4.1 mm for women and 16.70 ± 4.8 mm for men (U = 3742.5, P < .01). Total I-E rotation of the ankle complex was 42.10° ± 9.0° for women and 34.13° ± 10.1° for men (U = 2807, P < .001). All variables were normally distributed except for anterior displacement, inversion rotation, eversion rotation, and total I-E rotation in the women's ankles and eversion rotation in the men's ankles; these variables were skewed positively. Conclusions: Our study increases the available database on ankle-complex motion, and it forms the basis of norm-referenced clinical comparisons and the basis on which quantitative definitions of ankle pathologic conditions can be developed. PMID:21391797

  3. Cognitive Distraction and African American Women's Endorsement of Gender Role Stereotypes

    ERIC Educational Resources Information Center

    Smith, Kalynda; Craig-Henderson, Kellina

    2010-01-01

    The present study investigated the effect of cognitive distraction on the endorsement of gender role stereotypes in one sample of African American female participants. Participants' awareness and endorsement of gender role stereotypes for male and females was assessed. Following random assignment to distraction or no distraction conditions, they…

  4. Homework Distraction Scale: Confirming the Factor Structure With Middle School Students

    ERIC Educational Resources Information Center

    Xu, Jianzhong; Fan, Xitao; Du, Jianxia

    2016-01-01

    The goal of the current investigation was to evaluate psychometric properties of the Homework Distraction Scale (HDS) using 796 middle school students. Results from confirmatory factor analyses (CFAs) supported the presence of two distinct yet related subscales for the HDS: Conventional Distraction and Tech-Related Distraction. Results of…

  5. Osteochondral defects in the ankle: why painful?

    PubMed Central

    Reilingh, Mikel L.; Zengerink, Maartje; van Bergen, Christiaan J. A.

    2010-01-01

    Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. The ankle joint has a high congruency. During loading, compressed cartilage forces its water into the microfractured subchondral bone, leading to a localized high increased flow and pressure of fluid in the subchondral bone. This will result in local osteolysis and can explain the slow development of a subchondral cyst. The pain does not arise from the cartilage lesion, but is most probably caused by repetitive high fluid pressure during walking, which results in stimulation of the highly innervated subchondral bone underneath the cartilage defect. Understanding the natural history of osteochondral defects could lead to the development of strategies for preventing progressive joint damage. PMID:20151110

  6. Interpretation of the ankle in UHECR

    NASA Astrophysics Data System (ADS)

    Berezinsky, Veniamin

    Ankle is a flattening in CR spectrum observed first in Volcano Ranch experiment in 1963 at E _{a} ˜ 10 EeV, and it was interpreted as transition from galactic to extragalactic CRs. Since that time the ankle was observed in all large UHECR detectors and most recently in HiRes, TA and Auger detectors at E _{a} ˜ 4 - 5 EeV. At present there are two interpretations of the ankle: as transition from galactic to extragalactic CRs (the conventional interpretation) and as a part of the dip, produced by extragalactic protons interacting with the CMB photons. These two interpretations will be discussed in the light of recent observations and models of UHECR origin.

  7. Treatment of ankle sprains in young athletes.

    PubMed

    Smith, R W; Reischl, S F

    1986-01-01

    To study the incidence of fibulocollateral ligament ankle sprains in the young male athlete, a survey of 84 varsity basketball players was done. Seventy percent of the players had a history of an ankle sprain. Eighty percent of those with a positive history had multiple sprains. Most of the injuries were mild, but in 32% of the injuries, the athlete missed more than 2 weeks of play. No medical attention was sought in 55% of the cases. About 50% of the athletes with a sprain had residual symptoms from their injuries; 15% of the injured athletes felt that their residual symptoms compromised their playing performance. This article emphasizes the potential seriousness of the ankle sprain in the young athlete and presents a recommended method of management, including assessment of severity, treatment, and rehabilitation.

  8. Ankle Injuries and Disorders - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Ankle Exercises (Arabic) العربية Bilingual PDF Health Information Translations Chinese - Traditional (繁體中文) Ankle Sprain 踝部扭傷 - 繁體中文 (Chinese - Traditional) Bilingual PDF Health Information Translations French (français) Ankle Exercises Exercices pour la cheville - ...

  9. Management of Osseous and Soft-Tissue Ankle Equinus During Total Ankle Replacement.

    PubMed

    Roukis, Thomas S; Simonson, Devin C

    2015-10-01

    Obtaining functional alignment of a total ankle replacement, including physiologic sagittal plane range of motion, is paramount for a successful outcome. This article reviews the literature on techniques available for correction of osseous and soft-tissue equinus at the time of index total ankle replacement. These techniques include anterior tibiotalar joint cheilectomy, posterior superficial muscle compartment lengthening, posterior ankle capsule release, and release of the posterior portions of the medial and lateral collateral ligament complexes. The rationale for these procedures and the operative sequence of events for these procedures are presented.

  10. Ankle osteoarthritis: etiology, diagnostics, and classification.

    PubMed

    Barg, Alexej; Pagenstert, Geert I; Hügle, Thomas; Gloyer, Marcel; Wiewiorski, Martin; Henninger, Heath B; Valderrabano, Victor

    2013-09-01

    Osteoarthritis (OA) is defined as the syndrome of joint pain and dysfunction caused by substantial joint degeneration. In general, OA is the most common joint disease and is one of the most frequent and symptomatic health problems for middle-aged and older people: OA disables more than 10% of people who are older than 60 years. This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail.

  11. An unusual cause of an ankle mass

    PubMed Central

    Prinja, Aditya; Roberts, Catherine; Doherty, Tom; Oddy, Michael J

    2014-01-01

    We report the case of a patient who presented with a 7-year history of a mass over the medial aspect of his right ankle, which had been gradually increasing in size. He had given up his occupation as a bus driver due to decreased movement of his ankle. An initial diagnosis of endemic syphilis was made after treponemal antibody and treponema pallidum particle agglutination tests were positive. However, following surgical debulking, cultures grew Fusarium solani and the diagnosis was changed to eumycetoma. He received prolonged treatment with antifungal agents and at 18 months follow-up remains well. PMID:25260425

  12. Ankle injuries and the family physician.

    PubMed

    Birrer, R B

    1988-01-01

    In transmitting the body's weight, the ankle is subject to frequent static and dynamic injury due to concentrated stresses during standing and movement. The frequency of athletic ankle injuries ranges from 10 to 90 percent, with the highest rate occurring in basketball players. There is prolonged disability and recurrent instability for months to years for 25 to 40 per cent of these patients. Because most of this trauma is handled by primary care physicians, this review presents the mechanism of injury, relevant anatomy, physical examination, and appropriate therapeutic intervention in the acute and rehabilitative phases.

  13. Distraction by emotional sounds: Disentangling arousal benefits and orienting costs.

    PubMed

    Max, Caroline; Widmann, Andreas; Kotz, Sonja A; Schröger, Erich; Wetzel, Nicole

    2015-08-01

    Unexpectedly occurring task-irrelevant stimuli have been shown to impair performance. They capture attention away from the main task leaving fewer resources for target processing. However, the actual distraction effect depends on various variables; for example, only target-informative distractors have been shown to cause costs of attentional orienting. Furthermore, recent studies have shown that high arousing emotional distractors, as compared with low arousing neutral distractors, can improve performance by increasing alertness. We aimed to separate costs of attentional orienting and benefits of arousal by presenting negative and neutral environmental sounds (novels) as oddballs in an auditory-visual distraction paradigm. Participants categorized pictures while task-irrelevant sounds preceded visual targets in two conditions: (a) informative sounds reliably signaled onset and occurrence of visual targets, and (b) noninformative sounds occurred unrelated to visual targets. Results confirmed that only informative novels yield distraction. Importantly, irrespective of sounds' informational value participants responded faster in trials with high arousing negative as compared with moderately arousing neutral novels. That is, costs related to attentional orienting are modulated by information, whereas benefits related to emotional arousal are independent of a sound's informational value. This favors a nonspecific facilitating cross-modal influence of emotional arousal on visual task performance and suggests that behavioral distraction by noninformative novels is controlled after their motivational significance has been determined.

  14. Musical Distracters, Personality Type and Cognitive Performance in School Children

    ERIC Educational Resources Information Center

    Furnham, Adrian; Stephenson, Rebecca

    2007-01-01

    The aim of this study was to ascertain the nature of the interaction between the affective value of musical distraction, personality type and performance on the cognitive tasks of reading comprehension, free recall, mental arithmetic and verbal reasoning in children aged 11-12 years. It was hypothesized that the cognitive performance of extraverts…

  15. Auditory Distraction in Semantic Memory: A Process-Based Approach

    ERIC Educational Resources Information Center

    Marsh, John E.; Hughes, Robert W.; Jones, Dylan M.

    2008-01-01

    Five experiments demonstrate auditory-semantic distraction in tests of memory for semantic category-exemplars. The effects of irrelevant sound on category-exemplar recall are shown to be functionally distinct from those found in the context of serial short-term memory by showing sensitivity to: The lexical-semantic, rather than acoustic,…

  16. Cognitive Factors in Sexual Arousal: The Role of Distraction

    ERIC Educational Resources Information Center

    Geer, James H.; Fuhr, Robert

    1976-01-01

    Four groups of male undergraduates were instructed to perform complex cognitive operations when randomly presented single digits of a dichotic listening paradigm. An erotic tape recording was played into the nonattended ear. Sexual arousal varied directly as a function of the complexity of the distracting cognitive operations. (Author)

  17. Upper airway outcomes following midface distraction osteogenesis: a systematic review.

    PubMed

    Taylor, B A; Brace, M; Hong, P

    2014-07-01

    The objective of this paper is to systematically review the airway outcomes following distraction osteogenesis of midface with the goal of (1) deriving clinically oriented insights and (2) identifying gaps in knowledge to stimulate future research. Medline, EMBASE and Cochrane databases were searched and studies were included if subjects of any age had midface retrusion/hypoplasia and underwent midface distraction osteogenesis. Outcome measures of interest were any respiratory or airway associated measures, and reports of adverse events. A total of 368 abstracts were generated from the literature searches; 16 studies met the criteria for data extraction and analysis. All 16 studies were observational. Generally, midface distraction osteogenesis was reported to improve respiratory status and was well tolerated. Specifically, favorable outcomes in cephalometry (9 studies), polysomnography (9 studies), and decannulation rates (8 studies) were reported. In conclusion, upper airway status was improved in most patients who underwent midface distraction osteogenesis, yet long-term results and consistent objective measures are lacking. Studies reviewed were retrospective case series and details regarding patients who did not improve were deficient. A standardized prospective multicenter cohort trial with long-term patient follow up is required.

  18. Brachymetatarsia. Axial lengthening by using the callus distraction technique.

    PubMed

    Boike, A M; Gerber, M R; Snyder, A J

    1993-07-01

    The authors present a modified approach to the ilizarov callus distraction technique for bone lengthening on a patient with brachymetatarsia. This approach has certain advantages and disadvantages that will be discussed along with historical methods of treating brachymetatarsia. The actual case history, surgical technique, and perioperative care of the patient are described in detail. PMID:8350248

  19. Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study

    PubMed Central

    Kulkarni, Sunil; Kulkarni, GS; Shyam, Ashok K; Kulkarni, Milind; Kulkarni, Ruta; Kulkarni, Vidisha

    2011-01-01

    Background: Thromboangiitis obliterans (TAO), also known as Buerger disease, is characterized by thrombosis in medium-sized arteries and veins along with a marked inflammatory response. TAO can be managed by using the principle of distraction osteogenesis to induce neoangiogenesis. We report thirty patients of TAO in the age-group of 20–50 years were treated with the Ilizarov method. Materials and Methods: Patients with severe rest pain (n=30), absent distal pulsation (n=30) and ulcer (n=6) and/or gangrene of the toes (n=4), who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy was performed and distraction applied by use of olive wire. A two-ring frame was used for all cases. Results: Of the 30 cases, 25 patients became pain free while 1 had partial relief of pain. The four patients worsened on treatment and developed frank infection were amputed. The average distraction was 1.8±0.3 mm (range: 1.5–2.2 cm). The mean consolidation period was 98±11 days, after which the fixator was removed. The total duration of treatment was 122±23 days. There were two cases of osteomyelitis in our series; both healed after debridement and both patients had good result, with relief of pain. The ulcers started healing by 4–6 weeks. Conclusion: The principle of the distraction osteogenesis including neoangiogenesis can be used for treatment of TAO and has an acceptable complication rate. PMID:21886930

  20. U.s. State and federal laws targeting distracted driving.

    PubMed

    Catherine Chase, J D

    2014-01-01

    Distracted driving has burgeoned with the proliferation of cell phones, global positioning systems and other in-vehicle and personal electronic devices. Annually more than 3,300 people are killed and an additional 400,000 are injured in the United States in distracted driving crashes. The United States (U.S.) federal and state governments have responded to this public health problem with policies and laws; however, a more comprehensive and more effective approach is still needed. Some restrictions on the use of electronic devices while driving by federal employees and some voluntary guidelines and recommendations have been issued. Public opinion polls show support for addressing the issue of distracted driving with state laws. The majority of states have laws banning text messaging while driving and prohibiting the use of an electronic device by teenage or novice drivers. Some states prohibit all drivers from using a hand-held cellphone. Currently no state has a total ban on the use of personal electronic devices while driving. Successful past traffic safety campaigns changing driver behavior have demonstrated the necessity to adopt a "three Es" approach of Enactment of a law, Education of the public about the law, and rigorous Enforcement of the law. Experience reveals that this approach, along with future federal regulation of in-vehicle electronic devices and the employment of technology to limit the use of electronic devices while driving, is needed to alter personal behavior in order to reduce distractions and keep drivers focused on the driving task. PMID:24776229

  1. Nonoperative Management of Craniocervical Ligamentous Distraction Injury: Literature Review

    PubMed Central

    Kaplan, Nathan B.; Molinari, Christine; Molinari, Robert W.

    2015-01-01

    Study Design Literature review and case report. Objective Review the existing literature and report the successful nonoperative management of a two-level craniocervical ligamentous distraction injury. Methods A PubMed and Medline review revealed only three limited reports involving the nonoperative management of patients with craniocervical distraction injury. This article reviews the existing literature and reports the case of a 27-year-old man who was involved in a motorcycle accident and sustained multiple systemic injuries and ligamentous distraction injuries to both occipitocervical joints and both C1–C2 joints. The patient's traumatic brain injury and bilateral pulmonary contusions precluded safe operative management of the two-level craniocervical distraction injury. Therefore, the patient was placed in a halo immobilization device. Results The literature remains unclear as to the specific indications for nonoperative management of ligamentous craniocervical injuries. Nonoperative management was associated with poor outcomes in the majority of reported patients. We report a patient who was managed for 6 months in a halo device. Posttreatment computed tomography and flexion–extension radiographs demonstrated stable occipitocervical and C1–C2 joints bilaterally. The patient reported minimal neck pain and had excellent functional outcome with a Neck Disability Index score of 2 points at 41 months postoperatively. He returned to preinjury level of employment without restriction. Conclusions Further study is needed to determine which craniocervical injuries may be managed successfully with nonoperative measures. PMID:26682101

  2. Distraction osteogenesis for correction of post ankylosis mandibular deformities

    PubMed Central

    Khan, Ahmed; Fareed, Wamiq Musheer; Tandon, Parul; Zafar, Muhammad Sohail

    2015-01-01

    Abstract Temporomandibular joint ankylosis, a debilitating disease mainly affecting children, is characterized by progressive restriction of mouth opening and maxilla-mandibular developmental deformities. Craniofacial distraction osteogenesis has been developed as a standard surgical strategy for rectification of craniofacial deformities. The purpose of this study was to assess mono-planar distraction devices for the correction of various mandibular asymmetries in patients with unilateral temporomandibular joint ankylosis who developed restricted mouth opening and mandibular retrognathia. All patients were treated using one-stage distraction osteogenesis followed by temporalis fascia interpositional arthroplasty under general anesthesia. A significant increase in mandibular ramus and base length was observed. Although an increase in anterior lower facial height was observed, it was not significant statistically. A decrease in posterior lower facial height and corpus was observed. Oblique distraction with angular osteotomy allowed lengthening of both the ramus and corpus, yielding satisfactory results and hence eliminating the need of secondary surgery. In conclusion, univector internal distractors are effective for correction of multi-planar mandibular deficiencies by optimizing its placement through meticulous planning. PMID:26243521

  3. Swallowing disorders in Pierre Robin sequence: its correction by distraction.

    PubMed

    Monasterio, Fernando Ortíz; Molina, Fernando; Berlanga, Fidel; López, María Elena; Ahumada, Héctor; Takenaga, Raúl H; Ysunza, Antonio

    2004-11-01

    Pierre Robin sequence is characterized by micro-gnathia, glossoptosis, feeding difficulties, and upper respiratory obstruction, which are frequently complicated by bronchial aspiration and pulmonary infection. Gastroesophageal reflux is also common in these patients. To assess the results of mandibular distraction, a study was performed in 18 patients to detect swallowing disorders associated with apnea episodes and gastroesophageal reflux. Polysomnography, barium pharyngoscopy, determination of blood gases, and esophageal pH measurements were undertaken before and 4 months after distraction osteogenesis. Bilateral corticotomies, followed by distraction with external devices, were performed, achieving 7 to 19 mm of elongation (mean = 12 mm). Gastroesophageal reflux was found in 83% of cases associated with apnea episodes, but it disappeared after distraction osteogenesis. Mean preoperative oxygen saturation was 72%, and it was 93% afterward. The preoperative apnea index was 18.3, and the preoperative 8.5 hypopnea index was 8.5; both disappeared. Pharyngeal transit time became less than 1 second after treatment. Abnormal tongue movements and barium stasis in the pharyngeal recess and in the trachea were eliminated in all the patients.

  4. Distraction and Facilitation--Two Faces of the Same Coin?

    ERIC Educational Resources Information Center

    Wetzel, Nicole; Widmann, Andreas; Schroger, Erich

    2012-01-01

    Unexpected and task-irrelevant sounds can capture our attention and may cause distraction effects reflected by impaired performance in a primary task unrelated to the perturbing sound. The present auditory-visual oddball study examines the effect of the informational content of a sound on the performance in a visual discrimination task. The…

  5. Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle.

    PubMed

    Mani, S B; Do, H; Vulcano, E; Hogan, M V; Lyman, S; Deland, J T; Ellis, S J

    2015-05-01

    The foot and ankle outcome score (FAOS) has been evaluated for many conditions of the foot and ankle. We evaluated its construct validity in 136 patients with osteoarthritis of the ankle, its content validity in 37 patients and its responsiveness in 39. Data were collected prospectively from the registry of patients at our institution. All FAOS subscales were rated relevant by patients. The Pain, Activities of Daily Living, and Quality of Life subscales showed good correlation with the Physical Component score of the Short-Form-12v2. All subscales except Symptoms were responsive to change after surgery. We concluded that the FAOS is a weak instrument for evaluating osteoarthritis of the ankle. However, some of the FAOS subscales have relative strengths that allow for its limited use while we continue to seek other satisfactory outcome instruments. PMID:25922461

  6. Biomechanics of the normal and arthritic ankle joint.

    PubMed

    Snedeker, Jess G; Wirth, Stephan H; Espinosa, Norman

    2012-12-01

    Understanding biomechanics of the normal and arthritic ankle joint can aid in analysis of an underlying clinical problem and provide a strategic basis for a more optimal management. The challenge to the clinician and the biomechanist is that the mechanical complexity of the ankle joint still clouds current understanding. This article provides an overview of current understanding of functional ankle anatomy, how this function can be altered in the degenerated ankle, and how surgical intervention further affects foot and ankle biomechanics. The focus is on how altered loading of neighboring joints in the midfoot and hindfoot may induce postoperative joint remodeling and can manifest in secondary clinical problems.

  7. Sprained ankles as they relate to the basketball player.

    PubMed

    Johnson, K A; Teasdall, R D

    1993-04-01

    Concepts based on newer medical information concerning ankle injuries have changed in recent years. With these changing concepts, the method of treatment has also changed. It is the purpose of this article to review some of the commonly known information concerning ankle sprains, to emphasize the association of subtalar injury with the ankle sprain complex, to outline new information concerning the static stabilizers on the lateral aspect of the ankle, and finally, to utilize this information in producing a rationale for a new type of surgical treatment for chronic instability of the ankle.

  8. Clinical Examination Results in Individuals With Functional Ankle Instability and Ankle-Sprain Copers

    PubMed Central

    Wright, Cynthia J.; Arnold, Brent L.; Ross, Scott E.; Ketchum, Jessica; Ericksen, Jeffrey; Pidcoe, Peter

    2013-01-01

    Context: Why some individuals with ankle sprains develop functional ankle instability and others do not (ie, copers) is unknown. Current understanding of the clinical profile of copers is limited. Objective: To contrast individuals with functional ankle instability (FAI), copers, and uninjured individuals on both self-reported variables and clinical examination findings. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Participants consisted of 23 individuals with a history of 1 or more ankle sprains and at least 2 episodes of giving way in the past year (FAI: Cumberland Ankle Instability Tool [CAIT] score = 20.52 ± 2.94, episodes of giving way = 5.8 ± 8.4 per month), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers: CAIT score = 27.74 ± 1.69), and 23 individuals with no history of ankle sprain and no instability (uninjured: CAIT score = 28.78 ± 1.78). Intervention(s): Self-reported disability was recorded using the CAIT and Foot and Ankle Ability Measure for Activities of Daily Living and for Sports. On clinical examination, ligamentous laxity and tenderness, range of motion (ROM), and pain at end ROM were recorded. Main Outcome Measure(s): Questionnaire scores for the CAIT, Foot and Ankle Ability Measure for Activities of Daily Living and for Sports, ankle inversion and anterior drawer laxity scores, pain with palpation of the lateral ligaments, ankle ROM, and pain at end ROM. Results: Individuals with FAI had greater self-reported disability for all measures (P < .05). On clinical examination, individuals with FAI were more likely to have greater talar tilt laxity, pain with inversion, and limited sagittal-plane ROM than copers (P < .05). Conclusions: Differences in both self-reported disability and clinical examination variables distinguished individuals with FAI from copers at least 1 year after injury. Whether the deficits could be detected

  9. Effectiveness of an outside-the-boot ankle brace in reducing parachuting related ankle injuries

    PubMed Central

    Schmidt, M; Sulsky, S; Amoroso, P

    2005-01-01

    Objectives: To examine the efficacy of an outside-the-boot parachute ankle brace (PAB) in reducing risk of ankle injury to army paratrooper trainees and to identify inadvertent risks associated with PAB use. Design: The authors compared hospitalization rates for ankle, musculoskeletal, and other traumatic injury among 223 172 soldiers trained 1985–2002 in time periods defined by presence/absence of PAB use protocols. Multiple logistic regression analysis estimated adjusted odds ratios (OR) and 95% confidence intervals for injury outcomes, comparing pre and post brace periods to the brace protocol period. Setting: A research database consisting of training rosters from the US Army Airborne training facility (Fort Benning, GA) occupational, demographic, and hospitalization information. Main outcome measures: Injuries were considered training related if they occurred during a five week period starting with first scheduled static line parachute jump and a parachuting cause of injury code appeared in the hospital record. Results: Of 939 parachuting related hospitalizations during the defined risk period, 597 (63.6%) included an ankle injury diagnosis, 198 (21.1%) listed a musculoskeletal (non-ankle) injury, and 69 (7.3%) cited injuries to multiple body parts. Risk of ankle injury hospitalization was higher during both pre-brace (adjusted OR 2.38, 95% CI 1.92 to 2.95) and post-brace (adjusted OR 1.72, 95% CI 1.27 to 2.32) periods compared with the brace protocol period. Odds of musculoskeletal (non-ankle) injury or injury to multiple body parts did not change between the brace and post-brace periods. Conclusion: Use of a PAB during airborne training appears to reduce risk of ankle injury without increasing risk of other types of traumatic injury. PMID:15933409

  10. An examination of ankle, knee, and hip torque production in individuals with chronic ankle instability.

    PubMed

    Gribble, Phillip A; Robinson, Richard H

    2009-03-01

    There is some debate in the literature as to whether strength deficits exist at the ankle in individuals with chronic ankle instability (CAI). Additionally, there is evidence to suggest that knee and hip performance is altered in those with CAI. Therefore, the purpose of this study was to determine whether CAI is associated with deficits in ankle, knee, and hip torque. Fifteen subjects with unilateral CAI and fifteen subjects with healthy ankles participated. Subjects reported to the laboratory for one session during which the torque production of ankle plantar flexion/dorsiflexion, knee flexion/extension, and hip flexion/extension were measured with an isokinetic device. Subjects performed 5 maximum-effort repetitions of a concentric/concentric protocol at 60 degrees .s for both extremities. Average peak torque (APT) values were calculated. The subjects with CAI demonstrated significantly less APT production for knee flexion (F1,28 = 5.40; p = 0.03) and extension (F1,28 = 5.34; p = 0.03). Subjects with CAI exhibited significantly less APT for ankle plantar flexion in the injured limb compared with their noninjured limb (F1,28 = 6.51; p = 0.02). No significant difference in ankle dorsiflexion or hip flexion/extension APT production existed between the 2 groups. Individuals with CAI, in addition to deficits in ankle plantar flexion torque, had deficits in knee flexor and extensor torque, suggesting that distal joint instability may lead to knee joint neuromuscular adaptations. There were no similar deficits at the hip. Future research should determine what implications this has for prevention and rehabilitation of lower-extremity injury. Clinicians may need to consider including rehabilitation efforts to address these deficits when rehabilitating patients with CAI.

  11. Changes in growth and morphology of the condyle following mandibular distraction in minipigs: Overloading or Underloading?

    PubMed Central

    Rafferty, Katherine L.; Sun, Zongyang; Egbert, Mark; Bakko, Daniel W.; Herring, Susan W.

    2007-01-01

    Objective: Loading of temporomandibular tissues during mandibular distraction may cause changes in condylar growth and cartilage thickness. This study examines the effects of distraction on the condyle in a large animal model by explicitly measuring growth and in vivo loading. Design: Unilateral mandibular distraction was carried out on twenty growing minipigs divided into three groups. One group underwent distraction but not consolidation, whereas the other two groups were allowed a period of consolidation of either one or two weeks. Animals received fluorochrome and 5-bromo-2'-deoxyuridine (BrdU) labeling and masticatory strain was measured from the condylar neck. Condylar strain was also recorded in an age-matched sample of eight animals that received no distraction surgery. Immunohistochemical procedures were used to identify dividing prechondroblasts and histological analysis was used to measure mineral apposition rate, count dividing cells, and measure the thickness of condylar cartilage. Results: Strain magnitude, particularly compressive strain, was much larger on the non-distraction side compared to the distraction side condyle. Compared to normal loading levels, the distraction side condyle was underloaded whereas the condyle on the intact side was overloaded. Mineral apposition and cartilage thickness were greater on the distraction side condyle compared to the opposite side. Differences between the sides were most pronounced in the group with no consolidation and became progressively reduced with consolidation time. Conclusions: Increased mineralization and cartilage thickness on the distraction side condyle is associated with reduced, not increased loading, perhaps because of disruption of the distraction side masseter muscle. PMID:17573035

  12. The emotional side of cognitive distraction: Implications for road safety.

    PubMed

    Chan, Michelle; Singhal, Anthony

    2013-01-01

    Driver distraction is estimated to be one of the leading causes of motor vehicle accidents. However, little is known about the role of emotional distraction on driving, despite evidence that attention is highly biased toward emotion. In the present study, we used a dual-task paradigm to examine the potential for driver distraction from emotional information presented on roadside billboards. This purpose was achieved using a driving simulator and three different types of emotional information: neutral words, negative emotional words, and positive emotional words. Participants also responded to target words while driving and completed a surprise free recall task of all the words at the end of the study. The findings suggest that driving performance is differentially affected by the valence (negative versus positive) of the emotional content. Drivers had lower mean speeds when there were emotional words compared to neutral words, and this slowing effect lasted longer when there were positive words. This may be due to distraction effects on driving behavior, which are greater for positive arousing stimuli. Moreover, when required to process non-emotional target stimuli, drivers had faster mean speeds in conditions where the targets were interspersed with emotional words compared to neutral words, and again, these effects lasted longer when there were positive words. On the other hand, negative information led to better memory recall. These unique effects may be due to separate processes in the human attention system, particularly related to arousal mechanisms and their interaction with emotion. We conclude that distraction that is emotion-based can modulate attention and decision-making abilities and have adverse impacts on driving behavior for several reasons.

  13. Ankle impingement syndromes: a review of etiology and related implications.

    PubMed

    Hess, Gregory William

    2011-10-01

    Ankle injuries are common occurrences in athletics involving and requiring extreme ranges of motion. Ankle sprains specifically occur with a 1 in 10,000 person rate in active individuals each day. If trauma is repetitive, the ankle structures have potential to experience secondary injury and dysfunction. Included in this category of dysfunction are both anterior and posterior ankle impingement syndromes where disruption of the bony structures, joint capsule, ligaments, and tendons typically occurs. Ankle impingement is described as ankle pain that occurs during athletic activity, with recurrent, extreme dorsiflexion or plantar flexion with the joint under a load. Ankle impingements can be classified according to what structures become involved both anteriorly and posteriorly. Osseous impingement, soft tissue impingement, impingement of the distal fascicle of anterior inferior tibiofibular ligament, and meniscoid lesions are all documented causes of ankle impingement. These changes tend to be brought about and exacerbated by extreme ranges of motion. Understanding various impingement types will better enable the clinician to prevent, identify, treat, and rehabilitate affected ankles. Acknowledging activities that predispose to ankle impingement syndrome will enhance prevention and recovery processes. Description of ankle impingement etiology and pathology is the objective of the current review.

  14. Total Ankle Arthroplasty: An Overview of the Canadian Experience.

    PubMed

    Latham, Warren C W; Lau, Johnny T C

    2016-06-01

    Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.

  15. Ankle muscle strength influence on muscle activation during dynamic and static ankle training modalities.

    PubMed

    Lucas-Cuevas, Angel Gabriel; Baltich, Jennifer; Enders, Hendrik; Nigg, Sandro; Nigg, Benno

    2016-01-01

    Muscle weakness is considered a risk factor for ankle injury. Balance training and barefoot running have been used in an attempt to strengthen the muscles crossing the ankle. It is expected that training tasks that successfully strengthen the ankle would elicit increased muscular activity. However, it is unknown how an individual's ankle strength will influence the muscle activity used during a given task. Twenty-six participants performed dynamic (shod, barefoot running) and static tasks (squat on ground, squat on ®Bosu Ball) believed to strengthen the muscles surrounding the ankle. Electromyographic signals of the tibialis anterior, peroneus longus, gastrocnemius lateralis (GL) and gastrocnemius medialis (GM) were recorded and analysed using a non-linearly scaled wavelet analysis. Participants were divided into a strong group and a weak group according to their isometric plantar-flexion torque. The weak group required more relative GL and GM muscle activity during each training task compared to the strong group. No difference was observed between shod and barefoot running. There was a significant effect of training task on muscle activation level for the weak group. Differences in ankle strength had a significant impact on muscle activation.

  16. Invariant ankle moment patterns when walking with and without a robotic ankle exoskeleton.

    PubMed

    Kao, Pei-Chun; Lewis, Cara L; Ferris, Daniel P

    2010-01-19

    To guide development of robotic lower limb exoskeletons, it is necessary to understand how humans adapt to powered assistance. The purposes of this study were to quantify joint moments while healthy subjects adapted to a robotic ankle exoskeleton and to determine if the period of motor adaptation is dependent on the magnitude of robotic assistance. The pneumatically powered ankle exoskeleton provided plantar flexor torque controlled by the wearer's soleus electromyography (EMG). Eleven naïve individuals completed two 30-min sessions walking on a split-belt instrumented treadmill at 1.25m/s while wearing the ankle exoskeleton. After two sessions of practice, subjects reduced their soleus EMG activation by approximately 36% and walked with total ankle moment patterns similar to their unassisted gait (r(2)=0.98+/-0.02, THSD, p>0.05). They had substantially different ankle kinematic patterns compared to their unassisted gait (r(2)=0.79+/-0.12, THSD, p<0.05). Not all of the subjects reached a steady-state gait pattern within the two sessions, in contrast to a previous study using a weaker robotic ankle exoskeleton (Gordon and Ferris, 2007). Our results strongly suggest that humans aim for similar joint moment patterns when walking with robotic assistance rather than similar kinematic patterns. In addition, greater robotic assistance provided during initial use results in a longer adaptation process than lesser robotic assistance. PMID:19878952

  17. Invariant ankle moment patterns when walking with and without a robotic ankle exoskeleton.

    PubMed

    Kao, Pei-Chun; Lewis, Cara L; Ferris, Daniel P

    2010-01-19

    To guide development of robotic lower limb exoskeletons, it is necessary to understand how humans adapt to powered assistance. The purposes of this study were to quantify joint moments while healthy subjects adapted to a robotic ankle exoskeleton and to determine if the period of motor adaptation is dependent on the magnitude of robotic assistance. The pneumatically powered ankle exoskeleton provided plantar flexor torque controlled by the wearer's soleus electromyography (EMG). Eleven naïve individuals completed two 30-min sessions walking on a split-belt instrumented treadmill at 1.25m/s while wearing the ankle exoskeleton. After two sessions of practice, subjects reduced their soleus EMG activation by approximately 36% and walked with total ankle moment patterns similar to their unassisted gait (r(2)=0.98+/-0.02, THSD, p>0.05). They had substantially different ankle kinematic patterns compared to their unassisted gait (r(2)=0.79+/-0.12, THSD, p<0.05). Not all of the subjects reached a steady-state gait pattern within the two sessions, in contrast to a previous study using a weaker robotic ankle exoskeleton (Gordon and Ferris, 2007). Our results strongly suggest that humans aim for similar joint moment patterns when walking with robotic assistance rather than similar kinematic patterns. In addition, greater robotic assistance provided during initial use results in a longer adaptation process than lesser robotic assistance.

  18. Imaging of the foot and ankle.

    PubMed

    Pavlov, H

    1990-09-01

    The foot and ankle are subjected to daily stresses and strains ranging from normal walking activities to the excessive forces encountered in the active sports enthusiast. These traumatic events as well as systemic and local arthritic conditions and tumors can be temporarily or permanently disabling. Early, expedited, and cost-efficient diagnosis is the daily challenge for the radiologist, clinician, and patient. PMID:1975109

  19. Cutaneous mechanisms of isometric ankle force control.

    PubMed

    Choi, Julia T; Lundbye-Jensen, Jesper; Leukel, Christian; Nielsen, Jens Bo

    2013-07-01

    The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased cutaneous sensory function as evidenced by increased touch threshold. Absolute dorsiflexion force error increased without visual feedback during peroneal nerve stimulation. This was not a general effect of stimulation because force error did not increase during plantar nerve stimulation. The effects of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases.

  20. Mindless Feeding: Is Maternal Distraction During Bottle-Feeding Associated with Overfeeding?

    PubMed Central

    Golen, Rebecca B.; Ventura, Alison K.

    2015-01-01

    Mindless eating, or eating while distracted by surrounding stimuli, leads to overeating. The present study explored whether “mindless feeding,” or maternal distraction during bottle-feeding, is associated with greater infant formula/milk intakes and lower maternal sensitivity to infant cues. Mothers and their ≤24-week-old bottle-feeding infants (N=28) visited our laboratory for a video-recorded feeding observation. Infant intake was assessed by weighing bottles before and after the feedings. Maternal sensitivity to infant cues was objectively assessed by behavioral coding of video-records using the Nursing Child Assessment Feeding Scale. Maternal distraction was defined as looking away from the infant >75% of the feeding; using a mobile device; conversing with another adult; or sleeping. Twenty-nine percent (n=8) of mothers were distracted. While differences in intakes for infants of distracted vs. not distracted mothers did not reach significance (p=0.24), the association between distraction and infant intake was modified by two dimensions of temperament: orienting/regulation capacity (p=0.03) and surgency/extraversion (p=0.04). For infants with low orienting/regulation capacity, infants of distracted mothers consumed more (177.1 ± 33.8 ml) than those of not distracted mothers (92.4 ± 13.8 ml). Similar findings were noted for infants with low surgency/extraversion (distracted: 140.6 ± 22.5 ml; not distracted: 78.4 ± 14.3 ml). No association between distraction and intake was seen for infants with high orienting/regulation capacity or surgency/extraversion. A significantly greater proportion of distracted mothers showed low sensitivity to infant cues compared to not distracted mothers (p=0.04). In sum, mindless feeding may interact with infant characteristics to influence feeding outcomes; further experimental and longitudinal studies are needed. PMID:25953601

  1. Intra-articular knee injuries in racquet sports. A review of 128 arthroscopies.

    PubMed

    Powell, J M; Kavanagh, T G; Kennedy, D K; Marans, H J; Wright, T A

    1988-01-01

    Within the last decade, there has been a significant increase in racquet sport participation. The authors report that in a 5-year period, 17% of the injuries seen in a busy sports injuries clinic were associated with racquet sports, and over half of these were injuries to the knee. The findings are reported of those patients requiring knee arthroscopy, and the patterns of injury sustained are identified. Injuries to the knee in racquet sports are largely unavoidable and are inherent to the nature of the game.

  2. Ketofol for monitored anesthesia care in shoulder arthroscopy and labral repair: a case report.

    PubMed

    Lee, Kevin C; Shi, Hanyuan; Lee, Brian C

    2016-01-01

    A 21-year-old male (body mass index: 28.3) with a history of asthma and reactive airway disease since childhood underwent left shoulder arthroscopy and labral repair surgery under monitored anesthesia care. Because the procedure was performed in the beach chair position, access to the patient's airway was limited throughout. To avoid general anesthesia and to limit potential complications associated with monitored anesthesia care, a ketofol admixture was used. This case demonstrates that, in conjunction with regional anesthesia, ketofol may be an acceptable alternative to propofol for maintenance in outpatient orthopedic procedures. PMID:27382327

  3. Ketofol for monitored anesthesia care in shoulder arthroscopy and labral repair: a case report

    PubMed Central

    Lee, Kevin C; Shi, Hanyuan; Lee, Brian C

    2016-01-01

    A 21-year-old male (body mass index: 28.3) with a history of asthma and reactive airway disease since childhood underwent left shoulder arthroscopy and labral repair surgery under monitored anesthesia care. Because the procedure was performed in the beach chair position, access to the patient’s airway was limited throughout. To avoid general anesthesia and to limit potential complications associated with monitored anesthesia care, a ketofol admixture was used. This case demonstrates that, in conjunction with regional anesthesia, ketofol may be an acceptable alternative to propofol for maintenance in outpatient orthopedic procedures. PMID:27382327

  4. Design of a simple, lightweight, passive-elastic ankle exoskeleton supporting ankle joint stiffness.

    PubMed

    Kim, Seyoung; Son, Youngsu; Choi, Sangkyu; Ham, Sangyong; Park, Cheolhoon

    2015-09-01

    In this study, a passive-elastic ankle exoskeleton (PEAX) with a one-way clutch mechanism was developed and then pilot-tested with vertical jumping to determine whether the PEAX is sufficiently lightweight and comfortable to be used in further biomechanical studies. The PEAX was designed to supplement the function of the Achilles tendon and ligaments as they passively support the ankle torque with their inherent stiffness. The main frame of the PEAX consists of upper and lower parts connected to each other by tension springs (N = 3) and lubricated hinge joints. The upper part has an offset angle of 5° with respect to the vertical line when the springs are in their resting state. Each spring has a slack length of 8 cm and connects the upper part to the tailrod of the lower part in the neutral position. The tailrod freely rotates with low friction but has a limited range of motion due to the stop pin working as a one-way clutch. Because of the one-way clutch system, the tension springs store the elastic energy only due to an ankle dorsiflexion when triggered by the stop pin. This clutch mechanism also has the advantage of preventing any inconvenience during ankle plantarflexion because it does not limit the ankle joint motion during the plantarflexion phase. In pilot jumping tests, all of the subjects reported that the PEAX was comfortable for jumping due to its lightweight (approximately 1 kg) and compact (firmly integrated with shoes) design, and subjects were able to nearly reach their maximum vertical jump heights while wearing the PEAX. During the countermovement jump, elastic energy was stored during dorsiflexion by spring extension and released during plantarflexion by spring restoration, indicating that the passive spring torque (i.e., supportive torque) generated by the ankle exoskeleton partially supported the ankle joint torque throughout the process.

  5. Design of a simple, lightweight, passive-elastic ankle exoskeleton supporting ankle joint stiffness

    NASA Astrophysics Data System (ADS)

    Kim, Seyoung; Son, Youngsu; Choi, Sangkyu; Ham, Sangyong; Park, Cheolhoon

    2015-09-01

    In this study, a passive-elastic ankle exoskeleton (PEAX) with a one-way clutch mechanism was developed and then pilot-tested with vertical jumping to determine whether the PEAX is sufficiently lightweight and comfortable to be used in further biomechanical studies. The PEAX was designed to supplement the function of the Achilles tendon and ligaments as they passively support the ankle torque with their inherent stiffness. The main frame of the PEAX consists of upper and lower parts connected to each other by tension springs (N = 3) and lubricated hinge joints. The upper part has an offset angle of 5° with respect to the vertical line when the springs are in their resting state. Each spring has a slack length of 8 cm and connects the upper part to the tailrod of the lower part in the neutral position. The tailrod freely rotates with low friction but has a limited range of motion due to the stop pin working as a one-way clutch. Because of the one-way clutch system, the tension springs store the elastic energy only due to an ankle dorsiflexion when triggered by the stop pin. This clutch mechanism also has the advantage of preventing any inconvenience during ankle plantarflexion because it does not limit the ankle joint motion during the plantarflexion phase. In pilot jumping tests, all of the subjects reported that the PEAX was comfortable for jumping due to its lightweight (approximately 1 kg) and compact (firmly integrated with shoes) design, and subjects were able to nearly reach their maximum vertical jump heights while wearing the PEAX. During the countermovement jump, elastic energy was stored during dorsiflexion by spring extension and released during plantarflexion by spring restoration, indicating that the passive spring torque (i.e., supportive torque) generated by the ankle exoskeleton partially supported the ankle joint torque throughout the process.

  6. Attention and working memory in elderly: the influence of a distracting environment.

    PubMed

    Rodrigues, Pedro F S; Pandeirada, Josefa N S

    2015-02-01

    The present work investigated the effect of a distracting environment in the performance of attentional and working memory (WM) tasks in elderly participants. To this end, forty elderly performed two attentional tasks (simple reaction time and go/no-go tasks), and three WM tasks (arithmetic, memory for digits and sequences of letters and numbers). Each participant performed the tasks in a distracting and a non-distracting environment, with an interval of 14-21 days between sessions. The results revealed better performance in the attentional tasks when these were done in the non-distracting environment, as compared to when they were done in the distracting environment. Specifically, participants provided more accurate responses, fewer false alarms and omissions when responding in the non-distracting environment than when responding in the distracting environment. Participants were also faster at providing correct responses in the go/no-go task when it was performed in the non-distracting environment. As for the memory tasks, the effect of type of environment was significant only in the memory for digits in a forward direction task. Our data suggest the need to consider the potential damaging consequences of distracting environments when the elderly have to perform tasks that demand their attention. Specific examples of such situations are presented in the discussion (e.g., distracting effect of environment on medical and on psychological evaluations).

  7. Attention and working memory in elderly: the influence of a distracting environment.

    PubMed

    Rodrigues, Pedro F S; Pandeirada, Josefa N S

    2015-02-01

    The present work investigated the effect of a distracting environment in the performance of attentional and working memory (WM) tasks in elderly participants. To this end, forty elderly performed two attentional tasks (simple reaction time and go/no-go tasks), and three WM tasks (arithmetic, memory for digits and sequences of letters and numbers). Each participant performed the tasks in a distracting and a non-distracting environment, with an interval of 14-21 days between sessions. The results revealed better performance in the attentional tasks when these were done in the non-distracting environment, as compared to when they were done in the distracting environment. Specifically, participants provided more accurate responses, fewer false alarms and omissions when responding in the non-distracting environment than when responding in the distracting environment. Participants were also faster at providing correct responses in the go/no-go task when it was performed in the non-distracting environment. As for the memory tasks, the effect of type of environment was significant only in the memory for digits in a forward direction task. Our data suggest the need to consider the potential damaging consequences of distracting environments when the elderly have to perform tasks that demand their attention. Specific examples of such situations are presented in the discussion (e.g., distracting effect of environment on medical and on psychological evaluations). PMID:25117544

  8. Does attention capacity moderate the effect of driver distraction in older drivers?

    PubMed

    Cuenen, Ariane; Jongen, Ellen M M; Brijs, Tom; Brijs, Kris; Lutin, Mark; Van Vlierden, Karin; Wets, Geert

    2015-04-01

    With age, a decline in attention capacity may occur and this may impact driving performance especially while distracted. Although the effect of distraction on driving performance of older drivers has been investigated, the moderating effect of attention capacity on driving performance during distraction has not been investigated yet. Therefore, the aim was to investigate whether attention capacity has a moderating effect on older drivers' driving performance during visual distraction (experiment 1) and cognitive distraction (experiment 2). In a fixed-based driving simulator, older drivers completed a driving task without and with visual distraction (experiment 1, N=17, mean age 78 years) or cognitive distraction (experiment 2, N=35, mean age 76 years). Several specific driving measures of varying complexity (i.e., speed, lane keeping, following distance, braking behavior, and crashes) were investigated. In addition to these objective driving measures, subjective measures of workload and driving performance were also included. In experiment 1, crash occurrence increased with visual distraction and was negatively related to attention capacity. In experiment 2, complete stops at stop signs decreased, initiation of braking at pedestrian crossings was later, and crash occurrence increased with cognitive distraction. Interestingly, for a measure of lane keeping (i.e., standard deviation of lateral lane position (SDLP)), effects of both types of distraction were moderated by attention capacity. Despite the decrease of driving performance with distraction, participants estimated their driving performance during distraction as good. These results imply that attention capacity is important for driving. Driver assessment and training programs might therefore focus on attention capacity. Nonetheless, it is crucial to eliminate driver distraction as much as possible given the deterioration of performance on several driving measures in those with low and high attention capacity.

  9. Distraction osteogenesis for the cleft lip and palate patient.

    PubMed

    Molina, Fernando

    2004-04-01

    Gradual maxillary distraction by modified osteotomies and external force systems is a procedure with minimal morbidity and few complications. The interaction between surgeons and orthodontists is critical, however. The wide range of possibilities for remodeling a hypoplastic maxilla by distraction allows the potential to simultaneously advance and to elongate the midface, thereby restructuring the skeletal framework with mature new bone. An expansion of all the soft tissues of the face and palate (muscles, nerves, vessels, mucosa, skin) occurs in conjunction with bone elongation. This process ultimately produces excellent functional and aesthetic results in patients with midface deficiency, thus restoring their facial appearance and avoiding many years of facial deformity and associated psychologic sequelae. PMID:15145670

  10. The potential roles of nanobiomaterials in distraction osteogenesis.

    PubMed

    Makhdom, Asim M; Nayef, Lamees; Tabrizian, Maryam; Hamdy, Reggie C

    2015-01-01

    Distraction osteogenesis (DO) technique is used worldwide to treat many orthopedic conditions. Although successful, one limitation of this technique is the extended period of fixators until the bone is consolidated. The application of growth factors (GFs) is one promising approach to accelerate bone regeneration during DO. Despite promising in vivo results, its use is still limited in the clinic. This is secondary to inherent limitations of these GFs. Therefore, a development of delivery systems that allow sustained sequential release is necessary. Nanoparticles and nanocomposites have prevailing properties that can overcome the limitations of the current delivery systems. In addition, their use can overcome the current challenges associated with the insufficient mechanical properties of scaffolds and suboptimal osteogenic differentiation of transplanted cells in the distraction gap. We discuss the clinical implications, and potential early applications of the nanoparticles and nanocomposites for developing new treatments to accelerate bone regeneration in DO.

  11. Distractibility during infants' examining and repetitive rhythmic activity.

    PubMed

    Doolittle, E J; Ruff, H A

    1998-05-01

    The goal of this study was to assess the role of examining and repetitive rhythmic activity in infants' exploration of novel objects. Sixteen 8-month-old infants played with novel toys as auditory-visual slide distractors occurred on one side at random intervals. The results showed that examining, but not repetitive activities, declined with exposure to the objects. They also showed that infants had different patterns of distractibility during examining and repetitive rhythmic activities. The infants were slower to turn to the distractor if they were examining the toy than if they were engaged in other activity, but the probability of a response did not differ. In contrast, when engaged in repetitive rhythmic activity, infants were less likely to respond to the distractor than when engaged in other activities, including examining; the speed with which they responded, however, did not differ. The results suggest that, during these two activities, the mechanisms for resisting distraction are quite different. PMID:9589216

  12. Reducing Smoking Among Distracted Individuals: A Preliminary Investigation

    PubMed Central

    Wallaert, Matthew; Mann, Traci

    2014-01-01

    Introduction: According to the attentional myopia model, salient cues that serve to inhibit behavior can be especially effective under conditions of limited attention. A small field study tested the implications of this model for smoking reduction. Methods: Twenty-three undergraduate smokers were exposed to a prominent health warning for 2 5-day experimental phases, with phase order counterbalanced across participants. During one phase, participants simply viewed the warning at regular intervals. During the other phase, participants viewed the warning for the same duration but also simultaneously performed a distracting cognitive load task. Results: Participants in the phase that combined a health warning with cognitive load reported smoking significantly fewer cigarettes and taking significantly fewer puffs of smoke as compared to a baseline comparison phase—a reduction in smoking not observed in the absence of cognitive load. Conclusions: Sources of attentional distraction may heighten the impact of salient smoking warnings, resulting in significant reductions in smoking. PMID:25098673

  13. Neonatal mandibular distraction in a patient with Treacher Collins syndrome.

    PubMed

    Brevi, Bruno Carlo; Leporati, Massimiliano; Sesenna, Enrico

    2015-01-01

    The purpose of this study was to analyze a case of mandibular distraction in a case of Treacher Collins syndrome. Mandibular distraction is an adequate surgical treatment of patients with Pierre Robin sequence and represents an alternative to tracheostomy. In severe hypoplastic cases or when three-dimensional vector control or gonial angle control is necessary, extraoral bidirectional or multidirectional devices have an advantage over intraoral devices. The anchorage obtained with transfixing Kirschner wires fixed in the mandibular distal segment and symphysis is crucial in neonates for the stability of the devices. Moreover, with the use of a second pin for each bone segment, the extraoral devices allow to modify the vector orientation and consequently the shape of the newly formed mandible.

  14. Diminished Foot and Ankle Muscle Volumes in Young Adults With Chronic Ankle Instability

    PubMed Central

    Feger, Mark A.; Snell, Shannon; Handsfield, Geoffrey G.; Blemker, Silvia S.; Wombacher, Emily; Fry, Rachel; Hart, Joseph M.; Saliba, Susan A.; Park, Joseph S.; Hertel, Jay

    2016-01-01

    Background: Patients with chronic ankle instability (CAI) have demonstrated altered neuromuscular function and decreased muscle strength when compared with healthy counterparts without a history of ankle sprain. Up to this point, muscle volumes have not been analyzed in patients with CAI to determine whether deficits in muscle size are present following recurrent sprain. Purpose: To analyze intrinsic and extrinsic foot and ankle muscle volumes and 4-way ankle strength in young adults with and without CAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Five patients with CAI (mean age, 23.0 ± 4 years; 1 male, 4 females) and 5 healthy controls (mean age, 23.8 ± 4.5 years; 1 male, 4 females) volunteered for this study. Novel fast-acquisition magnetic resonance imaging (MRI) was used to scan from above the femoral condyles through the foot and ankle. The perimeter of each muscle was outlined on each axial slice and then the 2-dimensional area was multiplied by the slice thickness (5 mm) to calculate the muscle volume. Plantar flexion, dorsiflexion, inversion, and eversion isometric strength were measured using a handheld dynamometer. Patients with CAI were compared with healthy controls on all measures of muscle volume and strength. Extrinsic muscle volumes of patients with CAI were also compared with a normative database of healthy controls (n = 24) by calculating z scores for each muscle individually for each CAI subject. Results: The CAI group had smaller total shank, superficial posterior compartment, soleus, adductor hallucis obliqus, and flexor hallucis brevis muscle volumes compared with healthy controls as indicated by group means and associated 90% CIs that did not overlap. Cohen d effect sizes for the significant group differences were all large and ranged from 1.46 to 3.52, with 90% CIs that did not cross zero. The CAI group had lower eversion, dorsiflexion, and 4-way composite ankle strength, all with group means and associated 90

  15. Effects of Nintendo Wii Fit Plus training on ankle strength with functional ankle instability

    PubMed Central

    Kim, Ki-Jong; Jun, Hyun-Ju; Heo, Myoung

    2015-01-01

    [Purpose] The objective of this study was to examine the effects of a training program using the Nintendo Wii Fit Plus on the ankle muscle strengths of subjects with functional ankle instability. [Subjects and Methods] This study was conducted using subjects in their 20s who had functional ankle instability. They were randomized to a strengthening training group and a balance training group with 10 subjects in each, and they performed an exercise using Nintendo Wii Fit Plus for 20 minutes. In addition, every participant completed preparation and finishing exercises for 5 minutes, respectively. [Results] The muscle strengths after conducting plantar flexion and dorsiflexion significantly increased at the angular velocities of 60° and 120° in the strengthening training group. Furthermore, the muscle strengths after conducting plantar flexion, dorsiflexion, eversion, and inversion significantly increased at the angular velocities of 60° and 120° in the balance training group. [Conclusion] The balance training group using Nintendo Wii Fit Plus showed better results than the strengthening training group. Consequently, it is recommended to add the balance training program of the Nintendo Wii Fit Plus to conventional exercise programs to improve ankle muscle strength in functional ankle instability at a low cost. PMID:26696703

  16. The effects of ankle Kinesio taping on ankle stiffness and dynamic balance.

    PubMed

    Fayson, Shirleeah D; Needle, Alan R; Kaminski, Thomas W

    2013-01-01

    The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted. PMID:23777376

  17. Effects of Nintendo Wii Fit Plus training on ankle strength with functional ankle instability.

    PubMed

    Kim, Ki-Jong; Jun, Hyun-Ju; Heo, Myoung

    2015-11-01

    [Purpose] The objective of this study was to examine the effects of a training program using the Nintendo Wii Fit Plus on the ankle muscle strengths of subjects with functional ankle instability. [Subjects and Methods] This study was conducted using subjects in their 20s who had functional ankle instability. They were randomized to a strengthening training group and a balance training group with 10 subjects in each, and they performed an exercise using Nintendo Wii Fit Plus for 20 minutes. In addition, every participant completed preparation and finishing exercises for 5 minutes, respectively. [Results] The muscle strengths after conducting plantar flexion and dorsiflexion significantly increased at the angular velocities of 60° and 120° in the strengthening training group. Furthermore, the muscle strengths after conducting plantar flexion, dorsiflexion, eversion, and inversion significantly increased at the angular velocities of 60° and 120° in the balance training group. [Conclusion] The balance training group using Nintendo Wii Fit Plus showed better results than the strengthening training group. Consequently, it is recommended to add the balance training program of the Nintendo Wii Fit Plus to conventional exercise programs to improve ankle muscle strength in functional ankle instability at a low cost.

  18. The effects of ankle Kinesio taping on ankle stiffness and dynamic balance.

    PubMed

    Fayson, Shirleeah D; Needle, Alan R; Kaminski, Thomas W

    2013-01-01

    The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted.

  19. Effects of Nintendo Wii Fit Plus training on ankle strength with functional ankle instability.

    PubMed

    Kim, Ki-Jong; Jun, Hyun-Ju; Heo, Myoung

    2015-11-01

    [Purpose] The objective of this study was to examine the effects of a training program using the Nintendo Wii Fit Plus on the ankle muscle strengths of subjects with functional ankle instability. [Subjects and Methods] This study was conducted using subjects in their 20s who had functional ankle instability. They were randomized to a strengthening training group and a balance training group with 10 subjects in each, and they performed an exercise using Nintendo Wii Fit Plus for 20 minutes. In addition, every participant completed preparation and finishing exercises for 5 minutes, respectively. [Results] The muscle strengths after conducting plantar flexion and dorsiflexion significantly increased at the angular velocities of 60° and 120° in the strengthening training group. Furthermore, the muscle strengths after conducting plantar flexion, dorsiflexion, eversion, and inversion significantly increased at the angular velocities of 60° and 120° in the balance training group. [Conclusion] The balance training group using Nintendo Wii Fit Plus showed better results than the strengthening training group. Consequently, it is recommended to add the balance training program of the Nintendo Wii Fit Plus to conventional exercise programs to improve ankle muscle strength in functional ankle instability at a low cost. PMID:26696703

  20. REHABILITATION AFTER HIP ARTHROSCOPY AND LABRAL REPAIR IN A HIGH SCHOOL FOOTBALL ATHLETE

    PubMed Central

    Kolber, Morey J.

    2012-01-01

    Study Design: Case Report Background: Femoral acetabular impingement (FAI) has been implicated in the etiology of acetabular labral tears. The rehabilitation of younger athletes following arthroscopic surgery for FAI and labral tears is often complex and multifactorial. A paucity of evidence exists to describe the rehabilitation of younger athletes who have undergone arthroscopic hip surgery. Case Presentation: This case report describes a four-phase rehabilitation program for a high school football player who underwent hip arthroscopy with a labral repair and chondroplasty. Outcomes: The player returned to training for football 16 weeks later and at the 4 month follow-up was pain free with no signs of FAI. Discussion: There is little evidence regarding the rehabilitation of younger athletes who undergo arthroscopic hip surgery. This case study described a four phase rehabilitation program for a high school football player who underwent hip arthroscopy and labral repair. The patient achieved positive outcomes with a full return to athletic activity and football. The overall success of these patients depends on the appropriate surgical procedure and rehabilitation program. Key Words: Femoral acetabular impingement (FAI), hip, hip impingement Level of evidence: 4-Case report PMID:22530192

  1. Experience with Mandibular Reconstruction Using Transport-Disc-Distraction Osteogenesis

    PubMed Central

    Pingarrón-Martín, Lorena; Otero, T. González; Gallo, L.J. Arias

    2014-01-01

    The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors' knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients' education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes. PMID:26000082

  2. U.S. State and Federal Laws Targeting Distracted Driving

    PubMed Central

    Catherine Chase, J.D.

    2014-01-01

    Distracted driving has burgeoned with the proliferation of cell phones, global positioning systems and other in-vehicle and personal electronic devices. Annually more than 3,300 people are killed and an additional 400,000 are injured in the United States in distracted driving crashes. The United States (U.S.) federal and state governments have responded to this public health problem with policies and laws; however, a more comprehensive and more effective approach is still needed. Some restrictions on the use of electronic devices while driving by federal employees and some voluntary guidelines and recommendations have been issued. Public opinion polls show support for addressing the issue of distracted driving with state laws. The majority of states have laws banning text messaging while driving and prohibiting the use of an electronic device by teenage or novice drivers. Some states prohibit all drivers from using a hand-held cellphone. Currently no state has a total ban on the use of personal electronic devices while driving. Successful past traffic safety campaigns changing driver behavior have demonstrated the necessity to adopt a “three Es” approach of Enactment of a law, Education of the public about the law, and rigorous Enforcement of the law. Experience reveals that this approach, along with future federal regulation of in-vehicle electronic devices and the employment of technology to limit the use of electronic devices while driving, is needed to alter personal behavior in order to reduce distractions and keep drivers focused on the driving task. PMID:24776229

  3. Mechanics of knee and ankle bandages.

    PubMed

    Viljakka, T

    1986-02-01

    Different types of bandages were tested mechanically and clinically. Four elastic and three elastic adhesive bandages were mechanically tested. The former proved better. Seven different ankle bandages and three knee bandages were tested in a simulated clinical situation, measuring the pressure which developed while walking for 15, 50 and 100 min, and immediately after application of the bandage. The bandages slackened most markedly during the first period of walking. The compression pressure of the padded adhesive ankle bandage was lower than that produced by most other bandages. The padded adhesive and elastic bandages proved to be most suitable for clinical use. The padded knee bandage produced a lower compression load than the elastic bandage tested. On the basis of this trial we recommend the use of a padded knee bandage.

  4. Imaging in Foot and Ankle Arthritis.

    PubMed

    Wilkinson, Victoria H; Rowbotham, Emma L; Grainger, Andrew J

    2016-04-01

    The foot and ankle are commonly involved in a range of arthritides that affect the joints, bones, and soft tissues. Accurate plain film interpretation can often aid the diagnosis and monitor disease progression and treatment response. Ultrasound and MRI afford superior depiction of the soft tissues, and advances over recent years have centered on early detection of synovitis, enabling earlier diagnosis and treatment. Advantages and disadvantages of the imaging techniques of radiography, multidetector computed tomography, ultrasound, and MRI are discussed, as is optimization of these modalities for the assessment of the anatomically complex joints of the foot and ankle. Diagnostic features enabling differentiation between rheumatoid arthritis, seronegative spondyloarthropathies, osteoarthritis, gout, crystal deposition disease, pigmented villonodular synovitis, Charcot arthropathy, septic arthritis, synovial osteochondromatosis, hemophilia, and reflex sympathetic dystrophy are also reviewed. PMID:27336451

  5. Critical phase distractions in anaesthesia and the sterile cockpit concept.

    PubMed

    Broom, M A; Capek, A L; Carachi, P; Akeroyd, M A; Hilditch, G

    2011-03-01

    In aviation, the sterile cockpit rule prohibits non-essential activities during critical phases of flight, takeoff and landing, phases analogous to induction of, and emergence from, anaesthesia. We studied distraction during 30 anaesthetic inductions, maintenances and emergences. Mean (SD) noise during emergence (58.3 (6.2) dB) was higher than during induction (46.4 (4.3) dB) and maintenance (52 (4.5) dB; p<0.001). Sudden loud noises, greater than 70 dB, occurred more frequently at emergence (occurring 34 times) than at induction (occurring nine times) or maintenance (occurring 13 times). The median (IQR [range]) of staff entrances or exits were 0 (0-2 [0-7]), 6 (3-10 [1-18]) and 10 (5-12 [1-20]) for induction, maintenance and emergence, respectively (p<0.001). Conversations unrelated to the procedure occurred in 28/30 (93%) emergences. These data demonstrate increased distraction during emergence compared with other phases of anaesthesia. Recognising and minimising distraction should improve patient safety. Applying aviation's sterile cockpit rule may be a useful addition to our clinical practice.

  6. Age-related hearing loss increases cross-modal distractibility.

    PubMed

    Puschmann, Sebastian; Sandmann, Pascale; Bendixen, Alexandra; Thiel, Christiane M

    2014-10-01

    Recent electrophysiological studies have provided evidence that changes in multisensory processing in auditory cortex cannot only be observed following extensive hearing loss, but also in moderately hearing-impaired subjects. How the reduced auditory input affects audio-visual interactions is however largely unknown. Here we used a cross-modal distraction paradigm to investigate multisensory processing in elderly participants with an age-related high-frequency hearing loss as compared to young and elderly subjects with normal hearing. During the experiment, participants were simultaneously presented with independent streams of auditory and visual input and were asked to categorize either the auditory or visual information while ignoring the other modality. Unisensory sequences without any cross-modal input served as control conditions to assure that all participants were able to perform the task. While all groups performed similarly in these unisensory conditions, hearing-impaired participants showed significantly increased error rates when confronted with distracting cross-modal stimulation. This effect could be observed in both the auditory and the visual task. Supporting these findings, an additional regression analysis indicted that the degree of high-frequency hearing loss significantly modulates cross-modal visual distractibility in the auditory task. These findings provide new evidence that already a moderate sub-clinical hearing loss, a common phenomenon in the elderly population, affects the processing of audio-visual information.

  7. Supraliminal but not subliminal distracters bias working memory recall.

    PubMed

    Wildegger, Theresa; Myers, Nicholas E; Humphreys, Glyn; Nobre, Anna C

    2015-06-01

    Information of which observers are not consciously aware can nevertheless influence perceptual processes. Whether subliminal information might exert an influence on working memory (WM) representations is less clear, and relatively few studies have examined the interactions between subliminal and supraliminal information in WM. We present 3 experiments examining this issue. Experiments 1a and b replicated the finding that orientation stimuli can influence behavior subliminally in a visuomotor priming task. Experiments 2 and 3 used the same orientation stimuli, but participants had to remember a target orientation and report it back by adjusting a probe orientation after a memory delay. Before or after presentation of the target orientation, a subliminal or supraliminal distracter orientation was presented that was either irrelevant for task completion and never had to be reported (Experiment 2), or was relevant for task completion because it had to be reported on some trials (Experiment 3). In both experiments, presentation of a supraliminal distracter influenced WM recall of the target orientation. When the distracter was presented subliminally, however, there was no bias in orientation recall. These results suggest that information stored in WM is protected from influences of subliminal stimuli, while online information processing is modulated by subliminal information.

  8. Attention focusing versus distraction during exposure in dental phobia.

    PubMed

    Schmid-Leuz, Barbara; Elsesser, Karin; Lohrmann, Thomas; Jöhren, Peter; Sartory, Gudrun

    2007-11-01

    A survey of the discrepant findings regarding the effects of attention focusing and distraction on exposure suggested that subjective measures of anxiety and avoidance respond better to the latter condition, and heart rate (HR) reaction responds to the former. To test this hypothesis, 63 dental phobics were recruited who had not visited a dentist for a mean of 6.6 (1.5-25) years. Participants received a 1-h exposure session with either attention focusing or distraction. Subjective anxiety and HR to phobia-related pictures were assessed before and after the treatment session and again after 1 week. Avoidance was recorded in terms of adherence to the dental treatment schedule in the following 6 months. Contrary to expectation, state anxiety showed a greater decrease in the attention focusing than the distraction condition after 1 week. Both treatment conditions were similarly effective with regard to HR and avoidance. HR habituated in both groups after exposure and 73% of followed-up patients adhered to the dental treatment schedule. Comparison of the present with previous results suggests that the differences between attentional conditions tend to be more pronounced during shorter exposure sessions than were employed in the present study.

  9. Supraliminal But Not Subliminal Distracters Bias Working Memory Recall

    PubMed Central

    2015-01-01

    Information of which observers are not consciously aware can nevertheless influence perceptual processes. Whether subliminal information might exert an influence on working memory (WM) representations is less clear, and relatively few studies have examined the interactions between subliminal and supraliminal information in WM. We present 3 experiments examining this issue. Experiments 1a and b replicated the finding that orientation stimuli can influence behavior subliminally in a visuomotor priming task. Experiments 2 and 3 used the same orientation stimuli, but participants had to remember a target orientation and report it back by adjusting a probe orientation after a memory delay. Before or after presentation of the target orientation, a subliminal or supraliminal distracter orientation was presented that was either irrelevant for task completion and never had to be reported (Experiment 2), or was relevant for task completion because it had to be reported on some trials (Experiment 3). In both experiments, presentation of a supraliminal distracter influenced WM recall of the target orientation. When the distracter was presented subliminally, however, there was no bias in orientation recall. These results suggest that information stored in WM is protected from influences of subliminal stimuli, while online information processing is modulated by subliminal information. PMID:25867502

  10. Supraliminal but not subliminal distracters bias working memory recall.

    PubMed

    Wildegger, Theresa; Myers, Nicholas E; Humphreys, Glyn; Nobre, Anna C

    2015-06-01

    Information of which observers are not consciously aware can nevertheless influence perceptual processes. Whether subliminal information might exert an influence on working memory (WM) representations is less clear, and relatively few studies have examined the interactions between subliminal and supraliminal information in WM. We present 3 experiments examining this issue. Experiments 1a and b replicated the finding that orientation stimuli can influence behavior subliminally in a visuomotor priming task. Experiments 2 and 3 used the same orientation stimuli, but participants had to remember a target orientation and report it back by adjusting a probe orientation after a memory delay. Before or after presentation of the target orientation, a subliminal or supraliminal distracter orientation was presented that was either irrelevant for task completion and never had to be reported (Experiment 2), or was relevant for task completion because it had to be reported on some trials (Experiment 3). In both experiments, presentation of a supraliminal distracter influenced WM recall of the target orientation. When the distracter was presented subliminally, however, there was no bias in orientation recall. These results suggest that information stored in WM is protected from influences of subliminal stimuli, while online information processing is modulated by subliminal information. PMID:25867502

  11. Total ankle replacement. Early experiences with STAR prosthesis.

    PubMed Central

    Murnaghan, J. M.; Warnock, D. S.; Henderson, S. A.

    2005-01-01

    Early designs of Total Ankle Replacement (TAR) had a high failure rate. More recent experience with the 3-piece, meniscal bearing, total ankle replacement has been more promising. We report a review of the early results of our first 22 prostheses in 20 patients undergoing Scandinavian Total Ankle Replacement (STAR) in Northern Ireland. There was a mean follow-up time of 26 months. Seventeen patients are pain-free at the ankle joint during normal daily activities. Two of the early cases have required revision surgery due to technical errors. Other complications have included malleolar fractures, poor wound healing and postoperative stiffness. These early results show high levels of patient satisfaction, and we are encouraged to continue with total ankle arthroplasty. There is a steep initial learning curve and use of TAR should be restricted to foot and ankle surgeons. Images Fig 1 Figs 2a and b Figs 2 c and d PMID:16022128

  12. Participation in sports after arthrodesis of the foot or ankle.

    PubMed

    Vertullo, Christopher J; Nunley, James A

    2002-07-01

    Currently no data or guidelines exist for the surgeon on how to advise patients about returning to sports participation after arthrodesis within the foot or ankle. Sequelae of inappropriate activity after arthrodesis includes periarticular arthrosis, arthrodesis failure and stress fracture. Some arthrodeses will preclude certain sports because it limits the patient's ability to perform movement vital to the game, for example, ankle arthrodesis preventing basketball players from jumping. Questionnaires were sent to members of the American Orthopaedic Foot and Ankle Society (AOFAS) and to trainers of professional basketball and American football teams. This paper reports on the responses of orthopaedic foot and ankle surgeons about return to sports participation, after arthrodeses within the foot and ankle, and suggests guidelines for sports participation after an arthrodesis of the lower extremity. A selective sports participation policy is advised. Patients with an ankle or triple fusion should avoid high-impact sports, while those with more distal arthrodeses should be monitored for arthrosis and stress fracture.

  13. Pediatric Ankle Fractures: Concepts and Treatment Principles.

    PubMed

    Su, Alvin W; Larson, A Noelle

    2015-12-01

    Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management relies on appropriate examination, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, computed tomography. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high-risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity. PMID:26589088

  14. Diagnostic dilemmas in foot and ankle injuries

    SciTech Connect

    Keene, J.S.; Lange, R.H.

    1986-07-11

    Differential diagnosis of foot and ankle injuries should include (1) stress fractures of the great toe sesamoids, the shaft of the fifth metatarsal, and the tarsal navicular bone; (2) transchondral talar-dome fractures; (3) fractures of the os trigonum; and (4) dislocating peroneal tendons. Diagnosis of these injuries is challenging because the initial roentgenograms often are normal, and special clinical tests and ancillary studies are required.

  15. THIRD-DEGREE BURN IN THE REGION OF THE ELECTROSURGICAL PAD DURING SHOULDER ARTHROSCOPY: A CASE REPORT

    PubMed Central

    Gomide, Leandro Cardoso; Santos, Celso Eduardo Ribeiro Gonçalves; Pereira, Cleber Jesus; Carvalho, Luiz Cláudio Coelho; Queiroz, Sérgio Antônio Souza; Luciano, Roberto da Cunha; Pereira, Daniel Barros; Leocádio, Lélia Pereira

    2015-01-01

    The number of shoulder arthroscopy procedures is increasing and, because of this, the frequency of related complications is also increasing. This report presents a case of third-degree burn from an electrosurgical pad during this procedure and serves as an alert regarding the possible causes and how to try to prevent this rare, but possible complication. PMID:27026993

  16. Posterior Cranial Vault Distraction Osteogenesis with Barrel Stave Osteotomy in the Treatment of Craniosynostosis

    PubMed Central

    KOMURO, Yuzo; SHIMIZU, Azusa; SHIMOJI, Kazuaki; MIYAJIMA, Masakazu; ARAI, Hajime

    2015-01-01

    Twenty years have passed since distraction osteogenesis was introduced into the field of craniomaxillofacial surgery, with distraction osteogenesis gradually consolidating its position for midface advancement in syndromic craniosynostosis. On the other hand, no consensus has been reached regarding its adaptation to calvarial bone. We reported that distraction osteogenesis was useful in posterior cranial vault expansion, and subsequently, similar reports have been successively observed worldwide. In posterior cranial vault distraction, intracranial capacity could be greatly expanded due to its simultaneous expansion with the scalp, with little risk of relapse because new bone is regenerated in the distraction gap. The possibility was suggested that the standard of first carrying out fronto-orbital advancement (FOA) for brachycephaly observed in syndromic craniosynostosis will greatly change posterior cranial vault distraction. PMID:26226978

  17. Forces predicted at the ankle during running.

    PubMed

    Burdett, R G

    1982-01-01

    A biomechanical model of the ankle joint was developed and was used to predict the forces at the ankle during the stance phase of running. Measurements from five cadavers were averaged to obtain insertion points and directions of pull of equivalent tendons with respect to the assumed center of the ankle joint. A minimum joint force solution was obtained by assuming that only two equivalent muscle groups could exert force at one time. Three subjects ran at 4.47 m/s across a force platform that recorded the external forces and moments acting on the foot. Cinematography was used to measure the foot and leg positions during stance. Peak resultant joint forces ranging from 9.0 to 13.3 times body weight and peak Achilles tendon forces ranging from 5.3 to 10.0 times body weight were predicted. Small variations in some cases resulted in large differences in predicted forces. The highest tendon forces predicted exceeded those reported to cause damage to cadaver tendons in other studies. PMID:7132650

  18. Developing a Framework for Ankle Function: A Delphi Study

    PubMed Central

    Snyder, Kelli R.; Evans, Todd A.; Neibert, Peter J.

    2014-01-01

    Context: Addressing clinical outcomes is paramount to providing effective health care, yet there is no consensus regarding the appropriate outcomes to address after ankle injuries. Compounding the problem is the repetitive nature of lateral ankle sprains, referred to as functional (FAI) or chronic (CAI) ankle instability. Although they are commonly used terms in practice and research, FAI and CAI are inconsistently defined and assessed. Objective: To establish definitions of a healthy/normal/noninjured ankle, FAI, and CAI, as well as their characteristics and assessment techniques. Design: Delphi study. Setting: Telephone interviews and electronic surveys. Patients or Other Participants: Sixteen experts representing the fields of ankle function and treatment, ankle research, and outcomes assessment and research were selected as panelists. Data Collection and Analysis: A telephone interview produced feedback regarding the definition of, functional characteristics of, and assessment techniques for a healthy/normal/noninjured ankle, an unhealthy/acutely injured ankle, and FAI/CAI. Those data were compiled, reduced, and returned through electronic surveys and were either included by reaching consensus (80% agreement) or excluded. Results: The definitions of a healthy/normal/noninjured ankle and FAI reached consensus. Experts did not agree on a definition of CAI. Eleven functional characteristics of a healthy/normal/noninjured ankle, 32 functional characteristics of an unhealthy/acutely injured ankle, and 13 characteristics of FAI were agreed upon. Conclusions: Although a consensus was reached regarding the definitions and functional characteristics of a healthy/normal/noninjured ankle and FAI, the experts could only agree on 1 characteristic to include in the FAI definition. Several experts did, however, provide additional comments that reinforced the differences in the interpretation of those concepts. Although the experts could not agree on the definition of CAI, its

  19. Design, modelling and simulation aspects of an ankle rehabilitation device

    NASA Astrophysics Data System (ADS)

    Racu, C. M.; Doroftei, I.

    2016-08-01

    Ankle injuries are amongst the most common injuries of the lower limb. Besides initial treatment, rehabilitation of the patients plays a crucial role for future activities and proper functionality of the foot. Traditionally, ankle injuries are rehabilitated via physiotherapy, using simple equipment like elastic bands and rollers, requiring intensive efforts of therapists and patients. Thus, the need of robotic devices emerges. In this paper, the design concept and some modelling and simulation aspects of a novel ankle rehabilitation device are presented.

  20. Entrapment of the flexor hallucis longus tendon following ankle arthrodesis.

    PubMed

    Keith, Troy; Robinson, Andrew H N

    2016-03-01

    Impingement following arthroscopic ankle arthrodesis has not been reported in the literature previously. We present a case report of a 68-year-old male 9 months following an uncomplicated arthroscopic ankle fusion presenting with persistent posteromedial ankle pain. Flexor hallucis longus (FHL) tendon impingement resulting from a prominent os trigonum was identified. This was successfully treated utilising hindfoot endoscopy with excision of the os trigonum and FHL release.

  1. Ankle-Knee prosthesis with powered ankle and energy transfer for CYBERLEGs α-prototype.

    PubMed

    Geeroms, J; Flynn, L; Jimenez-Fabian, R; Vanderborght, B; Lefeber, D

    2013-06-01

    Restoring natural walking for amputees has been increasingly investigated because of demographic evolution, leading to increased number of amputations, and increasing demand for independence. The energetic disadvantages of passive pros-theses are clear, and active prostheses are limited in autonomy. This paper presents the simulation, design and development of an actuated knee-ankle prosthesis based on a variable stiffness actuator with energy transfer from the knee to the ankle. This approach allows a good approximation of the joint torques and the kinematics of the human gait cycle while maintaining compliant joints and reducing energy consumption during level walking. This first prototype consists of a passive knee and an active ankle, which are energetically coupled to reduce the power consumption.

  2. Potential Distractions and Unsafe Driving Behaviors Among Drivers of 1- to 12-year-old Children

    PubMed Central

    Macy, Michelle L.; Carter, Patrick M.; Bingham, C. Raymond; Cunningham, Rebecca M.; Freed, Gary L.

    2014-01-01

    Objective Driver distraction has been identified as a threat to individual drivers and public health. Motor vehicle collisions remain a leading cause of death for children yet little is known about distractions among drivers of children. This study sought to characterize potential distractions among drivers of children. Methods A two-site, cross-sectional, computerized survey of child passenger safety practices was conducted among adult drivers of 1- to 12-year-old children who presented for emergency care between October 2011-May 2012. Drivers indicated the frequency with which they engaged in ten potential distractions in the past month while driving with their child. Distractions were grouped in four categories: 1) non-driving, 2) cellular phone, 3) child, 4) directions. Information about other unsafe driving behaviors and sociodemographic characteristics was collected. Results Nearly 90% of eligible parents participated. Analysis included 570 (92.2%) drivers. Non-driving and cellular phone-related distractions were disclosed by >75% of participants. Fewer participants disclosed child (71.2%) and directions-related distractions (51.9%). Child age was associated with each distraction category. Cellular phone-related distractions were associated with the child riding daily in the family car, non-Hispanic white and other race/ethnicity, and higher education. Parents admitting to drowsy driving and being pulled over for speeding had over two-times higher odds of disclosing distractions from each category. Conclusions Distracted driving activities are common among drivers of child passengers and associated with other unsafe driving behaviors. Child passenger safety may be improved by preventing crash events through the reduction or elimination of distractions among drivers of child passengers. PMID:24767781

  3. Novel Rigid External Distraction Device Improves Stability and Controls the Vector During Midfacial Advancement.

    PubMed

    Resnick, Cory M; Rottgers, Stephen Alex; Langenfeld, Christopher C; Mulliken, John B; Padwa, Bonnie L

    2016-06-01

    The major limitation of the rigid external devices currently used for midfacial distraction after subcranial Le Fort III osteotomies is the ductile wire that connects the midface to the device, which makes it difficult to control the vector and force during distraction. The authors describe a novel external appliance that addresses this and other problems of contemporary devices, and application of a custom cranial template that facilitates precise placement of the device to achieve the planned vector of distraction.

  4. [Measurement ofthe ankle-brachial pressure index (ABPI)].

    PubMed

    Kulisić, Sandra Marinović

    2012-10-01

    Measurement of the ankle-brachial pressure index, also known as ankle-brachial index or ankle-arm index is a ratio of the ankle blood pressure and brachial blood pressure. It is easy to perform and allows for diagnosis and further definition of the severity of peripheral arterial disease with sensitivity 90% and specificity 98%. The test is not appropriate for mild arterial changes as in case of comorbidity. Its further objectives are to identify patients at an higher risk of cardiovascular events. PMID:23193828

  5. Ankle arthritis: review of diagnosis and operative management.

    PubMed

    Grunfeld, Robert; Aydogan, Umur; Juliano, Paul

    2014-03-01

    The diagnostic and therapeutic options for ankle arthritis are reviewed. The current standard of care for nonoperative options include the use of nonsteroidal antiinflammatory drugs, corticosteroid injections, orthotics, and ankle braces. Other modalities lack high-quality research studies to delineate their appropriateness and effectiveness. The gold standard for operative intervention in end-stage degenerative arthritis remains arthrodesis, but evidence for the superiority in functional outcomes of total ankle arthroplasty is increasing. The next few years will enable more informed decisions and, with more prospective high-quality studies, the most appropriate patient population for total ankle arthroplasty can be identified.

  6. Short-term ankle motor performance with ankle robotics training in chronic hemiparetic stroke.

    PubMed

    Roy, Anindo; Forrester, Larry W; Macko, Richard F

    2011-01-01

    Cerebrovascular accident (stroke) often results in impaired motor control and persistent weakness that may lead to chronic disability, including deficits in gait and balance function. Finding ways to restore motor control may help reduce these deficits; however, little is known regarding the capacity or temporal profile of short-term motor adaptations and learning at the hemiparetic ankle. Our objective was to determine the short-term effects of a single session of impedance-controlled ankle robot ("anklebot") training on paretic ankle motor control in chronic stroke. This was a double-arm pilot study on a convenience sample of participants with chronic stroke (n = 7) who had residual hemiparetic deficits and an equal number of age- and sex-matched nondisabled control subjects. Training consisted of participants in each group playing a target-based video game with the anklebot for an hour, for a total of 560 movement repetitions in dorsiflexion/plantar flexion ranges followed by retest 48 hours later. Task difficulty was adjusted to ankle range of motion, with robotic assistance decreased incrementally across training. Assessments included robotic measures of ankle motor control on unassisted trials before and after training and at 48 hours after training. Following exposure to the task, subjects with stroke improved paretic ankle motor control across a single training session as indexed by increased targeting accuracy (21.6 +/- 8.0 to 31.4 +/- 4.8, p = 0.05), higher angular speeds (mean: 4.7 +/- 1.5 degrees/s to 6.5 +/- 2.6 degrees/s, p < 0.01, peak: 42.8 +/- 9.0 degrees/s to 45.6 +/- 9.4 degrees/s, p = 0.03), and smoother movements (normalized jerk: 654.1 +/- 103.3 s(-2) to 537.6 +/- 86.7 s(-2), p < 0.005, number of speed peaks: 27.1 +/- 5.8 to 23.7 +/- 4.1, p < 0.01). In contrast, nondisabled subjects did not make statistically significant gains in any metric after training except in the number of successful passages (32.3 +/- 7.5 to 36.5 +/- 6.4, p = 0

  7. Assessment of Intraoperative Intra-articular Morphine and Clonidine Injection in the Acute Postoperative Period After Hip Arthroscopy

    PubMed Central

    Cogan, Charles J.; Knesek, Michael; Tjong, Vehniah K.; Nair, Rueben; Kahlenberg, Cynthia; Dunne, Kevin F.; Kendall, Mark C.; Terry, Michael A.

    2016-01-01

    Background: Previous authors have suggested that intra-articular morphine and clonidine injections after knee arthroscopy have demonstrated equivocal analgesic effect in comparison with bupivacaine while circumventing the issue of chondrotoxicity. There have been no studies evaluating the effect of intra-articular morphine after hip arthroscopy. Purpose: To evaluate the efficacy of intra-articular morphine in combination with clonidine on postoperative pain and narcotic consumption after hip arthroscopy surgery for femoroacetabular impingement. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was performed on 43 patients that underwent hip arthroscopy for femoroacetabular impingement at a single institution between September 2014 and May 2015. All patients received preoperative celecoxib and acetaminophen, and 22 patients received an additional intra-articular injection of 10 mg morphine and 100 μg of clonidine at the conclusion of the procedure. Narcotic consumption, duration of anesthesia recovery, and perioperative pain scores were compared between the 2 groups. Results: Patients who received intra-articular morphine and clonidine used significantly less opioid analgesic (mEq) in the postanesthesia recovery (median difference, 17 mEq [95% CI, –32 to –2 mEq]; P = .02) compared with the control group. There were no differences in time spent in recovery before hospital discharge or in visual analog pain scores recorded immediately postoperatively and at 1 hour after surgery. Conclusion: Intraoperative intra-articular injection of morphine and clonidine significantly reduced the narcotic requirement during the postsurgical recovery period after hip arthroscopy. The reduction in postsurgical opioids may decrease adverse effects, improve overall pain management, and lead to better quality of recovery and improved patient satisfaction. PMID:26977421

  8. A simplified modification of a reconstruction plate into a mandibular transport distraction device: A technical note

    PubMed Central

    Mohanty, Sujata; Dabas, Jitender; Gupta, Rekha

    2015-01-01

    Transport distraction is nowadays gaining enormous popularity and is becoming a promising option for reconstruction of mandibular defects. However, the vast number of distraction device designs create huge confusion in the clinician's mind to choose the right one. Considering these complex and costly designs, the authors decided to find a simplified way of combining a modified conventional reconstruction plate and monofocal distraction device that can act as a transport distraction device for bridging of bony defects. A case performed by this technique and device has been presented along with the description of device design. PMID:26933289

  9. Greater priming for previously distracting information in young than older adults when suppression is ruled out.

    PubMed

    Ward, Emma V; de Mornay Davies, Paul; Politimou, Nina

    2015-01-01

    The use of previously distracting information on memory tests with indirect instructions is usually age-equivalent, while young adults typically show greater explicit memory for such information. This could reflect qualitatively distinct initial processing (encoding) of distracting information by younger and older adults, but could also be caused by greater suppression of such information by younger adults on tasks with indirect instructions. In Experiment 1, young and older adults read stories containing distracting words, which they ignored, before studying a list of words containing previously distracting items for a free recall task. Half the participants were informed of the presence of previously distracting items in the study list prior to recall (direct instruction), and half were not (indirect instruction). Recall of previously distracting words was age-equivalent in the indirect condition, but young adults recalled more distracting words in the direct condition. In Experiment 2, participants performed the continuous identification with recognition task, which captures a measure of perceptual priming and recognition on each trial, and is immune to suppression. Priming and recognition of previously distracting words was greater in younger than older adults, suggesting that the young engage in more successful suppression of previously distracting information on tasks in which its relevance is not overtly signaled.

  10. The role of alcohol use on recent trends in distracted driving.

    PubMed

    Wilson, Fernando A; Stimpson, Jim P; Tibbits, Melissa K

    2013-11-01

    Distracted driving is now an increasingly deadly threat to road safety. We provide evidence that intoxicated driving is increasingly responsible for recent increases in fatalities from distracted driving crashes. This study describes trends in deaths on U.S. public roads caused by alcohol-involved and distracted drivers using the Fatality Analysis Reporting System (FARS)-a census of fatal crashes on U.S. public roads. Fatality rates per vehicle-miles traveled are calculated using data from the Federal Highway Administration. Alcohol-involved drivers who are simultaneously distracted were responsible for 1750 deaths in 2009, an increase of more than 63% from 2005 when there were 1072 deaths. Alcohol use while driving is increasingly responsible for a growing number of fatalities from distracted driving, accounting for 32% of deaths from distracted driving in 2009 versus 24% in 2005. The fatality rate from these crashes increased from 35.9 to 59.2 deaths per 100 billion vehicle-miles traveled after 2005. Alcohol use is quickly increasing as an important factor behind distracted driving fatalities. This has implications for policies combating distracted driving that do not address the role of alcohol use in distracted driving. PMID:24076300

  11. Mandibular lengthening by distraction osteogenesis in the setting of osteogenesis imperfecta.

    PubMed

    Black, Jonathan S; Denny, Arlen D

    2015-01-01

    Osteogenesis imperfecta (OI) is an inherited disorder characterized by bone fragility and deformity. The craniofacial skeleton may be involved either primarily or by result of a concomitant diagnosis. Distraction osteogenesis has emerged as a versatile reconstructive option for many craniofacial deformities. Mandibular lengthening by distraction has not been reported in a patient with OI. We present a patient in whom mandibular lengthening was successfully performed twice for hemifacial microsomia. Bilateral lengthening was initially performed with successful airway improvement. This was followed by transport distraction on the more severely affected side for condylar reconstruction. Successful mandibular lengthening by distraction is possible in the setting of OI. PMID:25565236

  12. Assessment study of insight ARTHRO VR (®) arthroscopy virtual training simulator: face, content, and construct validities.

    PubMed

    Bayona, Sofía; Fernández-Arroyo, José Manuel; Martín, Isaac; Bayona, Pilar

    2008-09-01

    The aims of this study were to test the face, content, and construct validities of a virtual-reality haptic arthroscopy simulator and to validate four assessment hypothesis. The participants in our study were 94 arthroscopists attending an international conference on arthroscopy. The interviewed surgeons had been performing arthroscopies for a mean of 8.71 years (σ = 6.94 years). We explained the operation, functionality, instructions for use, and the exercises provided by the simulator. They performed a trial exercise and then an exercise in which performance was recorded. After having using it, the arthroscopists answered a questionnaire. The simulator was classified as one of the best training methods (over phantoms), and obtained a mark of 7.10 out of 10 as an evaluation tool. The simulator was considered more useful for inexperienced surgeons than for surgeons with experience (mean difference 1.88 out of 10, P value < 0.001). The participants valued the simulator at 8.24 as a tool for learning skills, its fidelity at 7.41, the quality of the platform at 7.54, and the content of the exercises at 7.09. It obtained a global score of 7.82. Of the subjects, 30.8% said they would practise with the simulator more than 6 h per week. Of the surgeons, 89.4% affirmed that they would recommend the simulator to their colleagues. The data gathered support the first three hypotheses, as well as face and content validities. Results show statistically significant differences between experts and novices, thus supporting the construct validity, but studies with a larger sample must be carried out to verify this. We propose concrete solutions and an equation to calculate economy of movement. Analogously, we analyze competence measurements and propose an equation to provide a single measurement that contains them all and that, according to the surgeons' criteria, is as reliable as the judgment of experts observing the performance of an apprentice.

  13. Assessment study of insight ARTHRO VR (®) arthroscopy virtual training simulator: face, content, and construct validities.

    PubMed

    Bayona, Sofía; Fernández-Arroyo, José Manuel; Martín, Isaac; Bayona, Pilar

    2008-09-01

    The aims of this study were to test the face, content, and construct validities of a virtual-reality haptic arthroscopy simulator and to validate four assessment hypothesis. The participants in our study were 94 arthroscopists attending an international conference on arthroscopy. The interviewed surgeons had been performing arthroscopies for a mean of 8.71 years (σ = 6.94 years). We explained the operation, functionality, instructions for use, and the exercises provided by the simulator. They performed a trial exercise and then an exercise in which performance was recorded. After having using it, the arthroscopists answered a questionnaire. The simulator was classified as one of the best training methods (over phantoms), and obtained a mark of 7.10 out of 10 as an evaluation tool. The simulator was considered more useful for inexperienced surgeons than for surgeons with experience (mean difference 1.88 out of 10, P value < 0.001). The participants valued the simulator at 8.24 as a tool for learning skills, its fidelity at 7.41, the quality of the platform at 7.54, and the content of the exercises at 7.09. It obtained a global score of 7.82. Of the subjects, 30.8% said they would practise with the simulator more than 6 h per week. Of the surgeons, 89.4% affirmed that they would recommend the simulator to their colleagues. The data gathered support the first three hypotheses, as well as face and content validities. Results show statistically significant differences between experts and novices, thus supporting the construct validity, but studies with a larger sample must be carried out to verify this. We propose concrete solutions and an equation to calculate economy of movement. Analogously, we analyze competence measurements and propose an equation to provide a single measurement that contains them all and that, according to the surgeons' criteria, is as reliable as the judgment of experts observing the performance of an apprentice. PMID:27628252

  14. Quantitative MRI Evaluation of Articular Cartilage Using T2 Mapping Following Hip Arthroscopy for Femoroacetabular Impingement

    PubMed Central

    Mayer, Stephanie W.; Wagner, Naomi; Fields, Kara G.; Wentzel, Catherine; Burge, Alissa; Potter, Hollis G.; Lyman, Stephen; Kelly, Bryan T.

    2016-01-01

    Objectives: Cam-type femoroacetabular impingement (FAI) causes a shearing and delamination injury to the acetabular articular cartilage due to a mismatch between the size of the femoral head and the acetabulum. This mechanism is thought to lead to early osteoarthritis in this population. Cam decompression has been advocated to eliminate impingement, with the ultimate goal of halting the progression of articular cartilage delamination. Although outcomes following this procedure in the young adult population have been favorable at short and medium term follow up, it is not known whether the articular cartilage itself is protected from further injury by changing the biomechanics of the joint with decompression of the cam morphology. The purpose of this study is to compare the pre- and post-operative integrity of the acetabular articular cartilage using T2 mapping to determine if hip arthroscopy is protective of the articular cartilage at short- to medium term follow up. Methods: Males between 18 and 35 years of age who had pre-operative T2 mapping MRIs, underwent hip arthroscopy for cam or mixed-type FAI with an alpha angle greater than 50°, and had at least 2 year follow-up were identified. Post-operative MRIs were performed and T2 relaxation times in the transition zone and weight bearing articular cartilage in the anterosuperior acetabulum at deep and superficial chondral layers were recorded at nine points on three sagittal sequences on pre and post-operative MRIs. A paired t-test was used to compare T2 relaxation values between pre-operative and post-operative scans. Results: Eleven hips were evaluated. Mean age was 26.3 years (range 21 - 35). Mean follow up time to post-operative T2 mapping MRI was 2.6 years (range 2.4 - 2.7). The change in T2 relaxation time was not significantly different between pre- and post-operative MRI scans for any of the nine regions in the deep zone of the acetabular cartilage (p=0.065 - 0.969) or the superficial zone of the

  15. Predictive Factors for Lateral Ankle Sprains: A Literature Review

    PubMed Central

    Beynnon, Bruce D.; Murphy, Darlene F.; Alosa, Denise M.

    2002-01-01

    Objective: To review the prospective studies of ankle-ligament-injury risk factors. Data Sources: We searched MEDLINE from 1978 to 2001 using the terms ankle, ligament, injury, risk factor, and epidemiology. Data Synthesis: The results included many studies on the treatment and prevention of ankle injuries. There were, however, very few prospective studies focusing on identifying the risk factors that predispose an athlete to ankle-ligament trauma. Conclusions/Recommendations: There is some agreement among authors with regard to the risk factors for ankle-ligament injury; however, considerable controversy remains. Although female athletes are at significantly greater risk of suffering a serious knee sprain, such as disruption of the anterior cruciate ligament, this does not appear to be the case for ankle-ligament sprains. Therefore, sex does not appear to be a risk factor for suffering an ankle-ligament sprain. Athletes who have suffered a previous sprain have a decreased risk of reinjury if a brace is worn, and the consensus is that generalized joint laxity and anatomical foot type are not risk factors for ankle sprains. However, the literature is divided with regard to whether or not height, weight, limb dominance, ankle-joint laxity, anatomical alignment, muscle strength, muscle-reaction time, and postural sway are risk factors for ankle sprains. Future research is needed on this topic to develop a consensus on all ankle-injury risk factors. This will allow future intervention studies to be designed that will reduce the incidence and severity of this common injury. PMID:12937558

  16. Editorial Commentary: The Efficacy of Nonsteroidal Anti-inflammatory Drugs for Prophylaxis of Heterotopic Ossification in Hip Arthroscopy--Do We Treat Patients or X-rays?

    PubMed

    Miller, G Klaud

    2016-03-01

    A systematic review of 5 series comparing the incidence of heterotopic ossification after hip arthroscopy with and without nonsteroidal anti-inflammatory drug prophylaxis showed a statistically significant improvement with the use of prophylaxis.

  17. Cutaneous innervation of the ankle: an anatomical study showing danger zones for ankle surgery.

    PubMed

    Duscher, Dominik; Wenny, Raphael; Entenfellner, Johanna; Weninger, Patrick; Hirtler, Lena

    2014-05-01

    Three nerves innervate the skin in the foot and ankle region: the saphenous, sural, and superficial peroneal nerves. Because they are close to the medial and lateral malleoli, these nerves are at significant risk during orthopedic interventions. The aims of this study were to investigate the distal courses of the three cutaneous nerves of the ankle and to determine their exact relationships with easily identifiable bony landmarks. Ten freshly frozen and 40 embalmed lower extremities of adults were dissected. The positions of the superficial peroneal, sural, and saphenous nerves were determined using reference lines based on easily palpable osseous landmarks. The frequencies and distributions of all three nerves and their branches were converted into absolute numbers. A danger zone for each nerve was established on the basis of the distribution of crossings between the nerves and the different reference lines. Determination of the exact orientation of the nerves around the ankle should help minimize the nerve injury rate during surgical approaches in this area. Using this easily translatable new grid system, the course and danger zones of each cutaneous nerve around the ankle can be estimated clinically.

  18. Cutaneous innervation of the ankle: an anatomical study showing danger zones for ankle surgery.

    PubMed

    Duscher, Dominik; Wenny, Raphael; Entenfellner, Johanna; Weninger, Patrick; Hirtler, Lena

    2014-05-01

    Three nerves innervate the skin in the foot and ankle region: the saphenous, sural, and superficial peroneal nerves. Because they are close to the medial and lateral malleoli, these nerves are at significant risk during orthopedic interventions. The aims of this study were to investigate the distal courses of the three cutaneous nerves of the ankle and to determine their exact relationships with easily identifiable bony landmarks. Ten freshly frozen and 40 embalmed lower extremities of adults were dissected. The positions of the superficial peroneal, sural, and saphenous nerves were determined using reference lines based on easily palpable osseous landmarks. The frequencies and distributions of all three nerves and their branches were converted into absolute numbers. A danger zone for each nerve was established on the basis of the distribution of crossings between the nerves and the different reference lines. Determination of the exact orientation of the nerves around the ankle should help minimize the nerve injury rate during surgical approaches in this area. Using this easily translatable new grid system, the course and danger zones of each cutaneous nerve around the ankle can be estimated clinically. PMID:24343871

  19. Femoral and sciatic nerve block for knee arthroscopy in a patient with acute intermittent porphyria.

    PubMed

    Bosch, L; Villar, T; Latorre, M Y; Pacreu, S

    2016-01-01

    Acute intermittent porphyria is an autosomal dominant disorder that results from a partial deficiency of porphobilinogen deaminase and that causes very severe symptoms. Attacks may be triggered by a series of drugs and by other factors that the anesthesiologist should be aware of in order to reduce morbidity and mortality. Our objective is to review anesthetic considerations in acute intermittent porphyria. We present the case of a patient diagnosed with acute intermittent porphyria who was scheduled for knee arthroscopy. The anesthetic technique used was a femoral and sciatic nerve block under sedation with an infusion of remifentanil. The surgery proceeded without incident and the patient was discharged home after 24h. We consider the use of a peripheral plexus block of the lower limb to have been the safest anesthetic technique for this patient. PMID:27220836

  20. Closed Intramedullary Derotational Osteotomy and Hip Arthroscopy for Cam Femoroacetabular Impingement From Femoral Retroversion

    PubMed Central

    Matsuda, Dean K.; Gupta, Nikhil; Martin, Hal D.

    2014-01-01

    Femoral retroversion is an uncommon cause of cam femoroacetabular impingement that may require surgical treatment beyond arthroscopic or open femoroplasty. We present the case of a young adult with bilateral severe femoral retroversion in whom such treatment failed. We discuss the rationale, surgical technique, and outcome of this patient, who underwent bilateral closed intramedullary derotational proximal femoral osteotomies and interlocked nailing with adjunctive pre- and post-osteotomy hip arthroscopies. Clinical improvement with normal foot progression angles, radiographic union, and resolution of bilateral cam femoroacetabular impingement from femoral retroversion was achieved. This surgery permits rapid institution of weight-bearing ambulation and an early rehabilitative program. Femoral retroversion may be an underappreciated and insufficiently treated cause of cam femoroacetabular impingement that may be readily detected and successfully remedied with this less invasive procedure. PMID:24749047

  1. Improved limb positioning and hip access during hip arthroscopy with articulated traction device.

    PubMed

    Mei-Dan, Omer; McConkey, Mark O; Young, David A

    2013-02-01

    Surgeons use hip arthroscopy to address intra-articular pathology of the hip. To access the central compartment, traction must be applied to the leg. Various types of equipment and techniques have been used, but many have limitations. Improved ability to assess the offending pathology is achieved with improved ability to move the hip joint in space during surgery. Dynamic assessment of femoroacetabular impingement allows the surgeon to gauge the adequacy of resection. We describe the use of an articulated traction device that allows complete surgeon control over the leg position, as well as the freedom to place the leg in virtually any position with ease, unencumbered by the mechanics of a standard traction table. This device provides the surgeon with an improved ability to dynamically assess the hip and removes some of the responsibility of the operating room staff for intraoperative leg positioning. PMID:23802095

  2. Four Weeks of Balance Training does not Affect Ankle Joint Stiffness in Subjects with Unilateral Chronic Ankle Instability

    PubMed Central

    Jain, Tarang Kumar; Wauneka, Clayton N.; Liu, Wen

    2016-01-01

    Background Balance training has been shown to be effective in preventing ankle sprain recurrences in subjects with chronic ankle instability (CAI) but the biomechanical pathways underlying the clinical outcomes are still unknown. This study was conducted to determine if a 4-week balance training intervention can alter the mechanical characteristics in ankles with CAI. Methods Twenty-two recreationally active subjects with unilateral CAI were randomized to either a control (n = 11, 35.1 ± 9.3 years) or intervention (n = 11, 33.5 ± 6.6 years) group. Subjects in the intervention group were trained on the affected limb with static and dynamic components using a Biodex balance stability system for 4-weeks. The ankle joint stiffness and neutral zone in inversion and eversion directions on the involved and uninvolved limbs was measured at baseline and post-intervention using a dynamometer. Results At baseline, the mean values of the inversion stiffness (0.69 ± 0.37 Nm/degree) in the involved ankle was significantly lower (p < 0.011, 95% CI [0.563, 0.544]) than that of uninvolved contralateral ankle (0.99 ± 0.41 Nm/degree). With the available sample size, the eversion stiffness, inversion neutral zone, and eversion neutral zone were not found to be significantly different between the involved and uninvolved contralateral ankles. The 4-week balance training intervention failed to show any significant effect on the passive ankle stiffness and neutral zones in inversion and eversion. Conclusion Decreased inversion stiffness in the involved chronic unstable ankle was found that of uninvolved contralateral ankle. The 4-week balance training program intervention was ineffective in altering the mechanical characteristics of ankles with CAI. Level of evidence Randomized controlled clinical trial; Level of evidence, 1. PMID:27642647

  3. Multivariable Static Ankle Mechanical Impedance With Active Muscles.

    PubMed

    Lee, Hyunglae; Ho, Patrick; Rastgaar, Mohammad; Krebs, Hermano Igo; Hogan, Neville

    2014-01-01

    This paper reports quantification of multivariable static ankle mechanical impedance when muscles were active. Repetitive measurements using a highly backdrivable therapeutic robot combined with robust function approximation methods enabled reliable characterization of the nonlinear torque-angle relation at the ankle in two coupled degrees of freedom simultaneously, a combination of dorsiflexion-plantarflexion and inversion-eversion, and how it varied with muscle activation. Measurements on 10 young healthy seated subjects quantified the behavior of the human ankle when muscles were active at 10% of maximum voluntary contraction. Stiffness, a linear approximation to static ankle mechanical impedance, was estimated from the continuous vector field. As with previous measurements when muscles were maximally relaxed, we found that ankle stiffness was highly direction-dependent, being weakest in inversion/eversion. Predominantly activating a single muscle or co-contracting antagonistic muscles significantly increased ankle stiffness in all directions but it increased more in the sagittal plane than in the frontal plane, accentuating the relative weakness of the ankle in the inversion-eversion direction. Remarkably, the observed increase was not consistent with simple superposition of muscle-generated stiffness, which may be due to the contribution of unmonitored deep ankle muscles. Implications for the assessment of neuro-mechanical disorders are discussed.

  4. Recycling Energy to Restore Impaired Ankle Function during Human Walking

    PubMed Central

    Collins, Steven H.; Kuo, Arthur D.

    2010-01-01

    Background Humans normally dissipate significant energy during walking, largely at the transitions between steps. The ankle then acts to restore energy during push-off, which may be the reason that ankle impairment nearly always leads to poorer walking economy. The replacement of lost energy is necessary for steady gait, in which mechanical energy is constant on average, external dissipation is negligible, and no net work is performed over a stride. However, dissipation and replacement by muscles might not be necessary if energy were instead captured and reused by an assistive device. Methodology/Principal Findings We developed a microprocessor-controlled artificial foot that captures some of the energy that is normally dissipated by the leg and “recycles” it as positive ankle work. In tests on subjects walking with an artificially-impaired ankle, a conventional prosthesis reduced ankle push-off work and increased net metabolic energy expenditure by 23% compared to normal walking. Energy recycling restored ankle push-off to normal and reduced the net metabolic energy penalty to 14%. Conclusions/Significance These results suggest that reduced ankle push-off contributes to the increased metabolic energy expenditure accompanying ankle impairments, and demonstrate that energy recycling can be used to reduce such cost. PMID:20174659

  5. Rehabilitation of the Ankle after Acute Sprain or Chronic Instability.

    ERIC Educational Resources Information Center

    Mattacola, Carl G.; Dwyer, Maureen K.

    2002-01-01

    Outlines rehabilitation concepts applicable to acute and chronic ankle injury, providing evidence for current techniques used in ankle rehabilitation and describing a functional rehabilitation program that progresses from basic to advanced, while taking into account empirical data from the literature and clinical practice. The article notes that…

  6. Independent ankle motion control improves robotic balance simulator.

    PubMed

    Pospisil, Eric R; Luu, Billy L; Blouin, Jean-Sébastien; Van der Loos, H F Machiel; Croft, Elizabeth A

    2012-01-01

    We present a validation study for the effectiveness of an additional ankle-tilt platform to enhance somatosensory ankle feedback available to subjects actuating a 6-axis robotic balance simulator platform. To address this need, we have developed and integrated a device to permit independent manipulation of ankle rotation while the whole-body is actuated by the balance simulator. The addition of ankle rotation is shown to provide both quantitative and qualitative improvements to the balance simulation experience compared to when the ankle joint is referenced to the motion of the balance simulator. Eight out of ten subjects reported that balancing on the simulator with ankle motion required less conscious effort. This self-reported improvement corresponded to a 32% decrease in the mean-removed RMS amplitude for sway angle, demonstrating better balance control for subjects actuating the simulator. The new ankle-tilt platform enables examination of the contributions of ankle proprioception to the control of standing balance in human subjects.

  7. Review on design and control aspects of ankle rehabilitation robots.

    PubMed

    Jamwal, Prashant K; Hussain, Shahid; Xie, Sheng Q

    2015-03-01

    Ankle rehabilitation robots can play an important role in improving outcomes of the rehabilitation treatment by assisting therapists and patients in number of ways. Consequently, few robot designs have been proposed by researchers which fall under either of the two categories, namely, wearable robots or platform-based robots. This paper presents a review of both kinds of ankle robots along with a brief analysis of their design, actuation and control approaches. While reviewing these designs it was observed that most of them are undesirably inspired by industrial robot designs. Taking note of the design concerns of current ankle robots, few improvements in the ankle robot designs have also been suggested. Conventional position control or force control approaches, being used in the existing ankle robots, have been reviewed. Apparently, opportunities of improvement also exist in the actuation as well as control of ankle robots. Subsequently, a discussion on most recent research in the development of novel actuators and advanced controllers based on appropriate physical and cognitive human-robot interaction has also been included in this review. Implications for Rehabilitation Ankle joint functions are restricted/impaired as a consequence of stroke or injury during sports or otherwise. Robots can help in reinstating functions faster and can also work as tool for recording rehabilitation data useful for further analysis. Evolution of ankle robots with respect to their design and control aspects has been discussed in the present paper and a novel design with futuristic control approach has been proposed. PMID:24320195

  8. Ankle moment generation and maximum-effort curved sprinting performance.

    PubMed

    Luo, Geng; Stefanyshyn, Darren

    2012-11-15

    Turning at high speed along acute curves is crucial for athletic performance. One determinant of curved sprinting speed is the ground reaction force that can be created by the supporting limb; the moment generated at the ankle joint may influence such force generation. Body lean associated with curved sprints positions the ankle joints in extreme in-/eversion, and may hinder the ankle moment generation. To examine the influence of ankle moment generation on curved sprinting performance, 17 male subjects performed maximum-effort curved sprints in footwear with and without a wedge. The wedged footwear was constructed with the intention to align the ankle joints closer to their neutral frontal-plane configuration during counter-clockwise curved sprints so greater joint moments might be generated. We found, with the wedged footwear, the average eversion angle of the inside leg ankle was reduced, and the plantarflexion moment generation increased significantly. Meanwhile, the knee extension moment remained unchanged. With the wedged footwear, stance-average centripetal ground reaction force increased significantly while no difference in the vertical ground reaction force was detected. The subjects created a greater centripetal ground reaction impulse in the wedged footwear despite a shortened stance phase when compared to the control. Stance-average curved sprinting speed improved by 4.3% with the wedged footwear. The changes in ankle moment and curved sprinting speed observed in the current study supports the notion that the moment generation at the ankle joint may be a performance constraint for curved sprinting. PMID:23022207

  9. Adaptive sports ankle prosthetics. Interview by Sarah A. Curran.

    PubMed

    Lyle, David K

    2012-09-01

    Participating in sport at all levels is gaining a dedicated following and this is also apparent in individuals with an amputation. Currently, there is a wide variety of ankle prostheses available which attempt to provide function, control, and comfort, as well as good aesthetic appeal. Participation in sport, however, increases the demands placed upon ankle prostheses. This can compromise function and performance, and constrain the opportunities of participation in various outdoor and water sports. In acknowledging this limitation and the need to develop more versatile ankle prostheses, this article introduces the evolution of a prototype ankle prosthesis referred to as "Adaptive Sports Ankle." The ankle prosthesis, which is compatible with any foot pyramid adapter, offers the same range of motion as the normal human ankle joint and is made up of components that are chemical and corrosion resistant. These design features that are specifically created to accommodate below-the-knee amputees provide an ideal prosthesis for those wishing to lead an active lifestyle and participate in aquatic (i.e. swimming, surfing, and scuba diving), snowboarding, and equestrian activities. Although it is acknowledged that there is a need to establish research on the Adaptive Sports Ankle, its introduction to the market will enhance and expand opportunities of those individuals with a lower limb amputation to lead an active and healthy lifestyle.

  10. Review on design and control aspects of ankle rehabilitation robots.

    PubMed

    Jamwal, Prashant K; Hussain, Shahid; Xie, Sheng Q

    2015-03-01

    Ankle rehabilitation robots can play an important role in improving outcomes of the rehabilitation treatment by assisting therapists and patients in number of ways. Consequently, few robot designs have been proposed by researchers which fall under either of the two categories, namely, wearable robots or platform-based robots. This paper presents a review of both kinds of ankle robots along with a brief analysis of their design, actuation and control approaches. While reviewing these designs it was observed that most of them are undesirably inspired by industrial robot designs. Taking note of the design concerns of current ankle robots, few improvements in the ankle robot designs have also been suggested. Conventional position control or force control approaches, being used in the existing ankle robots, have been reviewed. Apparently, opportunities of improvement also exist in the actuation as well as control of ankle robots. Subsequently, a discussion on most recent research in the development of novel actuators and advanced controllers based on appropriate physical and cognitive human-robot interaction has also been included in this review. Implications for Rehabilitation Ankle joint functions are restricted/impaired as a consequence of stroke or injury during sports or otherwise. Robots can help in reinstating functions faster and can also work as tool for recording rehabilitation data useful for further analysis. Evolution of ankle robots with respect to their design and control aspects has been discussed in the present paper and a novel design with futuristic control approach has been proposed.

  11. Simultaneous bilateral total ankle replacement using a 3-component prosthesis

    PubMed Central

    2011-01-01

    Background and purpose Total ankle replacement is an established surgical procedure in patients with end-stage ankle osteoarthritis. We analyzed complications and medium-term results in patients with simultaneous bilateral total ankle replacement. Patients and methods 10 women and 16 men, mean age 60 (SD 13) years, were followed for a median of 5 (2–10) years. Results There were no intraoperative or perioperative complications, with the exception of 1 patient with prolonged wound healing. Major revision surgery was necessary in 6 of the 52 ankles, including 4 revisions of prosthetic components. The average pain score decreased from 6.9 (4−10) to 1.8 (0−4) points. The American Orthopaedic Foot and Ankle Society hindfoot score increased from 32 (SD 14) points preoperatively to 74 (SD 12) points postoperatively. The average range of motion increased from 28° (SD 12) preoperatively to 38° (SD 9) postoperatively. All 8 categories of SF-36 score improved. Interpretation Simultaneous bilateral total ankle replacement is a suitable method for restoration of function and attainment of pain relief in patients with bilateral end-stage ankle osteoarthritis. The results of this procedure, including complication rates, revision rates, and functional outcome, are comparable to those reported in patients with unilateral total ankle replacement. PMID:21999622

  12. Dislocated ankle fracture complicated by near total distal ischaemia

    PubMed Central

    Duygun, Fatih; Sertkaya, Omer; Aldemir, Cengiz; Dogan, Ali

    2013-01-01

    Total arterial ischaemia is rarely seen following a dislocated ankle fracture but if it does and intervention is not made, it can lead to serious morbidity. We present a 39-year-old woman with almost total occlusion in the arteria tibialis and arteria dorsalis pedis following a dislocated ankle fracture as a result of a bicycle fall. PMID:24248319

  13. Subtalar Arthroscopy

    MedlinePlus

    ... and subtalar joint has ligaments that can be torn with injury. If the ligaments heal with thick ... being removed from the subtalar joint has been torn and healed in an abnormal and often thickened ...

  14. Knee Arthroscopy

    MedlinePlus

    ... or an EKG (electrocardiogram). Surgery Arthroscopic picture of torn anterior cruciate ligament [yellow star]. Almost all arthroscopic ... most commonly used for: • Removal or repair of torn meniscal cartilage • Reconstruction of a torn anterior cruciate ...

  15. Wrist Arthroscopy

    MedlinePlus

    ... Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring Español Artritis ... Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring Español Artritis ...

  16. Shoulder arthroscopy

    MedlinePlus

    SLAP repair; SLAP lesion; Acromioplasty; Bankart repair; Bankart lesion; Shoulder repair; Shoulder surgery; Rotator cuff repair ... the lower part of the shoulder joint. A SLAP lesion involves the labrum and the ligament on ...

  17. Shoulder Arthroscopy

    MedlinePlus

    ... synovial fluid that lubricates the shoulder joint. Rotator cuff. Four tendons surround the shoulder capsule and help ... This thick tendon material is called the rotator cuff. The cuff covers the head of the humerus ...

  18. Knee arthroscopy

    MedlinePlus

    ... This is also called regional anesthesia. The pain medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist. General ... The pain medicine is injected around the nerve in your groin. ...

  19. Hip arthroscopy

    MedlinePlus

    ... MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ... MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ...

  20. Stability after Cleft Maxillary Distraction Osteogenesis or Conventional Orthognathic Surgery

    PubMed Central

    Svenstrup, Martin; Pedersen, Thomas Klit; Küseler, Annelise; Jensen, John; Nørholt, Sven Erik

    2015-01-01

    ABSTRACT Objectives To compare stability of maxillary advancements in patients with cleft lip and palate following distraction osteogenesis or orthognathic surgery. Material and Methods Inclusion criteria: 1) cleft lip and palate, 2) advancement > 8 mm. Eleven patients comprised the distraction osteogenesis group (DOG). Seven patients comprised the orthognathic treatment group (CONVG). Skeletal and soft tissue points were traced on lateral cephalograms: T1 (preoperatively), T2 (after surgery), T3 (follow-up). Group differences were analyzed using Students t-test. Results At T1-T2, advancement of 6.98 mm (P = 0.002) was observed in DOG. Horizontal overjet increased 11.62 mm (P = 0.001). A point-nasion-B point (ANB) angle increased 8.82° (P = 0.001). Aesthetic plane to upper lip was reduced 5.44 mm (P = 0.017) and the naso-labial angle increased 16.6° (P = 0.001). Vertical overbite (VOB) increased 2.27 mm (P = 0.021). In T2-T3, no significant changes were observed in DOG. In T1-T2, horizontal overjet increased 8.45 mm (P = 0.02). The ANB angle, 9.33° (P = 0.009) in CONVG. At T2-T3, VOB increased, 2.35 mm (P = 0.046), and the ANB angle reduced, 3.83° (P = 0.003). In T2-T3, no parameters changed in CONVG. At follow-up (T3), VOB increased in CONVG compared with DOG, (P = 0.01). Vertical position of A point differed between the groups (P = 0.04). No significant intergroup differences between soft tissue parameters occurred. Conclusions Distraction osteogenesis resulted in a stable position of the maxilla and movement upwards in vertical plane, however in case of orthognathic treatment sagittal relapse and a continued postoperatively downward movement was registered. PMID:26229581

  1. Hip arthroscopy in the warrior athlete: 2 to 10 year outcomes.

    PubMed

    Byrd, J W Thomas; Jones, Kay S; Schmitz, LtCol Matthew R; Doner, Geoffrey P

    2016-04-01

    Hip disorders are increasingly recognized among athletic populations. The rigors of military service expose individuals to the same risks as those participating in competitive sports, compounded by potential exposure to violent macrotrauma. This is a retrospective review of prospectively collected data among 62 active duty military personnel (64 hips) with 2-10-year follow-up. Follow-up averaged 47 months (range 24-120 months). The average age was 30 years (range 17-53 years) with 45 males and 17 females; 37 right and 27 left hips. Duration of symptoms prior to arthroscopy averaged 28 months (range 6-168 months). The average improvement was 22 points (pre-op 63; post-op 85) using the 100-point modified Harris hip score and was statistically significant (P <  0.001). Patients were improved after 60 of 64 procedures (94%) and returned to active duty following 52 (80%) and an average of 5 months (range 1 week-15 months). Forty-six (72%) underwent correction of FAI including 27 combined, 17 cam and two pincer lesions. Overall diagnoses and procedures are detailed. One patient underwent repeat arthroscopy and remained improved at 2-year follow-up; none were converted to total hip arthroplasty. There were two minor complications, a transient ulnar nerve neurapraxia and superficial sensory dysesthesias of the foot, both of which resolved within a few days. This is a heterogeneous cohort of pathology, but illustrates that hip disorders may exist among active duty military personnel and may benefit from arthroscopic intervention. A sense of awareness is important for accurate diagnosis and timely treatment.

  2. Nerve Injury in Patients Following Hip and Knee Arthroplasties and Knee Arthroscopy

    PubMed Central

    Yacub, Jennifer N.; Rice, J. Bradford; Dillingham, Timothy R.

    2016-01-01

    Objective To examine the reporting of lower limb neuropathy within 90 days of surgery for patients undergoing hip arthroplasty, knee arthroplasty or knee arthroscopy. Design This was a retrospective study utilizing data from the 1998 MarketScan Commercial Claims and Encounter Database (The MEDSTAT Group) to identify lower limb neuropathy following these surgeries. The sample was selected within the first nine months of 1998 using ICD-9 and CPT codes for hip and knee surgical procedures. Lower limb nerve injuries as determined by ICD-9 codes within 90 days post surgery were the main outcome measures. The influence of diabetes on the rates of nerve injuries following surgery was also examined. Results 14,979 patients underwent these surgical procedures, 10 of whom were reported to have sustained a nerve injury post surgery (0.07%). A majority (53.1%) of the sample was male and the largest age groups consisted of those aged 45–54 years (27.0%) and those aged 55–64 years (27.7%). Nerve injury occurred at a rate of 0.03% after hip arthroplasty, 0.01% following knee arthroplasty and 0.02% within three months of arthroscopic knee surgery. Overall, nerve injuries were two times more prevalent in the diabetic vs. non-diabetic population (0.11% vs. 0.06%); however, this difference did not meet conventional levels of statistical significance. Specific to knee arthroplasty, there were ten-fold differences in nerve injury rates between diabetics and non-diabetics, 0.11% vs. 0.01% respectively (p ≤ 0.01) – although the overall risks were small. Conclusion Nerve injuries following hip and knee arthroplasty, and knee arthroscopy were rare in a large population of patients younger than 65 years. Although the overall rates were low, there was an increased occurrence of nerve injuries in the diabetic population. This information is useful when counseling patients and benchmarking surgical complication rates. PMID:19620828

  3. 10-year survival of total ankle arthroplasties

    PubMed Central

    2011-01-01

    Background and purpose There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis. Patients and methods Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint—excluding incidental exchange of the polyethylene meniscus. Results Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79–0.83) at 5 years to 0.69 (95% CI: 0.67–0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons. Interpretation The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements—even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results. PMID:22066551

  4. Total ankle prostheses in rheumatoid arthropathy

    PubMed Central

    Schutte, Bernard; Louwerens, Jan Willem K; van den Hoogen, Frank H J; de Waal Malefijt, Maarten C

    2009-01-01

    Background and purpose The first generations of total ankle replacements (TARs) showed a high rate of early failure. In the last decades, much progress has been made in the development of TARs, with the newer generation showing better results. We evaluated TARs implanted with rheumatoid arthritis (RA) or juvenile inflammatory arthritis (JIA) as indication. Patients and methods 58 total ankle prostheses (Buechel-Pappas and STAR type) were implanted in patients with RA (n = 53) or JIA (n = 5) in 54 patients (4 bilateral). After a mean follow-up of 2.7 (1–9) years, all patients were reviewed by two orthopedic surgeons who were not the surgeons who performed the operation. Standard AP and lateral radiographs were taken and a Kofoed ankle score was obtained; this is a clinical score ranging from 0–100 and consists of sub-scores for pain, disability, and range of motion. Results 2 patients died of unrelated causes. Of the 52 patients who were alive (56 prostheses), 51 implants were still in place and showed no signs of loosening on the most recent radiographs. The mean Kofoed score at follow-up was 73 points (SD 16, range 21–92). 4 patients showed a poor result (score < 50) with persistent pain for which no obvious reason could be found. 5 implants were removed, 4 because of infection and 1 because of aseptic loosening. Interpretation Medium-term results of the STAR and BP types of TAR in RA were satisfactory. The main reason for failure of the implant was infection. PMID:19634020

  5. Virtual reality as a distraction technique in chronic pain patients.

    PubMed

    Wiederhold, Brenda K; Gao, Kenneth; Sulea, Camelia; Wiederhold, Mark D

    2014-06-01

    We explored the use of virtual reality distraction techniques for use as adjunctive therapy to treat chronic pain. Virtual environments were specifically created to provide pleasant and engaging experiences where patients navigated on their own through rich and varied simulated worlds. Real-time physiological monitoring was used as a guide to determine the effectiveness and sustainability of this intervention. Human factors studies showed that virtual navigation is a safe and effective method for use with chronic pain patients. Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures.

  6. Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome

    PubMed Central

    Tsui, Wai Kin; Yang, Yanqi; Cheung, Lim Kwong; Leung, Yiu Yan

    2016-01-01

    Abstract Background: To conduct a systematic review to answer the clinical question “What are the effectiveness of mandibular distraction osteogenesis (MDO) and its complications to treat patients with obstructive sleep apnea syndrome (OSAS)?”. Methods: A systematic search including a computer search with specific keywords, reference list search, and manual search were done. Relevant articles on MDO were assessed and selected in 3 rounds for final review based on 5 predefined inclusion criteria and followed by a round of critical appraisal. Different types of distraction and their treatment outcomes of OSAS were recorded with standardized form and analyzed. Results: Twelve articles were included in the final review. A total of 256 patients aged 7 days to 60 years were treated with either external or internal MDO, with a mean follow-up period of 6 to 37 months. The average distraction distance of 12 to 29 mm was achieved with various distraction protocols. The success rate for adult patients was 100%, and cure rates were ranged from 82% to 100%. The definition of success or cure for OSAS in children or infants was not defined. Therefore, there were no clearly reported success or cure rates for children/infants in the included studies. However, all studies reported that these patients showed significant improvement in OSAS, with many of them who avoided tracheostomy or had the tracheostomy decannulated. The complication rates were ranged from 0% to 21.4%, with most being from local wound infections or neurosensory disturbances. Conclusion: This systematic review showed that MDO was effective in resolving OSAS in adults with retrognathic mandible. MDO also showed promising results in infants or children with OSAS. From the results of this systematic review, we recommend to define the criteria of success or cure for OSAS surgery in children and infants. We also recommend setting up randomized controlled trials to compare MDO with traditional maxillomandibular

  7. Interruptions and Distractions in Healthcare: Review and Reappraisal

    PubMed Central

    Rivera, A. Joy; Karsh, Ben-Tzion

    2010-01-01

    Healthcare settings can be hectic, demanding, time-constrained environments. Within these environments, health care professionals (HCP) are expected to perform tasks that often require their undivided attention. However, HCPs are frequently interrupted, which can distract their attention and add to the complexity of their work. That said, not all interruptions are bad; many interruptions are essential to the patient care process and provide HCPs with necessary information. This paper systematically reviews the peer-reviewed literature on interruptions in healthcare settings to determine the state of the science and to identify gaps. It then provides a complex sociotechnical systems approach to understanding interruptions in healthcare. PMID:20378621

  8. Understanding acute ankle ligamentous sprain injury in sports

    PubMed Central

    Fong, Daniel TP; Chan, Yue-Yan; Mok, Kam-Ming; Yung, Patrick SH; Chan, Kai-Ming

    2009-01-01

    This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not

  9. Foot and Ankle Stress Fractures in Athletes.

    PubMed

    Greaser, Michael C

    2016-10-01

    The incidence of stress fractures in the general athletic population is less than 1%, but may be as high as 15% in runners. Stress fractures of the foot and ankle account for almost half of bone stress injuries in athletes. These injuries occur because of repetitive submaximal stresses on the bone resulting in microfractures, which may coalesce to form complete fractures. Advanced imaging such as MRI and triple-phase bone scans is used to evaluate patients with suspected stress fracture. Low-risk stress fractures are typically treated with rest and protected weight bearing. High-stress fractures more often require surgical treatment. PMID:27637667

  10. Robotic Ankle for Omnidirectional Rock Anchors

    NASA Technical Reports Server (NTRS)

    Parness, Aaron; Frost, Matthew; Thatte, Nitish

    2013-01-01

    Future robotic exploration of near-Earth asteroids and the vertical and inverted rock walls of lava caves and cliff faces on Mars and other planetary bodies would require a method of gripping their rocky surfaces to allow mobility without gravitational assistance. In order to successfully navigate this terrain and drill for samples, the grippers must be able to produce anchoring forces in excess of 100 N. Additionally, the grippers must be able to support the inertial forces of a moving robot, as well gravitational forces for demonstrations on Earth. One possible solution would be to use microspine arrays to anchor to rock surfaces and provide the necessary load-bearing abilities for robotic exploration of asteroids. Microspine arrays comprise dozens of small steel hooks supported on individual suspensions. When these arrays are dragged along a rock surface, the steel hooks engage with asperities and holes on the surface. The suspensions allow for individual hooks to engage with asperities while the remaining hooks continue to drag along the surface. This ensures that the maximum possible number of hooks engage with the surface, thereby increasing the load-bearing abilities of the gripper. Using the microspine array grippers described above as the end-effectors of a robot would allow it to traverse terrain previously unreachable by traditional wheeled robots. Furthermore, microspine-gripping robots that can perch on cliffs or rocky walls could enable a new class of persistent surveillance devices for military applications. In order to interface these microspine grippers with a legged robot, an ankle is needed that can robotically actuate the gripper, as well as allow it to conform to the large-scale irregularities in the rock. The anchor serves three main purposes: deploy and release the anchor, conform to roughness or misalignment with the surface, and cancel out any moments about the anchor that could cause unintentional detachment. The ankle design contains a

  11. Arthroscopic Approach to Posterior Ankle Impingement.

    PubMed

    Theodoulou, Michael H; Bohman, Laura

    2016-10-01

    Posterior ankle pain can occur for many reasons. If it is produced by forced plantarflexion of the foot, it is often a result of impingement from an enlarged posterior talar process or an os trigonum. This condition may present in an acute or chronic state. Management is initially nonoperative, but surgical treatments are available. This condition is often seen in athletes, so procedures that limit surgical trauma and allow early return to activity are ideal. An arthroscopic approach for this disorder produces good outcomes with limited complications. Understanding the indications, local anatomy, and surgical technique, allows good, reproducible outcomes.

  12. Arthroscopic Approach to Posterior Ankle Impingement.

    PubMed

    Theodoulou, Michael H; Bohman, Laura

    2016-10-01

    Posterior ankle pain can occur for many reasons. If it is produced by forced plantarflexion of the foot, it is often a result of impingement from an enlarged posterior talar process or an os trigonum. This condition may present in an acute or chronic state. Management is initially nonoperative, but surgical treatments are available. This condition is often seen in athletes, so procedures that limit surgical trauma and allow early return to activity are ideal. An arthroscopic approach for this disorder produces good outcomes with limited complications. Understanding the indications, local anatomy, and surgical technique, allows good, reproducible outcomes. PMID:27599438

  13. Finite element analysis of a composite artificial ankle

    NASA Technical Reports Server (NTRS)

    Perkins, Leigh Ann; Johnston, Lawrence; Denniston, Charles; Czekalski, Blaise E.

    1993-01-01

    Ultra-light carbon fiber composite materials are being utilized in artificial limbs with increasing frequency in recent years. Dr. Arthur Copes, an orthotist from Baton Rouge, Louisiana, has developed a graphite expoxy composite material artificial ankle (Copes/Bionic Ankle) that is intended to be used by amputees who require the most advanced above-and-below-the-knee prosthetic devices. The Copes/Bionic Ankle is designed to reproduce the function of the natural ankle joint by allowing the composite material to act as a spring mechanism without the use of metal mechanical parts. NASA Marshall Space Flight Center has agreed to participate in the design effort by providing the structural analysis of the artificial ankle design.

  14. Functional Design in Rehabilitation: Modular Mechanisms for Ankle Complex

    PubMed Central

    2016-01-01

    This paper is aimed at presenting an innovative ankle rehabilitation device based on a parallel mechanism. A functional analysis and design are described to obtain a device able to guarantee ankle movement while patient's body remains stationary. Human ankle is a challenging context where a series of joints are highly integrated. The proposed rehabilitation device permits a patient with walking defects to improve his or her gait. The research focuses on plantar-flexion-dorsiflexion movement. The robust design starts from an accurate modelling of ankle movements during walking, assessing motion data from healthy individuals and patients. The kinematics analysis and functional evaluations lead the study and development of the articulated system. In particular, results of simulations support the effectiveness of the current design. A 3D prototype is presented highlighting that the ankle motion is successfully demonstrated. PMID:27524881

  15. Functional Design in Rehabilitation: Modular Mechanisms for Ankle Complex.

    PubMed

    Aggogeri, Francesco; Pellegrini, Nicola; Adamini, Riccardo

    2016-01-01

    This paper is aimed at presenting an innovative ankle rehabilitation device based on a parallel mechanism. A functional analysis and design are described to obtain a device able to guarantee ankle movement while patient's body remains stationary. Human ankle is a challenging context where a series of joints are highly integrated. The proposed rehabilitation device permits a patient with walking defects to improve his or her gait. The research focuses on plantar-flexion-dorsiflexion movement. The robust design starts from an accurate modelling of ankle movements during walking, assessing motion data from healthy individuals and patients. The kinematics analysis and functional evaluations lead the study and development of the articulated system. In particular, results of simulations support the effectiveness of the current design. A 3D prototype is presented highlighting that the ankle motion is successfully demonstrated.

  16. Total ankle replacement – surgical treatment and rehabilitation

    PubMed Central

    Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting. PMID:27407223

  17. Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

    PubMed

    Gross, Christopher E; Neumann, Julie A; Godin, Jonathan A; DeOrio, James K

    2016-04-01

    Rates of medial and/or lateral gutter impingement after total ankle replacement are not insignificant. If impingement should occur, it typically arises an average of 17 months after total ankle replacement. Our patient underwent treatment for right ankle medial gutter bony impingement with arthroscopic debridement 5 years after her initial total ankle replacement. Standard anteromedial and anterolateral portals and a 30° 2.7-mm-diameter arthroscope were used. An aggressive soft-tissue and bony resection was performed using a combination of curettes, a 3.5-mm shaver, a 5.5-mm unsheathed burr, a drill, and a radiofrequency ablator. This case shows that arthroscopic treatment is an effective and potentially advantageous alternative to open treatment of impingement after total ankle replacement. In addition, symptoms of impingement often improve in a short amount of time after arthroscopic debridement of the medial and/or lateral gutter.

  18. Functional Design in Rehabilitation: Modular Mechanisms for Ankle Complex.

    PubMed

    Aggogeri, Francesco; Pellegrini, Nicola; Adamini, Riccardo

    2016-01-01

    This paper is aimed at presenting an innovative ankle rehabilitation device based on a parallel mechanism. A functional analysis and design are described to obtain a device able to guarantee ankle movement while patient's body remains stationary. Human ankle is a challenging context where a series of joints are highly integrated. The proposed rehabilitation device permits a patient with walking defects to improve his or her gait. The research focuses on plantar-flexion-dorsiflexion movement. The robust design starts from an accurate modelling of ankle movements during walking, assessing motion data from healthy individuals and patients. The kinematics analysis and functional evaluations lead the study and development of the articulated system. In particular, results of simulations support the effectiveness of the current design. A 3D prototype is presented highlighting that the ankle motion is successfully demonstrated. PMID:27524881

  19. Comparison of Hypnosis and Distraction in Severely Ill Children Undergoing Painful Medical Procedures.

    ERIC Educational Resources Information Center

    Smith, Julien T.; And Others

    1996-01-01

    An ethnically diverse sample of high and low hypnotizable children (N=27) suffering from cancer or blood disorders were trained along with their parents to use both distraction and hypnosis to reduce pain and anxiety. Distraction produced significant positive effects for observer-rated distress scores for the low hypnotizable children. Discusses…

  20. 77 FR 24764 - Visual-Manual NHTSA Driver Distraction Guidelines for In-Vehicle Electronic Devices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-25

    ... proposing voluntary NHTSA Driver Distraction Guidelines for in-vehicle electronic devices (77 FR 11200). The...-Vehicle Electronic Devices AGENCY: National Highway Traffic Safety Administration (NHTSA), Department of..., 2012, NHTSA published proposed voluntary NHTSA Driver Distraction Guidelines for in-vehicle...

  1. The Use of Choice-Based Distraction to Decrease the Distress of Children at the Dentist

    ERIC Educational Resources Information Center

    Filcheck, Holly A.; Allen, Keith D.; Ogren, Hilary; Darby, James Brandt; Holstein, Brian; Hupp, Steve

    2005-01-01

    This research was conducted to examine whether choice-based distraction provides an effective means of reducing the distress of children undergoing routine dental treatment. Sixty children between the ages of 5-12 who required restorative dental treatment were assigned randomly to either a Control group or a Distraction group in which the…

  2. 77 FR 12907 - Visual-Manual NHTSA Driver Distraction Guidelines for In-Vehicle Electronic Devices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-02

    ... many speakers as possible, we prefer that speakers not use technological aids (e.g., audio-visuals... National Highway Traffic Safety Administration Visual-Manual NHTSA Driver Distraction Guidelines for In... proposed NHTSA Driver Distraction Guidelines (77 FR 11200). NHTSA is announcing a set of public...

  3. Why Does Working Memory Capacity Predict RAPM Performance? A Possible Role of Distraction

    ERIC Educational Resources Information Center

    Jarosz, Andrew F.; Wiley, Jennifer

    2012-01-01

    Current theories concerning individual differences in working memory capacity (WMC) suggest that WMC reflects the ability to control the focus of attention and resist interference and distraction. The current set of experiments tested whether susceptibility to distraction is partially responsible for the established relationship between…

  4. Perpendicular serial maxillary distraction osteogenesis in cleft lip and palate patients

    PubMed Central

    Ylikontiola, Leena P.; Sándor, George K.; Harila, Virpi

    2015-01-01

    Background: Cleft lip and palate patients often have a retruded maxilla with a severely narrowed deficient maxillary arch. This report aims to describe the management of severe maxillary retrusion and constriction in cleft lip and palate patients using distraction osteogenesis applied in serial sequence in two directions perpendicular to each other. Materials and Methods: Two adult male cleft lip and palate patients were treated with maxillary distraction osteogenesis in two stages. In the first stage, surgically assisted rapid palatal expansion with a tooth-borne device was performed to significantly expand the maxillary arch in the transverse dimension. After the teeth were orthodontically aligned, the horizontal distraction of the maxilla was made by two internal maxillary distraction devices. Results: In the first patient, the maxilla was initially widened by 11 mm and then distracted forward by 20 mm. Despite the breakage of the shaft of one of the two distractors at the end of distraction, a satisfactory occlusion was found at the time of distractor device removal. The maxillary position has remained stable through 8 years of follow-up. In the second patient, the palate was widened by 14 mm and the maxilla was distracted forward by 22 mm. The maxillary position has remained stable through 3 years of follow-up. Conclusion: Sequential serial distraction of maxilla in two planes perpendicular to each other is a safe and stable approach for the treatment of cleft lip and palate patients with severe transverse and anteroposterior discrepancies. PMID:26981462

  5. "Shhh! We're Tryin' to Concentrate": Attention and Environmental Distracters in Novel Word Learning

    ERIC Educational Resources Information Center

    Dixon, Wallace E., Jr.; Salley, Brenda J.

    2006-01-01

    The authors' purpose in this study was to evaluate the role of attention, as a central dimension of temperament, in children's real-time acquisition of novel vocabulary. Environmental distractions were administered to 47 22-month-old children as they acquired novel vocabulary in a fast-mapping task. Two distraction conditions impeded novel word…

  6. Lateral and syndesmotic ankle sprain injuries: a narrative literature review

    PubMed Central

    Dubin, Joshua C.; Comeau, Doug; McClelland, Rebecca I.; Dubin, Rachel A.; Ferrel, Ernest

    2011-01-01

    Objective The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles. Methods Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing. Discussion Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care. Conclusion An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully

  7. The role of series ankle elasticity in bipedal walking

    PubMed Central

    Zelik, Karl E.; Huang, Tzu-Wei P.; Adamczyk, Peter G.; Kuo, Arthur D.

    2014-01-01

    The elastic stretch-shortening cycle of the Achilles tendon during walking can reduce the active work demands on the plantarflexor muscles in series. However, this does not explain why or when this ankle work, whether by muscle or tendon, needs to be performed during gait. We therefore employ a simple bipedal walking model to investigate how ankle work and series elasticity impact economical locomotion. Our model shows that ankle elasticity can use passive dynamics to aid push-off late in single support, redirecting the body's center-of-mass (COM) motion upward. An appropriately timed, elastic push-off helps to reduce dissipative collision losses at contralateral heelstrike, and therefore the positive work needed to offset those losses and power steady walking. Thus, the model demonstrates how elastic ankle work can reduce the total energetic demands of walking, including work required from more proximal knee and hip muscles. We found that the key requirement for using ankle elasticity to achieve economical gait is the proper ratio of ankle stiffness to foot length. Optimal combination of these parameters ensures proper timing of elastic energy release prior to contralateral heelstrike, and sufficient energy storage to redirect the COM velocity. In fact, there exist parameter combinations that theoretically yield collision-free walking, thus requiring zero active work, albeit with relatively high ankle torques. Ankle elasticity also allows the hip to power economical walking by contributing indirectly to push-off. Whether walking is powered by the ankle or hip, ankle elasticity may aid walking economy by reducing collision losses. PMID:24365635

  8. Are there any relationships among ankle proprioception acuity, pre-landing ankle muscle responses, and landing impact in man?

    PubMed

    Fu, Siu Ngor; Hui-Chan, Christina Wan Ying

    2007-05-01

    Proprioceptive input has been suggested to contribute to the pre-landing muscle responses associated with drop-landing, but its precise role has yet to be delineated. This study set out to examine the relationships among ankle proprioception, pre-landing muscle responses, and landing impact on drop-landing in healthy man. Fifteen healthy male basketball players aged 18 to 26 participated in this study. Passive ankle joint repositioning errors were used to examine ankle joint proprioception. Pre-landing EMG responses in the ankle muscles and the impact force on landing were recorded while the players performed self-initiated drops from a height of 30 cm. Results demonstrated that averaged ankle repositioning errors were significantly correlated with the co-contraction indexes between left tibialis anterior and medial gastrocnemius muscles (TA/MG CoI) (r=0.67, p=0.006), and showed a trend towards a relationship with the right TA/MG CoI (r=0.47, p=0.079). TA/MG CoI from both ankles were further related to the magnitude of the total impact force on landing (r=0.54 and 0.53, respectively; p<0.05). We concluded that male basketball players with less accurate ankle joint sense adopted greater co-contraction of ankle dorsiflexors and platarflexors, which was in turn associated with greater impact force at the moment of landing.

  9. Mindless feeding: Is maternal distraction during bottle-feeding associated with overfeeding?

    PubMed

    Golen, Rebecca B; Ventura, Alison K

    2015-08-01

    Mindless eating, or eating while distracted by surrounding stimuli, leads to overeating. The present study explored whether "mindless feeding," or maternal distraction during bottle-feeding, is associated with greater infant formula/milk intakes and lower maternal sensitivity to infant cues. Mothers and their ≤24-week-old bottle-feeding infants (N = 28) visited our laboratory for a video-recorded feeding observation. Infant intake was assessed by weighing bottles before and after the feedings. Maternal sensitivity to infant cues was objectively assessed by behavioral coding of video-records using the Nursing Child Assessment Feeding Scale. Maternal distraction was defined as looking away from the infant >75% of the feeding; using a mobile device; conversing with another adult; or sleeping. Twenty-nine percent (n = 8) of mothers were distracted. While differences in intakes for infants of distracted vs. not distracted mothers did not reach significance (p = 0.24), the association between distraction and infant intake was modified by two dimensions of temperament: orienting/regulation capacity (p = 0.03) and surgency/extraversion (p = 0.04). For infants with low orienting/regulation capacity, infants of distracted mothers consumed more (177.1 ± 33.8 ml) than those of not distracted mothers (92.4 ± 13.8 ml). Similar findings were noted for infants with low surgency/extraversion (distracted: 140.6 ± 22.5 ml; not distracted: 78.4 ± 14.3 ml). No association between distraction and intake was seen for infants with high orienting/regulation capacity or surgency/extraversion. A significantly greater proportion of distracted mothers showed low sensitivity to infant cues compared to not distracted mothers (p = 0.04). In sum, mindless feeding may interact with infant characteristics to influence feeding outcomes; further experimental and longitudinal studies are needed.

  10. Disentangling effects of auditory distraction and of stimulus-response sequence.

    PubMed

    Roeber, Urte; Berti, Stefan; Müller, Dagmar; Widmann, Andreas; Schröger, Erich

    2009-03-01

    When we pay attention to one task, irrelevant changes may interfere. The effect of changes on behavioral and electrophysiological responses has been studied in two separate research fields: Research on Distraction states that a rare irrelevant change takes attention away from the primary task. Research on Sequences states that any change in stimulus or response incurs a cost or benefit depending on the kind of change. To disentangle distraction from sequence effects, we made task-irrelevant changes rare in one condition and frequent in another while also assessing stimulus and response changes from trial to trial. Participants used key presses to classify syllables presented in two different, irrelevant voice pitches. We found that distraction and sequence interacted to alter reaction times and errors on the primary task and also to alter ERP markers of distraction (P3a). The sequential effects cannot, however, fully account for distraction.

  11. Understanding commercial truck drivers' decision-makin process concerning distracted driving.

    PubMed

    Swedler, David I; Pollack, Keshia M; Gielen, Andrea C

    2015-05-01

    A concurrent mixed methods design was used to explore personal and workplace factors, informed by the Theory of Planned Behavior, that affect truck drivers' decision-making about distracted driving on the job. Qualitative data were collected via semi-structured interviews with experts in truck safety and distracted driving, and quantitative data were collected via online survey of truck drivers in the United States. Findings from the interviews illustrated how drivers perceived distractions and the importance of supervisors enforcing organizational distracted driving policies. Survey results found that behavioral intentions were most important in regards to texting and crash and near-crash outcomes, while perceived norms from management best described the correlation between dispatch device use and negative crash-related outcomes. By using a mixed methods design, rather than two separate studies, these findings revealed nuanced differences into the influence of supervisors on distracted driving. PMID:25732132

  12. Understanding commercial truck drivers' decision-makin process concerning distracted driving.

    PubMed

    Swedler, David I; Pollack, Keshia M; Gielen, Andrea C

    2015-05-01

    A concurrent mixed methods design was used to explore personal and workplace factors, informed by the Theory of Planned Behavior, that affect truck drivers' decision-making about distracted driving on the job. Qualitative data were collected via semi-structured interviews with experts in truck safety and distracted driving, and quantitative data were collected via online survey of truck drivers in the United States. Findings from the interviews illustrated how drivers perceived distractions and the importance of supervisors enforcing organizational distracted driving policies. Survey results found that behavioral intentions were most important in regards to texting and crash and near-crash outcomes, while perceived norms from management best described the correlation between dispatch device use and negative crash-related outcomes. By using a mixed methods design, rather than two separate studies, these findings revealed nuanced differences into the influence of supervisors on distracted driving.

  13. Osteogenic growth peptide accelerates bone healing during distraction osteogenesis in rabbit tibia.

    PubMed

    Zhao, Z-Y; Shao, L; Zhao, H-M; Zhong, Z-H; Liu, J-Y; Hao, C-G

    2011-01-01

    Distraction osteogenesis is a valuable treatment method that allows limb lengthening or reconstruction of large bone defects. However, its major disadvantage is the long period required for the consolidation of a distraction callus. Osteogenic growth peptide (OGP) stimulates endochondral bone formation in fracture callus, but its capacity to promote regenerate ossification during distraction osteogenesis has not been evaluated. This study investigated whether intravenously administered OGP accelerated bone healing during distraction osteogenesis in 36 male New Zealand White rabbits, randomized into two groups. The treatment group received OGP (200 ng/kg body weight) in phosphate-buffered saline (PBS), intravenously, each day; the control group received PBS alone. A 15-mm lengthening of the right lower leg was performed using the method of Ilizarov. Evidence from biomechanical, histological and radiographic evaluations demonstrated that systemic OGP treatment promoted optimal new bone formation during distraction osteogenesis in this rabbit model.

  14. Lyme arthritis of the pediatric ankle.

    PubMed

    Aiyer, Amiethab; Walrath, Jessica; Hennrikus, William

    2014-10-01

    Lyme arthritis results from acute inflammation caused by the spirochete Borrelia burgdorferi. The number of cases per year has been rising since 2006, with a majority of patients being affected in the northeastern United States. Development of Lyme arthritis is of particular importance to the orthopedic surgeon because Lyme arthritis often presents as an acute episode of joint swelling and tenderness and may be confused with bacterial septic arthritis. Considering the vast difference in treatment management between these 2 pathologies, differentiating between them is of critical importance. Septic arthritis often needs to be addressed surgically, whereas Lyme arthritis can be treated with oral antibiotics alone. Laboratory testing for Lyme disease often results in a delay in diagnosis because many laboratories batch-test Lyme specimens only a few times per week because of increased expense. The authors present a case of Lyme arthritis in the pediatric ankle in an endemic region. No clear algorithm exists to delineate between septic arthritis and Lyme arthritis of the joint. Improved clinical guidelines for the identification and diagnosis of Lyme arthritis of the ankle are important so that appropriate antibiotics can be used and surgery can be avoided.

  15. Arthroscopic Anatomy of the Ankle Joint.

    PubMed

    Ray, Ronald G

    2016-10-01

    There are a number of variations in the intra-articular anatomy of the ankle which should not be considered pathological under all circumstances. The anteromedial corner of the tibial plafond (between the anterior edge of the tibial plafond and the medial malleolus) can have a notch, void of cartilage and bone. This area can appear degenerative arthroscopically; it is actually a normal variant of the articular surface. The anterior inferior tibiofibular ligament (AITF) can possess a lower, accessory band which can impinge on the anterolateral edge of the talar dome. In some cases it can cause irritation along this area of the talus laterally. If it is creating local irritation it can be removed since it does not provide any additional stabilization to the syndesmosis. There is a beveled region at the anterior leading edge of the lateral and dorsal surfaces of the talus laterally. This triangular region is void of cartilage and subchondral bone. The lack of talar structure in this region allows the lower portion of the AITF ligament to move over the talus during end range dorsiflexion of the ankle, preventing impingement. The variation in talar anatomy for this area should not be considered pathological. PMID:27599433

  16. Bicycling safety and distracted behavior in The Hague, the Netherlands.

    PubMed

    Terzano, Kathryn

    2013-08-01

    As planners and public health officials in many cities around the world seek to increase bicycle ridership, bicyclists who are performing a secondary task (such as listening to a portable music device) may pose a risk to public safety. This study examines bicycling safety and potentially distracted behavior in The Hague, the Netherlands, a place where bicycling is a common, everyday travel mode among all walks of life and where bicycling infrastructure is well developed. Based on 1360 observations of bicycling behavior, this study shows that bicyclists who were using a cell phone, listening to a portable music device, or talking with other bicyclists exhibited more unsafe behaviors than those bicyclists who were not performing a secondary task. Furthermore, bicyclists who were performing a secondary task also more frequently created situations where other people had to evade them to avoid an accident. As with distracted car driving, the performance of a secondary task while bicycling may be unsafe for the person engaging in the behavior as well as for other people around them.

  17. Do advertisements at the roadside distract the driver?

    NASA Astrophysics Data System (ADS)

    Kettwich, Carmen; Klinger, Karsten; Lemmer, Uli

    2008-04-01

    Nowadays drivers have to get along with an increasing complex visual environment. More and more cars are on the road. There are not only distractions available within the vehicle, like radio and navigation system, the environment outside the car has also become more and more complex. Hoardings, advertising pillars, shop fronts and video screens are just a few examples. For this reason the potential risk of driver distraction is rising. But in which way do the advertisements at the roadside influence the driver's attention? The investigation which is described is devoted to this topic. Various kinds of advertisements played an important role, like illuminated and non-illuminated posters as well as illuminated animated ads. Several test runs in an urban environment were performed. The gaze direction of the driver's eye was measured with an eye tracking system. The latter consists of three cameras which logged the eye movements during the test run and a small-sized scene camera recording the traffic scene. 16 subjects (six female and ten male) between 21 and 65 years of age took part in this experiment. Thus the driver's fixation duration of the different advertisements could be determined.

  18. Complications following metatarsal lengthening by callus distraction for brachymetatarsia.

    PubMed

    Masada, K; Fujita, S; Fuji, T; Ohno, H

    1999-01-01

    We performed six metatarsal lengthenings in four patients for brachymetatarsia of the fourth toe by callus distraction from 1991 to 1995. Healing was achieved in all cases. The average amount of lengthening was 30% (range, 15-41%) of the original length. The average healing index was 82 days/cm (range, 66-113 days/cm). After the operation, range of movement of the metatarsophalangeal joint decreased in all cases (120 degrees before and 57 degrees after surgery). In two cases in which the lengthening exceeded 40% of the original length, stiffness of the joint (20 degrees and 0 degrees each) and joint deformity occurred. These two cases also had angulation of the metatarsal. Corrective osteotomy and release surgery was performed in one case. Angulation of the metatarsal was corrected, but the range of movement of the joint did not much recover after surgery. Another case was left untreated because the patient had no complaints. In metatarsal lengthening by callus distraction, the amount of lengthening should not exceed 40% of the original length. PMID:10344327

  19. Posterior Cranial Vault Distraction Osteogenesis: Evolution of Technique

    PubMed Central

    Ong, Juling; Harshbarger, Raymond J.; Kelley, Patrick; George, Timothy

    2014-01-01

    The rapid growth of the brain in the first few years of life drives the expansion of the cranial vault. This expansion occurs primarily at the cranial sutures; premature fusion of these results in growth restriction perpendicular to the axis of the suture. The result of this is physical deformation of the cranial and facial skeleton, as well as the distortion of the underling brain and its physiology. These patients can present with symptoms of raised intracranial pressure, neurodevelopmental delay, as well as the morphological features of craniosynostosis. Acquired conditions such as the slit ventricle syndrome may also result in cephalocranial disproportion with these clinical features. Traditional vault remodeling surgery is able to correct the physical abnormalities as well as correcting cephalocranial disproportion. Its limitations include the degree of scalp expansion achievable as well as resulting defects in the bone. The use of distraction osteogenesis of the cranial vault permits a controlled expansion in a predetermined vector in a gradual manner. When used in the calvarium, this combines the benefits of tissue expansion on the scalp, as well as stimulating the production of new bone, reducing the defects resulting from expansion. In this review, the authors describe some of the surgical considerations important to the use of this technique. This includes the relevant anatomy and technical aspects illustrated with the use of clinical cases. Finally, they present a summary of their experience and discuss the complications associated with cranial vault distraction osteogenesis. PMID:25383052

  20. Gait Kinematics After Taping in Participants With Chronic Ankle Instability

    PubMed Central

    Chinn, Lisa; Dicharry, Jay; Hart, Joseph M.; Saliba, Susan; Wilder, Robert; Hertel, Jay

    2014-01-01

    Context: Chronic ankle instability is characterized by repetitive lateral ankle sprains. Prophylactic ankle taping is a common intervention used to reduce the risk of ankle sprains. However, little research has been conducted to evaluate the effect ankle taping has on gait kinematics. Objective: To investigate the effect of taping on ankle and knee kinematics during walking and jogging in participants with chronic ankle instability. Design: Controlled laboratory study. Setting: Motion analysis laboratory. Patients or Participants: A total of 15 individuals (8 men, 7 women; age = 26.9 ± 6.8 years, height = 171.7 ± 6.3 cm, mass = 73.5 ± 10.7 kg) with self-reported chronic ankle instability volunteered. They had an average of 5.3 ± 3.1 incidences of ankle sprain. Intervention(s): Participants walked and jogged in shoes on a treadmill while untaped and taped. The tape technique was a traditional preventive taping procedure. Conditions were randomized. Main Outcome Measure(s): Frontal-plane and sagittal-plane ankle and sagittal-plane knee kinematics were recorded throughout the entire gait cycle. Group means and 90% confidence intervals were calculated, plotted, and inspected for percentages of the gait cycle in which the confidence intervals did not overlap. Results: During walking, participants were less plantar flexed from 64% to 69% of the gait cycle (mean difference = 5.73° ± 0.54°) and less inverted from 51% to 61% (mean difference = 4.34° ± 0.65°) and 76% to 81% (mean difference = 5.55° ± 0.54°) of the gait cycle when taped. During jogging, participants were less dorsiflexed from 12% to 21% (mean difference = 4.91° ± 0.18°) and less inverted from 47% to 58% (mean difference = 6.52° ± 0.12°) of the gait cycle when taped. No sagittal-plane knee kinematic differences were found. Conclusions: In those with chronic ankle instability, taping resulted in a more neutral ankle position during walking and jogging in shoes on a treadmill. This change in

  1. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint... ankle joint. The device limits translation and rotation: in one or more planes via the geometry of...

  2. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint... ankle joint. The device limits translation and rotation: in one or more planes via the geometry of...

  3. Trans-4 Portal as a New Portal for Accessing the Lunate in Wrist Arthroscopy: a Cadaveric Study

    PubMed Central

    Shahryar-Kamrani, Reza; Saremi, Hossein; Oryadi-Zanjani, Leila; Nabian, Mohammad Hossein; Amoozadeh, Azita; Moradi, Amir Hossein

    2016-01-01

    Background Evolving wrist arthroscopy requires creating new portals, and creating portals reciprocally leads to increased indications for arthroscopic wrist procedures. To facilitate access to the lunate bone and fossa for new arthroscopic procedures, a new portal was used. This is a cadaveric study of this portal. Objectives In this cadaveric study, we evaluated a portal in wrist arthroscopy for procedures involving the lunate bone and lunate fossa. Materials and Methods Seventeen wrists from 10 fresh cadavers were included in this study. After diagnostic arthroscopy, a portal (Trans-4) was made through the fourth extensor compartment, exactly along the lunate’s long axis under direct visualization from the 3-4 portal. Strand retractors were used to protect the extensor tendons and posterior capsule. Lunate bone core decompression and osteoscopy were done through the portal. At the end of the procedure, the position of the decompression hole in the lunate and any possible injury to the extensor tendons, distal radius cartilage, lunate cartilage, and perilunate ligaments were investigated. Results Lunate bone decompression was performed successfully in all cases using the trans-4 portal. In 15 wrists, the lunate hole was located in the middle third. In the other two wrists, it was located slightly radial in one case and slightly on the ulnar side in the other case. There was no cortical penetration during decompression, and no extensor tendon, superficial nerve branches, or peri-lunate ligament injuries were observed. Conclusions The trans-4 portal could be a safe working portal in wrist arthroscopy that enables access to the lunate bone and lunate fossa.

  4. Managing ankle ligament sprains and tears: current opinion.

    PubMed

    McGovern, Ryan P; Martin, RobRoy L

    2016-01-01

    The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

  5. Bone alterations are associated with ankle osteoarthritis joint pain

    PubMed Central

    Nakamura, Yukio; Uchiyama, Shigeharu; Kamimura, Mikio; Komatsu, Masatoshi; Ikegami, Shota; Kato, Hiroyuki

    2016-01-01

    The etiology of ankle osteoarthritis (OA) is largely unknown. We analyzed 24 ankle OA of 21 patients diagnosed by plain radiographs using magnetic resonance imaging (MRI). Ankle joint pain disappeared in 22 out of 24 joints by conservative treatment. MRI bone signal changes in and around the ankle joints were observed in 22 of 24 joints. Bone signal changes along the joint line were seen in 10 of 11 joints as a Kellgren-Lawrence (KL) grade of II to IV. Such signal changes were witnessed in only 4 of 13 joints with KL grade 0 or I. In the talocrural joint, bone alterations occurred in both tibia and talus bones through the joint line in cases of KL grade III or IV, while focal bone alterations were present in the talus only in KL grade I or II cases. Sixteen of 24 joints exhibited intraosseous bone signal changes, which tended to correspond to joint pain of any ankle OA stage. Our results suggest that bone alterations around the ankle joint might be one of the etiologies of OA and associated with ankle joint pain. PMID:26776564

  6. Bone alterations are associated with ankle osteoarthritis joint pain.

    PubMed

    Nakamura, Yukio; Uchiyama, Shigeharu; Kamimura, Mikio; Komatsu, Masatoshi; Ikegami, Shota; Kato, Hiroyuki

    2016-01-18

    The etiology of ankle osteoarthritis (OA) is largely unknown. We analyzed 24 ankle OA of 21 patients diagnosed by plain radiographs using magnetic resonance imaging (MRI). Ankle joint pain disappeared in 22 out of 24 joints by conservative treatment. MRI bone signal changes in and around the ankle joints were observed in 22 of 24 joints. Bone signal changes along the joint line were seen in 10 of 11 joints as a Kellgren-Lawrence (KL) grade of II to IV. Such signal changes were witnessed in only 4 of 13 joints with KL grade 0 or I. In the talocrural joint, bone alterations occurred in both tibia and talus bones through the joint line in cases of KL grade III or IV, while focal bone alterations were present in the talus only in KL grade I or II cases. Sixteen of 24 joints exhibited intraosseous bone signal changes, which tended to correspond to joint pain of any ankle OA stage. Our results suggest that bone alterations around the ankle joint might be one of the etiologies of OA and associated with ankle joint pain.

  7. Summary of Human Ankle Mechanical Impedance During Walking

    PubMed Central

    Rouse, Elliott J.; Krebs, Hermano Igo

    2016-01-01

    The human ankle joint plays a critical role during walking and understanding the biomechanical factors that govern ankle behavior and provides fundamental insight into normal and pathologically altered gait. Previous researchers have comprehensively studied ankle joint kinetics and kinematics during many biomechanical tasks, including locomotion; however, only recently have researchers been able to quantify how the mechanical impedance of the ankle varies during walking. The mechanical impedance describes the dynamic relationship between the joint position and the joint torque during perturbation, and is often represented in terms of stiffness, damping, and inertia. The purpose of this short communication is to unify the results of the first two studies measuring ankle mechanical impedance in the sagittal plane during walking, where each study investigated differing regions of the gait cycle. Rouse et al. measured ankle impedance from late loading response to terminal stance, where Lee et al. quantified ankle impedance from pre-swing to early loading response. While stiffness component of impedance increases significantly as the stance phase of walking progressed, the change in damping during the gait cycle is much less than the changes observed in stiffness. In addition, both stiffness and damping remained low during the swing phase of walking. Future work will focus on quantifying impedance during the “push off” region of stance phase, as well as measurement of these properties in the coronal plane. PMID:27766187

  8. Managing ankle ligament sprains and tears: current opinion

    PubMed Central

    McGovern, Ryan P; Martin, RobRoy L

    2016-01-01

    The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

  9. Multivariable Dynamic Ankle Mechanical Impedance With Active Muscles

    PubMed Central

    Lee, Hyunglae; Krebs, Hermano Igo; Hogan, Neville

    2015-01-01

    Multivariable dynamic ankle mechanical impedance in two coupled degrees-of-freedom (DOFs) was quantified when muscles were active. Measurements were performed at five different target activation levels of tibialis anterior and soleus, from 10% to 30% of maximum voluntary contraction (MVC) with increments of 5% MVC. Interestingly, several ankle behaviors characterized in our previous study of the relaxed ankle were observed with muscles active: ankle mechanical impedance in joint coordinates showed responses largely consistent with a second-order system consisting of inertia, viscosity, and stiffness; stiffness was greater in the sagittal plane than in the frontal plane at all activation conditions for all subjects; and the coupling between dorsiflexion–plantarflexion and inversion–eversion was small—the two DOF measurements were well explained by a strictly diagonal impedance matrix. In general, ankle stiffness increased linearly with muscle activation in all directions in the 2-D space formed by the sagittal and frontal planes, but more in the sagittal than in the frontal plane, resulting in an accentuated “peanut shape.” This characterization of young healthy subjects’ ankle mechanical impedance with active muscles will serve as a baseline to investigate pathophysiological ankle behaviors of biomechanically and/or neurologically impaired patients. PMID:25203497

  10. Effect of anterior translation of the talus on outcomes of three-component total ankle arthroplasty

    PubMed Central

    2013-01-01

    Background Ankle osteoarthritis commonly involves sagittal malalignment with anterior translation of the talus relative to the tibia. Total ankle arthroplasty has become an increasingly popular treatment for patients with symptomatic ankle osteoarthritis. However, no comprehensive study has been conducted on the outcomes of total ankle arthroplasty for osteoarthritis with preoperative sagittal malalignment. The purpose of this study was to evaluate the effect of anterior translation of the talus on outcomes of three-component total ankle arthroplasty. Methods One hundred and four osteoarthritic ankles in 104 patients who underwent three-component total ankle arthroplasty were included in this study. The 104 ankles were divided into 2 groups: ankles with anteriorly translated talus (50 ankles), and ankles with non-translated talus (54 ankles). Clinical and radiographic outcomes were assessed in both groups. The mean follow-up duration was 42.8 ± 17.9 months (range, 24 to 95 months). Results Forty-six (92%) of 50 ankles with anterior translation of the talus showed relocation of the talus within the mortise at 6 months, and 48 (96%) ankles were relocated at 12 months after total ankle arthroplasty. But, 2 (4%) ankles were not relocated until the final follow-up. The AOFAS scores, ankle range of motion, and radiographic outcomes showed no significant difference between the two groups at the final follow-up (p > 0.05 for each). Conclusions In majority of cases, the anteriorly translated talus in osteoarthritic ankles was restored to an anatomical position within 6 months after successful three-component total ankle arthroplasty. The clinical and radiographic outcomes in the osteoarthritic ankles with anteriorly translated talus group were comparable with those in non-translated talus group. PMID:24007555

  11. Seasonality of Ankle Swelling: Population Symptom Reporting Using Google Trends.

    PubMed

    Liu, Fangwei; Allan, G Michael; Korownyk, Christina; Kolber, Michael; Flook, Nigel; Sternberg, Harvey; Garrison, Scott

    2016-07-01

    In our experience, complaints of ankle swelling are more common in summer, typically from patients with no obvious cardiovascular disease. Surprisingly, this observation has never been reported. To objectively establish this phenomenon, we sought evidence of seasonality in the public's Internet searches for ankle swelling. Our data, obtained from Google Trends, consisted of all related Google searches in the United States from January 4, 2004, to January 26, 2016. Consistent with our expectations and confirmed by similar data for Australia, Internet searches for information on ankle swelling are highly seasonal (highest in midsummer), with seasonality explaining 86% of search volume variability.

  12. Seasonality of Ankle Swelling: Population Symptom Reporting Using Google Trends.

    PubMed

    Liu, Fangwei; Allan, G Michael; Korownyk, Christina; Kolber, Michael; Flook, Nigel; Sternberg, Harvey; Garrison, Scott

    2016-07-01

    In our experience, complaints of ankle swelling are more common in summer, typically from patients with no obvious cardiovascular disease. Surprisingly, this observation has never been reported. To objectively establish this phenomenon, we sought evidence of seasonality in the public's Internet searches for ankle swelling. Our data, obtained from Google Trends, consisted of all related Google searches in the United States from January 4, 2004, to January 26, 2016. Consistent with our expectations and confirmed by similar data for Australia, Internet searches for information on ankle swelling are highly seasonal (highest in midsummer), with seasonality explaining 86% of search volume variability. PMID:27401424

  13. Ultrasound-guided interventions of the foot and ankle.

    PubMed

    Yablon, Corrie M

    2013-02-01

    Ultrasound (US) provides excellent delineation of tendons and ligaments in the foot and ankle and provides real-time visualization of a needle during interventions, yielding greater accuracy and efficacy than the traditional blind approach using anatomical landmarks. For this reason, US is rapidly gaining acceptance as the preferred modality for guiding interventions in the foot and ankle where the anatomy is complex, neurovascular structures should be identified, and precise technique is demanded. In the foot and ankle, US is especially useful to guide tendon sheath, bursal, and Achilles paratenon injections, Morton neuroma injections, plantar fascial injections, and joint aspirations and injections.

  14. Outcome of unilateral ankle arthrodesis and total ankle replacement in terms of bilateral gait mechanics.

    PubMed

    Chopra, Swati; Rouhani, Hossein; Assal, Mathieu; Aminian, Kamiar; Crevoisier, Xavier

    2014-03-01

    Previous studies assessed the outcome of ankle arthrodesis (AA) and total ankle replacement (TAR) surgeries; however, the extent of postoperative recovery towards bilateral gait mechanics (BGM) is unknown. We evaluated the outcome of the two surgeries at least 2 years post rehabilitation, focusing on BGM. 36 participants, including 12 AA patients, 12 TAR patients, and 12 controls were included. Gait assessment over 50 m distance was performed utilizing pressure insoles and 3D inertial sensors, following which an intraindividual comparison was performed. Most spatiotemporal and kinematic parameters in the TAR group were indicative of good gait symmetry, while the AA group presented significant differences. Plantar pressure symmetry among the AA group was also significantly distorted. Abnormality in biomechanical behavior of the AA unoperated, contralateral foot was observed. In summary, our results indicate an altered BGM in AA patients, whereas a relatively fully recovered BGM is observed in TAR patients, despite the quantitative differences in several parameters when compared to a healthy population. Our study supports a biomechanical assessment and rehabilitation of both operated and unoperated sides after major surgeries for ankle osteoarthrosis.

  15. Use of a trabecular metal implant in ankle arthrodesis after failed total ankle replacement

    PubMed Central

    2010-01-01

    Background and purpose Arthrodesis after failed total ankle replacement is complicated and delayed union, nonunion, and shortening of the leg often occur—especially with large bone defects. We investigated the use of a trabecular metal implant and a retrograde intramedullary nail to obtain fusion. Patients and methods 13 patients with a migrated or loose total ankle implant underwent arthrodesis with the use of a retrograde intramedullary nail through a trabecular metal Tibial Cone. The mean follow-up time was 1.4 (0.6–3.4) years. Results At the last examination, 7 patients were pain-free, while 5 had some residual pain but were satisfied with the procedure. 1 patient was dissatisfied and experienced pain and swelling when walking. The implant-bone interfaces showed no radiographic zones or gaps in any patient, indicating union. Interpretation The method is a new way of simplifying and overcoming some of the problems of performing arthrodesis after failed total ankle replacement. PMID:21067435

  16. Effects of hip and head position on ankle range of motion, ankle passive torque, and passive gastrocnemius tension.

    PubMed

    Andrade, R J; Lacourpaille, L; Freitas, S R; McNair, P J; Nordez, A

    2016-01-01

    Ankle joint range of motion (ROM) is notably influenced by the position of the hip joint. However, this result remains unexplained. Thus, the aim of this study was to test if the ankle passive torque and gastrocnemius muscle tension are affected by the hip and the head positions. The torque and the muscle shear elastic modulus (measured by elastography to estimate muscle tension) were collected in nine participants during passive ankle dorsiflexions performed in four conditions (by combining hip flexion at 90 or 150°, and head flexed or neutral). Ankle maximum dorsiflexion angle significantly decreased by flexing the hip from 150 to 90° (P < 0.001; mean difference 17.7 ± 2.5°), but no effect of the head position was observed (P > 0.05). Maximal passive torque and shear elastic modulus were higher with the hip flexed at 90° (P < 0.001). During submaximal ROM, no effects of the head and hip positioning (P > 0.05) were found for both torque and shear elastic modulus at a given common ankle angle among conditions. Shifts in maximal ankle angle due to hip angle manipulation are not related neither to changes in passive torque nor tension of the gastrocnemius. Further studies should be addressed to better understand the functional role of peripheral nerves and fasciae in the ankle ROM limits.

  17. Virtual-reality distraction and cold-pressor pain tolerance: does avatar point of view matter?

    PubMed

    Dahlquist, Lynnda M; Herbert, Linda J; Weiss, Karen E; Jimeno, Monica

    2010-10-01

    This study tested the effects of distraction using virtual-reality (VR) technology on acute pain tolerance in young adults. Forty-one undergraduate students, aged 18-23 years, used a VR head-mounted display helmet, steering wheel, and foot pedal to play an auto racing video game while undergoing exposure to very cold water (cold pressor set at 1 °C). Two different game views were tested that were hypothesized to affect the degree to which participants felt "present" in the virtual environment: a first-person view, in which the participant saw the virtual environment through the eyes of the game character being manipulated; and a third-person view, in which the participant viewed the game character from a distance. The length of time participants tolerated the cold-water exposure (pain tolerance) under each distraction condition was compared to a baseline (no distraction) trial. Subjects also rated the degree to which they felt "present" in the virtual environment after each distraction trial. Results demonstrated that participants had significantly higher pain tolerance during both VR-distraction conditions relative to baseline (no distraction) trials. Although participants reported a greater sense of presence during the first-person condition than the third-person condition, pain-tolerance scores associated with the two distraction conditions did not differ. The types of VR applications in which presence may be more or less important are discussed.

  18. Non-erotic cognitive distractions during sexual activity in sexual minority and heterosexual young adults.

    PubMed

    Lacefield, Katharine; Negy, Charles

    2012-04-01

    The present study examined 100 lesbian and gay college students and 100 heterosexual students to determine whether group differences exist in frequency of a range of non-erotic cognitive distractions during sexual activity. Non-erotic cognitive distraction is a descriptive term for both self-evaluative cognitions related to physical performance and body image concerns, as well as additional cognitive distractions (e.g., contracting an STI or emotional concerns) during sexual activity. Participants were matched on gender (96 males and 104 females), age, and ethnicity, and completed questionnaires assessing frequency of non-erotic cognitive distractions during sexual activity, as well as measures of additional variables (trait and body image anxiety, attitudes toward sexual minorities, self-esteem, and religiosity). Results indicated that sexual minorities experienced significantly more cognitive distractions related to body image, physical performance, and STIs during sexual activity than heterosexuals. Regarding gender, men reported more distractions related to STIs than women. Interaction effects were observed between sexual orientation and gender for body image-, disease-, and external/emotional-based distractions. Implications of these findings are discussed.

  19. Non-erotic cognitive distractions during sexual activity in sexual minority and heterosexual young adults.

    PubMed

    Lacefield, Katharine; Negy, Charles

    2012-04-01

    The present study examined 100 lesbian and gay college students and 100 heterosexual students to determine whether group differences exist in frequency of a range of non-erotic cognitive distractions during sexual activity. Non-erotic cognitive distraction is a descriptive term for both self-evaluative cognitions related to physical performance and body image concerns, as well as additional cognitive distractions (e.g., contracting an STI or emotional concerns) during sexual activity. Participants were matched on gender (96 males and 104 females), age, and ethnicity, and completed questionnaires assessing frequency of non-erotic cognitive distractions during sexual activity, as well as measures of additional variables (trait and body image anxiety, attitudes toward sexual minorities, self-esteem, and religiosity). Results indicated that sexual minorities experienced significantly more cognitive distractions related to body image, physical performance, and STIs during sexual activity than heterosexuals. Regarding gender, men reported more distractions related to STIs than women. Interaction effects were observed between sexual orientation and gender for body image-, disease-, and external/emotional-based distractions. Implications of these findings are discussed. PMID:21796485

  20. Distraction osteogenesis enhances remodeling of remote bones of the skeleton: a pilot study.

    PubMed

    Funk, Julia F; Krummrey, Gert; Perka, Carsten; Raschke, Michael J; Bail, Hermann J

    2009-12-01

    Bone injuries have a systemic influence on the remodeling of bone. This effect has not been examined concerning its extent and duration. We measured the systemic effect of distraction osteogenesis on the remodeling of bones of the axial skeleton by means of the mineral apposition rate and bone formation rate in an animal experiment. Distraction osteogenesis was performed on the tibiae of 24 mature Yucatan minipigs. After a 4-day latency period, the tibiae were distracted 2 mm/day for 10 days. The ensuing consolidation phase lasted 10 days. Three fluorescent labeling substances were applied intravenously: calcein green at the second postoperative day, tetracycline 1 day after the end of the distraction phase, and xylene orange 2 days before sacrifice. We prepared ground sections from the ninth right ribs. The mineral apposition rate and bone formation rate were measured histomorphometrically on labeled osteons. The median mineral apposition rate during distraction was 2.39 microm/day (2.12-2.62 microm/day), which was higher than the rate during consolidation (median, 1.62 microm/day; 1.54-1.84 microm/day). The median bone formation rate confirmed this result and was 840.51 microm(2)/day (744.20-1148.26 microm(2)/day) during distraction and 384.25 microm(2)/day (330.84-467.71 microm(2)/day) during consolidation. Thus, a short period of distraction osteogenesis appears to have an anabolic effect on the mineral apposition rate of remote cortical bone.