Powered ankle-foot prosthesis to assist level-ground and stair-descent gaits.

PubMed

Au, Samuel; Berniker, Max; Herr, Hugh

2008-05-01

The human ankle varies impedance and delivers net positive work during the stance period of walking. In contrast, commercially available ankle-foot prostheses are passive during stance, causing many clinical problems for transtibial amputees, including non-symmetric gait patterns, higher gait metabolism, and poorer shock absorption. In this investigation, we develop and evaluate a myoelectric-driven, finite state controller for a powered ankle-foot prosthesis that modulates both impedance and power output during stance. The system employs both sensory inputs measured local to the external prosthesis, and myoelectric inputs measured from residual limb muscles. Using local prosthetic sensing, we first develop two finite state controllers to produce biomimetic movement patterns for level-ground and stair-descent gaits. We then employ myoelectric signals as control commands to manage the transition between these finite state controllers. To transition from level-ground to stairs, the amputee flexes the gastrocnemius muscle, triggering the prosthetic ankle to plantar flex at terminal swing, and initiating the stair-descent state machine algorithm. To transition back to level-ground walking, the amputee flexes the tibialis anterior muscle, triggering the ankle to remain dorsiflexed at terminal swing, and initiating the level-ground state machine algorithm. As a preliminary evaluation of clinical efficacy, we test the device on a transtibial amputee with both the proposed controller and a conventional passive-elastic control. We find that the amputee can robustly transition between the finite state controllers through direct muscle activation, allowing rapid transitioning from level-ground to stair walking patterns. Additionally, we find that the proposed finite state controllers result in a more biomimetic ankle response, producing net propulsive work during level-ground walking and greater shock absorption during stair descent. The results of this study highlight the potential of prosthetic leg controllers that exploit neural signals to trigger terrain-appropriate, local prosthetic leg behaviors.

Biomechanical Evaluation of a Prototype Foot/Ankle Prosthesis

PubMed Central

Quesada, P. M.; Pitkin, M.; Colvin, J.

2016-01-01

In this paper, we report on our pilot evaluation of a prototype foot/ankle prosthesis. This prototype has been designed and fabricated with the intention of providing decreased ankle joint stiffness during the middle portion of the stance phase of gait, and increased (i.e., more normal) knee range of motion during stance. Our evaluation involved fitting the existing prototype foot/ankle prosthesis, as well as a traditional solid ankle cushioned heel (SACH) foot, to an otherwise healthy volunteer with a below-knee (BK) amputation. We measured this individual’s lower extremity joint kinematics and kinetics during walking using a video motion analysis system and force platform. These measurements permitted direct comparison of prosthetic ankle joint stiffness and involved side knee joint motion, as well as prosthetic ankle joint moment and power. PMID:10779119

The influence of a hydraulic prosthetic ankle on residual limb loading during sloped walking

PubMed Central

Nickel, Eric A.; Medvec, Joseph; Barrons, Kyle; Mion, Spencer; Hansen, Andrew H.

2017-01-01

In recent years, numerous prosthetic ankle-foot devices have been developed to address the demands of sloped walking for individuals with lower-limb amputation. The goal of this study was to compare the performance of a passive, hydraulic ankle-foot prosthesis to two related, non-hydraulic ankles based on their ability to minimize the socket reaction moments of individuals with transtibial amputation during a range of sloped walking tasks. After a two-week accommodation period, kinematic data were collected on seven subjects with a transtibial amputation walking on an instrumented treadmill set at various slopes. Overall, this study was unable to find significant differences in the torque at the distal end of the prosthetic socket between an ankle-foot prosthesis with a hydraulic range-of-motion and other related ankle-foot prosthesis designs (rigid ankle, multiaxial ankle) during the single-support phase of walking. In addition, socket comfort and perceived exertion were not significantly different for any of the ankle-foot prostheses tested in this study. These results suggest the need for further work to determine if more advanced designs (e.g., those with microprocessor control of hydraulic features, powered ankle-foot designs) can provide more biomimetic function to prosthesis users. PMID:28278172

Design and development of a novel viscoelastic ankle-foot prosthesis based on the human ankle biomechanics.

PubMed

Safaeepour, Zahra; Esteki, Ali; Tabatabai Ghomshe, Farhad; Mousavai, Mohammad E

2014-10-01

In the present study, a new approach was applied to design and develop a viscoelastic ankle-foot prosthesis. The aim was to replicate the intact ankle moment-angle loop in the normal walking speed. The moment-angle loop of intact ankle was divided into four parts, and the appropriate models including two viscoelastic units of spring-damper mechanism were considered to replicate the passive ankle dynamics. The developed prototype was then tested on a healthy subject with the amputee gait simulator. The result showed that prosthetic ankle moment-angle loop was similar to that of intact ankle with the distinct four periods. The findings suggest that the prototype successfully provided the human ankle passive dynamics. Therefore, the viscoelastic units could imitate the four periods of a normal gait. The novel viscoelastic foot prosthesis could provide natural ankle dynamics in a gait cycle. Applying simple but biomechanical approach is suggested in conception of new designs for prosthetic ankle-foot mechanisms. © The International Society for Prosthetics and Orthotics 2014.

Effects of a powered ankle-foot prosthesis on kinetic loading of the unaffected leg during level-ground walking

PubMed Central

2013-01-01

Background People with a lower-extremity amputation that use conventional passive-elastic ankle-foot prostheses encounter a series of stress-related challenges during walking such as greater forces on their unaffected leg, and may thus be predisposed to secondary musculoskeletal injuries such as chronic joint disorders. Specifically, people with a unilateral transtibial amputation have an increased susceptibility to knee osteoarthritis, especially in their unaffected leg. Previous studies have hypothesized that the development of this disorder is linked to the abnormally high peak knee external adduction moments encountered during walking. An ankle-foot prosthesis that supplies biomimetic power could potentially mitigate the forces and knee adduction moments applied to the unaffected leg of a person with a transtibial amputation, which could, in turn, reduce the risk of knee osteoarthritis. We hypothesized that compared to using a passive-elastic prosthesis, people with a transtibial amputation using a powered ankle-foot prosthesis would have lower peak resultant ground reaction forces, peak external knee adduction moments, and corresponding loading rates applied to their unaffected leg during walking over a wide range of speeds. Methods We analyzed ground reaction forces and knee joint kinetics of the unaffected leg of seven participants with a unilateral transtibial amputation and seven age-, height- and weight-matched non-amputees during level-ground walking at 0.75, 1.00, 1.25, 1.50, and 1.75 m/s. Subjects with an amputation walked while using their own passive-elastic prosthesis and a powered ankle-foot prosthesis capable of providing net positive mechanical work and powered ankle plantar flexion during late stance. Results Use of the powered prosthesis significantly decreased unaffected leg peak resultant forces by 2-11% at 0.75-1.50 m/s, and first peak knee external adduction moments by 21 and 12% at 1.50 and 1.75 m/s, respectively. Loading rates were not significantly different between prosthetic feet. Conclusions Use of a biomimetic powered ankle-foot prosthesis decreased peak resultant force at slow and moderate speeds and knee external adduction moment at moderate and fast speeds on the unaffected leg of people with a transtibial amputation during level-ground walking. Thus, use of an ankle-foot prosthesis that provides net positive mechanical work could reduce the risk of comorbidities such as knee osteoarthritis. PMID:23758860

Amputation effects on the underlying complexity within transtibial amputee ankle motion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wurdeman, Shane R., E-mail: shanewurdeman@gmail.com; Advanced Prosthetics Center, Omaha, Nebraska 68134; Myers, Sara A.

2014-03-15

The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed “more appropriate” and the other “less appropriate” based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points ofmore » the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a “more appropriate” prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a “less appropriate” prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.« less

Robotic cadaver testing of a new total ankle prosthesis model (German Ankle System).

PubMed

Richter, Martinus; Zech, Stefan; Westphal, Ralf; Klimesch, Yvone; Gosling, Thomas

2007-12-01

An investigation was carried out into possible increased forces, torques, and altered motions during load-bearing ankle motion after implantation of two different total ankle prostheses. We hypothesized that the parameters investigated would not differ in relation to the two implants compared. We included two different ankle prostheses (Hintegra, Newdeal, Vienne, France; German Ankle System, R-Innovation, Coburg, Germany). The prostheses were implanted in seven paired cadaver specimens. The specimens were mounted on an industrial robot that enables complex motion under predefined conditions (RX 90, Stäubli, Bayreuth, Germany). The robot detected the load-bearing (30 kg) motion of the 100(th) cycle of the specimens without prostheses as the baseline for the later testing, and mimicked that exact motion during 100 cycles after the prostheses were implanted. The resulting forces, torques, and bone motions were recorded and the differences between the prostheses compared. The Hintegra and German Ankle System, significantly increased the forces and torques in relation to the specimen without a prosthesis with one exception (one-sample-t-test, each p < or = 0.01; exception, parameter lateral force measured with the German Ankle System, p = 0.34). The force, torque, and motion differences between the specimens before and after implantation of the prostheses were lower with the German Ankle System than with the Hintegra (unpaired t-test, each p < or = 0.05). The German Ankle System prosthesis had less of an effect on resulting forces and torques during partial weightbearing passive ankle motion than the Hintegra prosthesis. This might improve function and minimize loosening during the clinical use.

Design and characterization of a biologically inspired quasi-passive prosthetic ankle-foot.

PubMed

Mooney, Luke M; Lai, Cara H; Rouse, Elliott J

2014-01-01

By design, commonly worn energy storage and release (ESR) prosthetic feet cannot provide biologically realistic ankle joint torque and angle profiles during walking. Additionally, their anthropomorphic, cantilever architecture causes their mechanical stiffness to decrease throughout the stance phase of walking, opposing the known trend of the biological ankle. In this study, the design of a quasi-passive pneumatic ankle-foot prosthesis is detailed that is able to replicate the biological ankle's torque and angle profiles during walking. The prosthetic ankle is comprised of a pneumatic piston, bending spring and solenoid valve. The mechanical properties of the pneumatic ankle prosthesis are characterized using a materials testing machine and the properties are compared to those from a common, passive ESR prosthetic foot. The characterization spanned a range of ankle equilibrium pressures and testing locations beneath the foot, analogous to the location of center of pressure within the stance phase of walking. The pneumatic ankle prosthesis was shown to provide biologically appropriate trends and magnitudes of torque, angle and stiffness behavior, when compared to the passive ESR prosthetic foot. Future work will focus on the development of a control system for the quasi-passive device and clinical testing of the pneumatic ankle to demonstrate efficacy.

Design and Preliminary Evaluation of a Two DOFs Cable-Driven Ankle–Foot Prosthesis with Active Dorsiflexion–Plantarflexion and Inversion–Eversion

PubMed Central

Ficanha, Evandro Maicon; Ribeiro, Guilherme Aramizo; Dallali, Houman; Rastgaar, Mohammad

2016-01-01

This paper describes the design of an ankle–foot robotic prosthesis controllable in the sagittal and frontal planes. The prosthesis was designed to meet the mechanical characteristics of the human ankle including power, range of motion, and weight. To transfer the power from the motors and gearboxes to the ankle–foot mechanism, a Bowden cable system was used. The Bowden cable allows for optimal placement of the motors and gearboxes in order to improve gait biomechanics such as the metabolic energy cost and gait asymmetry during locomotion. Additionally, it allows flexibility in the customization of the device to amputees with different residual limb sizes. To control the prosthesis, impedance controllers in both sagittal and frontal planes were developed. The impedance controllers used torque feedback from strain gages installed on the foot. Preliminary evaluation was performed to verify the capability of the prosthesis to track the kinematics of the human ankle in two degrees of freedom (DOFs), the mechanical efficiency of the Bowden cable transmission, and the ability of the prosthesis to modulate the impedance of the ankle. Moreover, the system was characterized by describing the relationship between the stiffness of the impedance controllers to the actual stiffness of the ankle. Efficiency estimation showed 85.4% efficiency in the Bowden cable transmission. The prosthesis was capable of properly mimicking human ankle kinematics and changing its mechanical impedance in two DOFs in real time with a range of stiffness sufficient for normal human walking. In dorsiflexion–plantarflexion (DP), the stiffness ranged from 0 to 236 Nm/rad and in inversion–eversion (IE), the stiffness ranged from 1 to 33 Nm/rad. PMID:27200342

Biomechanics of the ankle-foot system during stair ambulation: implications for design of advanced ankle-foot prostheses.

PubMed

Sinitski, Emily H; Hansen, Andrew H; Wilken, Jason M

2012-02-02

Unilateral lower limb prosthesis users display temporal, kinematic, and kinetic asymmetries between limbs while ascending and descending stairs. These asymmetries are due, in part, to the inability of current prosthetic devices to effectively mimic normal ankle function. The purpose of this study was to provide a comprehensive set of biomechanical data for able-bodied and unilateral transtibial amputee (TTA) ankle-foot systems for level-ground (LG), stair ascent (SA), and stair descent (SD), and to characterize deviations from normal performance associated with prosthesis use. Ankle joint kinematics, kinetics, torque-angle curves, and effective shapes were calculated for twelve able-bodied individuals and twelve individuals with TTA. The data from this study demonstrated the prosthetic limb can more effectively mimic the range of motion and power output of a normal ankle-foot during LG compared to SA and SD. There were larger differences between the prosthetic and able-bodied limbs during SA and SD, most evident in the torque-angle curves and effective shapes. These data can be used by persons designing ankle-foot prostheses and provide comparative data for assessment of future ankle-foot prosthesis designs. Published by Elsevier Ltd.

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.

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 cemented prosthesis. 888.3100 Section 888.3100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3100...

21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ankle joint metal/composite semi-constrained cemented prosthesis. 888.3100 Section 888.3100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3100...

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 cemented prosthesis. 888.3100 Section 888.3100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3100...

Increasing ankle push-off work with a powered prosthesis does not necessarily reduce metabolic rate for transtibial amputees.

PubMed

Quesada, Roberto E; Caputo, Joshua M; Collins, Steven H

2016-10-03

Amputees using passive ankle-foot prostheses tend to expend more metabolic energy during walking than non-amputees, and reducing this cost has been a central motivation for the development of active ankle-foot prostheses. Increased push-off work at the end of stance has been proposed as a way to reduce metabolic energy use, but the effects of push-off work have not been tested in isolation. In this experiment, participants with unilateral transtibial amputation (N=6) walked on a treadmill at a constant speed while wearing a powered prosthesis emulator. The prosthesis delivered different levels of ankle push-off work across conditions, ranging from the value for passive prostheses to double the value for non-amputee walking, while all other prosthesis mechanics were held constant. Participants completed six acclimation sessions prior to a data collection in which metabolic rate, kinematics, kinetics, muscle activity and user satisfaction were recorded. Metabolic rate was not affected by net prosthesis work rate (p=0.5; R 2 =0.007). Metabolic rate, gait mechanics and muscle activity varied widely across participants, but no participant had lower metabolic rate with higher levels of push-off work. User satisfaction was affected by push-off work (p=0.002), with participants preferring values of ankle push-off slightly higher than in non-amputee walking, possibly indicating other benefits. Restoring or augmenting ankle push-off work is not sufficient to improve energy economy for lower-limb amputees. Additional necessary conditions might include alternate timing or control, individualized tuning, or particular subject characteristics. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessing the Relative Contributions of Active Ankle and Knee Assistance to the Walking Mechanics of Transfemoral Amputees Using a Powered Prosthesis

PubMed Central

Simon, Ann M.; Hargrove, Levi J.

2016-01-01

Powered knee-ankle prostheses are capable of providing net-positive mechanical energy to amputees. Yet, there are limitless ways to deliver this energy throughout the gait cycle. It remains largely unknown how different combinations of active knee and ankle assistance affect the walking mechanics of transfemoral amputees. This study assessed the relative contributions of stance phase knee swing initiation, increasing ankle stiffness and powered plantarflexion as three unilateral transfemoral amputees walked overground at their self-selected walking speed. Five combinations of knee and ankle conditions were evaluated regarding the kinematics and kinetics of the amputated and intact legs using repeated measures analyses of variance. We found eliminating active knee swing initiation or powered plantarflexion was linked to increased compensations of the ipsilateral hip joint during the subsequent swing phase. The elimination of knee swing initiation or powered plantarflexion also led to reduced braking ground reaction forces of the amputated and intact legs, and influenced both sagittal and frontal plane loading of the intact knee joint. Gradually increasing prosthetic ankle stiffness influenced the shape of the prosthetic ankle plantarflexion moment, more closely mirroring the intact ankle moment. Increasing ankle stiffness also corresponded to increased prosthetic ankle power generation (despite a similar maximum stiffness value across conditions) and increased braking ground reaction forces of the amputated leg. These findings further our understanding of how to deliver assistance with powered knee-ankle prostheses and the compensations that occur when specific aspects of assistance are added/removed. PMID:26807889

Robotic lower limb prosthesis design through simultaneous computer optimizations of human and prosthesis costs

NASA Astrophysics Data System (ADS)

Handford, Matthew L.; Srinivasan, Manoj

2016-02-01

Robotic lower limb prostheses can improve the quality of life for amputees. Development of such devices, currently dominated by long prototyping periods, could be sped up by predictive simulations. In contrast to some amputee simulations which track experimentally determined non-amputee walking kinematics, here, we explicitly model the human-prosthesis interaction to produce a prediction of the user’s walking kinematics. We obtain simulations of an amputee using an ankle-foot prosthesis by simultaneously optimizing human movements and prosthesis actuation, minimizing a weighted sum of human metabolic and prosthesis costs. The resulting Pareto optimal solutions predict that increasing prosthesis energy cost, decreasing prosthesis mass, and allowing asymmetric gaits all decrease human metabolic rate for a given speed and alter human kinematics. The metabolic rates increase monotonically with speed. Remarkably, by performing an analogous optimization for a non-amputee human, we predict that an amputee walking with an appropriately optimized robotic prosthesis can have a lower metabolic cost - even lower than assuming that the non-amputee’s ankle torques are cost-free.

Control and Evaluation of a Powered Transfemoral Prosthesis for Stair Ascent.

PubMed

Ledoux, Elissa D; Goldfarb, Michael

2017-07-01

This paper assesses the metabolic effort exerted by three transfemoral amputees, when using a powered knee and ankle prosthesis for stair ascent, relative to ascending stairs with passive knee and ankle prostheses. The paper describes a controller that provides step-over stair ascent behavior reflective of healthy stair ascent biomechanics, and describes its implementation in a powered prosthesis prototype. Stair ascent experiments were performed with three unilateral transfemoral amputee subjects, comparing the oxygen consumption required to ascend stairs using the powered prosthesis (with a step-over gait), relative to using their daily-use energetically passive prostheses (with a step-to gait). Results indicate on average a 24% reduction in oxygen consumption and a 30% reduction in stair ascent timewhen using the powered prosthesis, relative to when using the passive prostheses. All subjects expressed a strong preference for ascending stairs using the powered prosthesis.

Custom-Made Total Talonavicular Replacement in a Professional Rock Climber.

PubMed

Giannini, Sandro; Cadossi, Matteo; Mazzotti, Antonio; Ramponi, Laura; Belvedere, Claudio; Leardini, Alberto

Professional athletes are often eager to resume sporting activities at preinjury levels. When facing the challenge of restoring joint function after a complex articular fracture, innovative solutions must be explored. We describe the results of what we believe to be the first custom-made talonavicular prosthesis implanted in a professional rock climber who had developed post-traumatic ankle and talonavicular arthritis as sequelae of a complex talar and navicular fracture. Using computed tomography scan reconstruction of the contralateral healthy ankle and direct metal laser sintering, a custom-made talonavicular prosthesis was obtained and implanted using an anteromedial approach. The patient was clinically and radiographically evaluated every 6 months after surgery for 30 months. A 3-dimensional videofluoroscopic analysis was performed to assess the range of motion about the prosthesis. At the last follow-up visit, the functional scores were excellent (Tegner activity scale score of 9 of 10), and he had completely resumed his sporting activity. The American Orthopaedic Foot and Ankle Society score had increased from 36 to 81 points, and no signs of radiolucency were observed on the radiographs. The 3-dimensional videofluoroscopic analysis showed 15° of dorsiflexion and 4° of plantar flexion at the ankle. A customized solution is an option when the patient's expectations are not likely to be met by standard treatment, such as arthrodesis. A custom-made talonavicular prosthesis can be an effective solution for complex ankle injury sequelae in patients demanding high functionality. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

TOTAL ANKLE ARTHROPLASTY: BRAZILIAN EXPERIENCE WITH THE HINTEGRA PROSTHESIS.

PubMed

Nery, Caio; Fernandes, Túlio Diniz; Réssio, Cibele; Fuchs, Mauro Luiz; Godoy Santos, Alexandre Leme de; Ortiz, Rafael Trevisan

2010-01-01

Ankle arthrosis is becoming more and more common. The search for solutions that preserve joint function has led to a new generation of prosthesis with three components and more degrees of freedom. This paper presents the results achieved for ten patients treated with the HINTEGRA Prosthesis (Integra, New Deal), through collaborative action between the Foot and Ankle Groups of the Orthopedics and Traumatology divisions of Escola Paulista de Medicina, Unifesp, and the School of Medicine of the University of São Paulo (USP). The ten patients (six women and four men, aged between 29 and 66 years), underwent a surgical procedure consisting of Hintermann's technique, between January and June 2005. They were evaluated at prearranged intervals, and the data were subjected to statistical analysis. The surgery led to a significant improvement in ankle mobility. Radiological evaluation showed no signs of loosening or failure in the prosthetic components in any of the patients studied. Although the complication rate in our sample was high, it was equivalent to the rates found by other authors, and directly represents the learning curve associate with this kind of procedure. Four years after the procedure, it was found that the patients pain levels had significantly decreased, and that their functional patterns had significantly improved, with AOFAS and Hintermann scores indicating results that were excellent for 20%, good for 70% and poor for 10%. Treatment of ankle arthritis by means of total arthroplasty using the HINTEGRA prosthesis was capable of providing good results over an average observation period of four years.

The VSPA Foot: A Quasi-Passive Ankle-Foot Prosthesis With Continuously Variable Stiffness.

PubMed

Shepherd, Max K; Rouse, Elliott J

2017-12-01

Most commercially available prosthetic feet do not exhibit a biomimetic torque-angle relationship, and are unable to modulate their mechanics to assist with other mobility tasks, such as stairs and ramps. In this paper, we present a quasi-passive ankle-foot prosthesis with a customizable torque-angle curve and an ability to quickly modulate ankle stiffness between tasks. The customizable torque-angle curve is obtained with a cam-based transmission and a fiberglass leaf spring. To achieve variable stiffness, the leaf spring's support conditions can be actively modulated by a small motor, shifting the torque-angle curve to be more or less stiff. We introduce the design, characterize the available torque-angle curves, and present kinematics from a transtibial amputee subject performing level-ground walking, stair ascent/descent, and ramp ascent/descent. The subject exhibited a more normative range of motion on stairs and ramps at lower stiffness levels, and preferred different stiffness levels for each task. Paired with an appropriate intent recognition system, our novel ankle prosthesis could improve gait biomechanics during walking and many other mobility tasks.

TOTAL ANKLE ARTHROPLASTY: BRAZILIAN EXPERIENCE WITH THE HINTEGRA PROSTHESIS

PubMed Central

Nery, Caio; Fernandes, Túlio Diniz; Réssio, Cibele; Fuchs, Mauro Luiz; Godoy Santos, Alexandre Leme de; Ortiz, Rafael Trevisan

2015-01-01

Ankle arthrosis is becoming more and more common. The search for solutions that preserve joint function has led to a new generation of prosthesis with three components and more degrees of freedom. This paper presents the results achieved for ten patients treated with the HINTEGRA Prosthesis (Integra, New Deal), through collaborative action between the Foot and Ankle Groups of the Orthopedics and Traumatology divisions of Escola Paulista de Medicina, Unifesp, and the School of Medicine of the University of São Paulo (USP). The ten patients (six women and four men, aged between 29 and 66 years), underwent a surgical procedure consisting of Hintermann's technique, between January and June 2005. They were evaluated at prearranged intervals, and the data were subjected to statistical analysis. The surgery led to a significant improvement in ankle mobility. Radiological evaluation showed no signs of loosening or failure in the prosthetic components in any of the patients studied. Although the complication rate in our sample was high, it was equivalent to the rates found by other authors, and directly represents the learning curve associate with this kind of procedure. Four years after the procedure, it was found that the patients pain levels had significantly decreased, and that their functional patterns had significantly improved, with AOFAS and Hintermann scores indicating results that were excellent for 20%, good for 70% and poor for 10%. Treatment of ankle arthritis by means of total arthroplasty using the HINTEGRA prosthesis was capable of providing good results over an average observation period of four years. PMID:27022527

Standing stability enhancement with an intelligent powered transfemoral prosthesis.

PubMed

Lawson, Brian Edward; Varol, Huseyin Atakan; Goldfarb, Michael

2011-09-01

The authors have developed a ground-adaptive standing controller for a powered knee and ankle prosthesis which is intended to enhance the standing stability of transfemoral amputees. The finite-state-based controller includes a ground-searching phase, a slope estimation phase, and a joint impedance modulation phase, which together enable the prosthesis to quickly conform to the ground and provide stabilizing assistance to the user. In order to assess the efficacy of the ground-adaptive standing controller, the control approach was implemented on a powered knee and ankle prosthesis, and experimental data were collected on an amputee subject for a variety of standing conditions. Results indicate that the controller can estimate the ground slope within ±1° over a range of ±15°, and that it can provide appropriate joint impedances for standing on slopes within this range.

Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

PubMed

Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

2013-01-01

Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in prosthetic ankle-foot complex compared to normal one. The predicted plantar pressures and von Misses stress distributions for a normal foot were consistent with other FE models given in the literature. The present study is aimed to open new approaches for the development of ankle prosthesis.

Bionic Running for Unilateral Transtibial Military Amputees

DTIC Science & Technology

2010-01-01

Bellman, R., 2010, “An Active Ankle-Foot Prosthesis With Biomechanical Energy Regeneration”, Transactions of the ASME Journal...Lefeber, D., 2008, “A Biomechanical Transtibial Prosthesis Powered by Pleated Pneumatic Artificial Muscles,” Model Identification and Control, 4, 394- 405. ...Inc., have designed, built, and demonstrated a first of its kind motor powered, single board computer controlled, running prosthesis for military

Step-to-Step Ankle Inversion/Eversion Torque Modulation Can Reduce Effort Associated with Balance.

PubMed

Kim, Myunghee; Collins, Steven H

2017-01-01

Below-knee amputation is associated with higher energy expenditure during walking, partially due to difficulty maintaining balance. We previously found that once-per-step push-off work control can reduce balance-related effort, both in simulation and in experiments with human participants. Simulations also suggested that changing ankle inversion/eversion torque on each step, in response to changes in body state, could assist with balance. In this study, we investigated the effects of ankle inversion/eversion torque modulation on balance-related effort among amputees ( N = 5) using a multi-actuated ankle-foot prosthesis emulator. In stabilizing conditions, changes in ankle inversion/eversion torque were applied so as to counteract deviations in side-to-side center-of-mass acceleration at the moment of intact-limb toe off; higher acceleration toward the prosthetic limb resulted in a corrective ankle inversion torque during the ensuing stance phase. Destabilizing controllers had the opposite effect, and a zero gain controller made no changes to the nominal inversion/eversion torque. To separate the balance-related effects of step-to-step control from the potential effects of changes in average mechanics, average ankle inversion/eversion torque and prosthesis work were held constant across conditions. High-gain stabilizing control lowered metabolic cost by 13% compared to the zero gain controller ( p = 0.05). We then investigated individual responses to subject-specific stabilizing controllers following an enforced exploration period. Four of five participants experienced reduced metabolic rate compared to the zero gain controller (-15, -14, -11, -6, and +4%) an average reduction of 9% ( p = 0.05). Average prosthesis mechanics were unchanged across all conditions, suggesting that improvements in energy economy might have come from changes in step-to-step corrections related to balance. Step-to-step modulation of inversion/eversion torque could be used in new, active ankle-foot prostheses to reduce walking effort associated with maintaining balance.

Spring Ankle with Regenerative Kinetics to Build a New Generation of Transtibial Prostheses

DTIC Science & Technology

2008-07-31

form factor that is portable to the wearer. The objective is to build a transtibial prosthesis that will support a Military amputee’s return to...active duty. 15. SUBJECT TERMS Transtibial Prosthesis , regenerative, spring, wearable robot 16. SECURITY CLASSIFICATION OF: 17. LIMITATION...Regenerative Kinetics” to build a new generation of transtibial prostheses Keywords: Transtibial Prosthesis , regenerative, spring, wearable robot

Multi-Axis Prosthetic Knee Resembles Alpine Skiing Movements of an Intact Leg

PubMed Central

Demšar, Ivan; Duhovnik, Jože; Lešnik, Blaž; Supej, Matej

2015-01-01

The purpose of the study was to analyse the flexion angles of the ski boot, ankle and knee joints of an above-knee prosthesis and to compare them with an intact leg and a control group of skiers. One subject with an above-knee amputation of the right leg and eight healthy subjects simulated the movement of a skiing turn by performing two-leg squats in laboratory conditions. By adding additional loads in proportion to body weight (BW; +1/3 BW, +2/3 BW, +3/3 BW), various skiing regimes were simulated. Change of Flexion Angle (CoFA) and Range of Motion (RoM) in the ski boot, ankle and knee joints were calculated and compared. An average RoM in the skiing boot on the side of prosthesis (4.4 ± 1.1°) was significantly lower compared to an intact leg (5.9 ± 1.8°) and the control group (6.5 ± 2.3°). In the ankle joint, the average RoM was determined to be 13.2±2.9° in the prosthesis, 12.7 ± 2.8° in an intact leg and 14.8±3.6 in the control group. However, the RoM of the knee joint in the prosthesis (42.2 ± 4.2°) was significantly larger than that of the intact leg (34.7 ± 4.4°). The average RoM of the knee joint in the control group was 47.8 ± 5.4°. The influences of additional loads on the kinematics of the lower extremities were different on the side of the prosthesis and on the intact leg. In contrast, additional loads did not produce any significant differences in the control group. Although different CoFAs in the ski boot, ankle and knee joints were used, an above-knee prosthesis with a built-in multi-axis prosthetic knee enables comparable leg kinematics in simulated alpine skiing. Key points The RoM in the ski boot on the side of the prosthetic leg was smaller than the RoM of the intact leg and the control group of healthy subjects. The RoM in the ankle joint of prosthetic leg was comparable to that of the intact leg and the control group of healthy subjects. The RoM in the prosthetic knee joint was greater than the RoM in the knee joint of the intact leg and smaller than that of the control group. The total knee flexions in the laboratory measurements were comparable with field measurements. Additional load affects the RoM of the ski boot, ankle and knee joints for the amputated skier in both legs. No significant influence from the additional load was found on the RoM in the control group of healthy subjects. The above-knee prosthesis with a multiple-axis prosthetic knee reproduces the alpine skiing kinematics of an intact leg. PMID:26664282

Speed adaptation in a powered transtibial prosthesis controlled with a neuromuscular model.

PubMed

Markowitz, Jared; Krishnaswamy, Pavitra; Eilenberg, Michael F; Endo, Ken; Barnhart, Chris; Herr, Hugh

2011-05-27

Control schemes for powered ankle-foot prostheses would benefit greatly from a means to make them inherently adaptive to different walking speeds. Towards this goal, one may attempt to emulate the intact human ankle, as it is capable of seamless adaptation. Human locomotion is governed by the interplay among legged dynamics, morphology and neural control including spinal reflexes. It has been suggested that reflexes contribute to the changes in ankle joint dynamics that correspond to walking at different speeds. Here, we use a data-driven muscle-tendon model that produces estimates of the activation, force, length and velocity of the major muscles spanning the ankle to derive local feedback loops that may be critical in the control of those muscles during walking. This purely reflexive approach ignores sources of non-reflexive neural drive and does not necessarily reflect the biological control scheme, yet can still closely reproduce the muscle dynamics estimated from biological data. The resulting neuromuscular model was applied to control a powered ankle-foot prosthesis and tested by an amputee walking at three speeds. The controller produced speed-adaptive behaviour; net ankle work increased with walking speed, highlighting the benefits of applying neuromuscular principles in the control of adaptive prosthetic limbs.

Effects of alignment on the roll-over shapes of prosthetic feet.

PubMed

Hansen, Andrew

2008-12-01

Recent work suggests that a prosthetic ankle-foot component's roll-over shape - the effective rocker it conforms to between initial contact and opposite initial contact (the 'roll-over' interval of walking) - is closely linked to its final alignment in the prosthesis (as determined by a skilled prosthetist using heuristic techniques). If true, this information may help to determine the appropriate alignment for a lower limb prosthesis before it is built, or a priori. Knowledge is needed for future models that will incorporate the roll-over shape including the relative effect of alignment on the roll-over shape's radius of curvature and arc length. The purpose of this study was to evaluate the hypotheses that: (i) Changes in prosthesis alignment alter the position and orientation of a foot's roll-over shape in prosthesis-based coordinates, and (ii) these changes occur without changing the radius of curvature or arc length of the roll-over shape. To examine the hypotheses, this study examined the effects of nine alignment settings on the roll-over shapes of two prosthetic feet. The idea that alignment changes move and rotate roll-over shapes of prosthetic feet in prosthesis coordinates is supported by this work, but the hypothesis that the radius of curvature and arc length do not change for different alignments is not strongly supported by the data. A revised approach is presented that explains some of the changes to the roll-over shape parameters due to changes in rotational alignment.

The Influence of Ambulatory Aid on Lower-Extremity Muscle Activation During Gait.

PubMed

Sanders, Michael; Bowden, Anton E; Baker, Spencer; Jensen, Ryan; Nichols, McKenzie; Seeley, Matthew K

2018-05-10

Foot and ankle injuries are common and often require a nonweight-bearing period of immobilization for the involved leg. This nonweight-bearing period usually results in muscle atrophy for the involved leg. There is a dearth of objective data describing muscle activation for different ambulatory aids that are used during the aforementioned nonweight-bearing period. To compare activation amplitudes for 4 leg muscles during (1) able-bodied gait and (2) ambulation involving 3 different ambulatory aids that can be used during the acute phase of foot and ankle injury care. Within-subject, repeated measures. University biomechanics laboratory. Sixteen able-bodied individuals (7 females and 9 males). Each participant performed able-bodied gait and ambulation using 3 different ambulatory aids (traditional axillary crutches, knee scooter, and a novel lower-leg prosthesis). Muscle activation amplitude quantified via mean surface electromyography amplitude throughout the stance phase of ambulation. Numerous statistical differences (P < .05) existed for muscle activation amplitude between the 4 observed muscles, 3 ambulatory aids, and able-bodied gait. For the involved leg, comparing the 3 ambulatory aids: (1) knee scooter ambulation resulted in the greatest vastus lateralis activation, (2) ambulation using the novel prosthesis and traditional crutches resulted in greater biceps femoris activation than knee scooter ambulation, and (3) ambulation using the novel prosthesis resulted in the greatest gastrocnemius activation (P < .05). Generally speaking, muscle activation amplitudes were most similar to able-bodied gait when subjects were ambulating using the knee scooter or novel prosthesis. Type of ambulatory aid influences muscle activation amplitude. Traditional axillary crutches appear to be less likely to mitigate muscle atrophy during the nonweighting, immobilization period that often follows foot or ankle injuries. Researchers and clinicians should consider these results when recommending ambulatory aids for foot or ankle injuries.

[Ankle arthrodesis with interposition graft as a salvage procedure after failed total ankle replacement].

PubMed

Schill, Stephan

2007-12-01

Restoration of painless function to the lower limb by ankle fusion after failure of total ankle arthroplasty. Loose total ankle replacement. Severe ankle destruction and axial deviation in rheumatoid patients. Severe osteoarthritis in the subtalar and ankle joints. Infected total ankle replacement. Severe arterial occlusive disease of the affected extremity. Transfibular approach to the subtalar and ankle joints. Osteotomy and resection of the distal fibula 7-8 cm proximal to the tip of the lateral malleolus. Removal of the prosthetic components, synovectomy, and revitalization of the remaining bone surface. Removal of any residual articular cartilage from the subtalar joint surfaces. Determination of the extent of bone loss and defect filling with horizontally or vertically placed tricortical and cancellous bone graft from the resected fibula and, if necessary, from the ipsilateral anterior iliac crest. Tibiotalocalcaneal arthrodesis by retrograde insertion of a retrograde locking nail. Wound closure in layers. Split below-knee cast. Mobilization with below-knee cast without weight bearing for 6 weeks. Dynamic locking of the intramedullary nail. Partial weight bearing with a walker up to 20 kg for an additional 6 weeks. Gradual increase in weight bearing in accordance with radiologic evidence of consolidation. Fitted orthopedic shoe with rocker-bottom sole, and made to measure insoles. From January 2003 to September 2006, 15 patients with infected ankle prosthesis loosening (six Thompson-Richards prostheses, eight S.T.A.R. prostheses, and one Salto prosthesis) were treated. All patients underwent tibiotalocalcaneal interposition arthrodesis with femoral nailing in retrograde technique. The average AOFAS (American Orthopaedic Foot and Ankle Society) Score was 57.9 points (35-81 points) postoperatively. One patient developed a nonunion and revision surgery will have to be performed. Another patient with delayed wound healing and skin necrosis needed plastic surgery.

Medium term follow-up of the AES ankle prosthesis: High rate of asymptomatic osteolysis.

PubMed

Rodriguez, Dante; Bevernage, Bernhard Devos; Maldague, Pierre; Deleu, Paul-André; Tribak, Karim; Leemrijse, Thibaut

2010-06-01

The AES (Ankle Evolutive System) is a cobalt-chromium three-component ankle prosthesis with a hydroxyapatite coating, similar to the Buechel-Pappas ankle prosthesis, but with some modifications. Our objective was to assess its medium term follow-up results as well as its complications. 21 patients (mean age of 57.6 years) were operated by a total ankle arthroplasty (TAA), using the AES implant, according to the standard technique. Only 18 patients were included. The other three patients were excluded from the study: two had been revised for avascular talar necrosis and one patient was happy with her outcome but could not present for logistic reasons at the last follow-up. Indications for surgery included posttraumatic osteoarthritis, primary osteoarthritis, hemochromatosis, rheumatic arthritis and osteoarthritis as a sequel of ankle instability. All patients were analyzed clinically and radiologically. Special attention was given to the presence or not of areas of osteolysis around the implants as well on conventional radiography as on CT-scan imaging, according to a specific protocol. The mean follow-up was 39.4 months. Average American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score improved from 52.2 preoperatively to 86.6 postoperatively. No intra-operative complications or early complications have been noted. Delayed complications were the following: one valgus malalignment, one recurrent painful anterior heterotrophic bone formation. Above all, we noted on conventional X-ray the presence of osteolysis in 77% (14) of our patients, with a size of 0.5-1cm or greater on conventional X-ray. The most vulnerable area seemed to be the posterior tibial plafond. The four remaining patients did not show any cyst formation on X-ray but did also, just as the other 14 patients, on the CT-scan. CT-scan, on the contrary, found more osteolysis in the body of the talus, underneath the implant, an area masked on conventional X-ray. Only one patient was revised with allograft bone filling of a symptomatic osteolysis, without the need for implant removal. This retrospective study shows a high frequency of delayed appearance of osteolysis (77%) in 18 AES total ankle arthroplasties. Fortunately at this moment and considering one revision, this considerable amount of asymptomatic osteolysis could not warrant a durable uncomplicated outcome. Copyright 2009 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

The influence of push-off timing in a robotic ankle-foot prosthesis on the energetics and mechanics of walking.

PubMed

Malcolm, Philippe; Quesada, Roberto E; Caputo, Joshua M; Collins, Steven H

2015-02-22

Robotic ankle-foot prostheses that provide net positive push-off work can reduce the metabolic rate of walking for individuals with amputation, but benefits might be sensitive to push-off timing. Simple walking models suggest that preemptive push-off reduces center-of-mass work, possibly reducing metabolic rate. Studies with bilateral exoskeletons have found that push-off beginning before leading leg contact minimizes metabolic rate, but timing was not varied independently from push-off work, and the effects of push-off timing on biomechanics were not measured. Most lower-limb amputations are unilateral, which could also affect optimal timing. The goal of this study was to vary the timing of positive prosthesis push-off work in isolation and measure the effects on energetics, mechanics and muscle activity. We tested 10 able-bodied participants walking on a treadmill at 1.25 m · s(-1). Participants wore a tethered ankle-foot prosthesis emulator on one leg using a rigid boot adapter. We programmed the prosthesis to apply torque bursts that began between 46% and 56% of stride in different conditions. We iteratively adjusted torque magnitude to maintain constant net positive push-off work. When push-off began at or after leading leg contact, metabolic rate was about 10% lower than in a condition with Spring-like prosthesis behavior. When push-off began before leading leg contact, metabolic rate was not different from the Spring-like condition. Early push-off led to increased prosthesis-side vastus medialis and biceps femoris activity during push-off and increased variability in step length and prosthesis loading during push-off. Prosthesis push-off timing had no influence on intact-side leg center-of-mass collision work. Prosthesis push-off timing, isolated from push-off work, strongly affected metabolic rate, with optimal timing at or after intact-side heel contact. Increased thigh muscle activation and increased human variability appear to have caused the lack of reduction in metabolic rate when push-off was provided too early. Optimal timing with respect to opposite heel contact was not different from normal walking, but the trends in metabolic rate and center-of-mass mechanics were not consistent with simple model predictions. Optimal push-off timing should also be characterized for individuals with amputation, since meaningful benefits might be realized with improved timing.

Metabolics of stair ascent with a powered transfemoral prosthesis.

PubMed

Ledoux, E D; Lawson, B E; Shultz, A H; Bartlett, H L; Goldfarb, M

2015-01-01

This paper evaluates the effectiveness of a powered knee and ankle prosthesis for stair ascent through a metabolic assessment comparing energy expenditure of a single transfemoral amputee subject while ascending stairs with the powered prosthesis relative to his passive daily use device, as well as comparing the kinematics and kinetics obtained with the passive prosthesis to healthy biomechanics. The subject wore a portable system that measured pulmonary gaseous exchange rates of oxygen and carbon dioxide while he ascended stairs with each of the prostheses in alternating tests. The results indicated that the amputee's energy expenditure decreased by 32 percent while climbing with the powered prosthesis as compared to his passive one, and the kinematics and kinetics achieved were representative of healthy biomechanics.

Development of the transtibial prosthesis controlled pneumatically and electrically by microcomputer system.

PubMed

Shimada, Youichi; Terayama, Yukio

2006-01-01

This report represents the development of the prototype transtibial prosthesis to assist a smooth and comfortable walking for an unilateral amputee. This prosthesis is composed of two air cylinders, solenoid valves, portable and small air tank for compressed air storage, a multiple sensor system and a microprocessor. Two air cylinders are located around the rods to act as antagonistic and agonistic muscles. The system causes flexion and extension of the foot plate jointed at the ankle with compressed air, injected -or discharged via a solenoid or electromagnetic valves. The valves or solenoids are controlled with a microprocessor (Microchip Technology Inc., PIC16F876), the microprocessor generates control signals to the interface circuits for valve opening and closing consistent with the foot position during the walking phase. The control patterns generated in the microprocessor are modified with feedback from the touch sensor, ankle joint angle sensor and the two dimensional acceleration sensor. The primary walking pattern for an individual amputee should be developed through the gait analysis with video.

Post-Traumatic Periprosthetic Tibial and Fibular Fracture After Total Ankle Arthroplasty: A Case Report.

PubMed

Brock, Amanda K; Tan, Eric W; Shafiq, Babar

Periprosthetic fractures after total ankle arthroplasty are uncommon, with most cases occurring intraoperatively. We describe a post-traumatic periprosthetic fracture of the distal tibia and fibula after total ankle arthroplasty that was treated with minimally invasive plate osteosynthesis. It is important for orthopedic surgeons not only to recognize the risk factors for postoperative periprosthetic total ankle arthroplasty fractures, but also to be familiar with the treatment options available to maximize function and minimize complications. The design of the tibial prosthesis and surgical techniques required to prepare the ankle joint for implantation are important areas of future research to limit the risk of periprosthetic fractures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Sagittal Distal Tibial Articular Angle and the Relationship to Talar Subluxation in Total Ankle Arthroplasty.

PubMed

Veljkovic, Andrea; Norton, Adam; Salat, Peter; Abbas, Kaniza Zahra; Saltzman, Charles; Femino, John E; Phisitkul, Phinit; Amendola, Annunziato

2016-09-01

Longevity of total ankle replacement (TAR) depends heavily on anatomic alignment. The lateral talar station (LTS) classifies the sagittal position of the talus relative to the tibia. We hypothesized that correcting the sagittal distal tibial articular angle (sDTAA) during TAR would anatomically realign the tibiotalar joint and potentially reduce the risk of prosthesis subluxation. The LTS (millimeters) and sDTAA (degrees) were measured twice by 2 blinded observers using weight-bearing lateral ankle radiographs obtained before (n = 96) and after (n = 94) TAR, with excellent interobserver and intraobserver reliability (correlation coefficient >0.9). Preoperative LTS was as follows: anterior (60.4%), posterior (27.1%), and neutral (12.5%). A strong preoperative correlation was found between LTS and sDTAA (r = 0.81; P < .0001). In ankles that were initially anterior and became less anterior postoperatively (n = 41), LTS decreased from an average 8.1 mm to 6.5 mm and the LTS changed 1.1 mm per degree of sDTAA change. In ankles that were initially posterior (n = 25), LTS increased from an average of -5.1 mm to -2.8 mm and the LTS changed 0.6 mm per degree of sDTAA change. The correlation between LTS and sDTAA was reduced postoperatively (r = 0.62; P < .0001). Our results suggest that rather than following generic recommendations, the surgeon should customize the sagittal distal tibial cut to the individual patient based on the preoperative LTS in order to achieve neutral TAR alignment. Level III, retrospective comparative series. © The Author(s) 2016.

Clinical evaluation and radiographic assessment of bone lysis of the AES total ankle replacement.

PubMed

Besse, Jean-Luc; Brito, Nuno; Lienhart, Christophe

2009-10-01

AES mobile-bearing total ankle replacement is evolved from the Buechel Pappas model. We report medium-term results of a prospective study with AES. All patients who underwent AES TAR for ankle arthritis, by a single surgeon, from 2003 to 2006 were included, excluding neurologic disease, talar osteonecrosis and malalignment more than 20 degrees. All were reviewed at 6 months, 1 year, and at yearly intervals thereafter. X-rays were analyzed by three observers, using a 10-zone protocol. Fifty consecutive AES implants in 47 patients (mean age, 56 years; range, 21 to 79 year) were included, with at least 2 years' followup (mean 40 months). Preoperative diagnosis was mainly post-traumatic (50%) and osteoarthritis secondary to instability (36%). Associated procedures were performed in 38%. Eighty-two percent had good functional results. The mean AOFAS score rose from 36.9 +/- 1.7 preoperatively to 85.4 +/- 12, dorsiflexion from 3 degrees to 7.3 degrees, and plantarflexion from 30.8 degrees to 37.8 degrees. Two ankles underwent secondary arthrodesis for talar subsidence and mechanical dislocation. Ninety-eight percent of implants were well positioned at 90 degrees +/-4. Mean prosthesis ROM on X-ray was 22.1 degrees. There were tibia/implant interface cysts (greater than 5 mm) in 62% of cases, and talar/implant interface cysts in 43%. Although functional outcomes were comparable to the other mobile TAR in the literature, bone lysis with the AES prosthesis was more frequent with risk of subsidence. We therefore stopped implantation of this prosthesis and recommend preventive grafting for severe lysis.

Design of a power-asymmetric actuator for a transtibial prosthesis.

PubMed

Bartlett, Harrison L; Lawson, Brian E; Goldfarb, Michael

2017-07-01

This paper presents the design and characterization of a power-asymmetric actuator for a transtibial prosthesis. The device is designed to provide the combination of: 1) joint locking, 2) high power dissipation, and 3) low power generation. This actuator functionality allows for a prosthesis to be designed with minimal mass and power consumption relative to a fully-powered robotic prosthesis while maintaining much of the functionality necessary for activities of daily living. The actuator achieves these design characteristics while maintaining a small form factor by leveraging a combination of electromechanical and hydraulic components. The design of the actuator is described herein, and results of an experimental characterization are provided that indicate that the actuator is capable of providing the functional capabilities required of an ankle prosthesis in a compact and lightweight package.

Once-per-step control of ankle-foot prosthesis push-off work reduces effort associated with balance during walking.

PubMed

Kim, Myunghee; Collins, Steven H

2015-05-01

Individuals with below-knee amputation have more difficulty balancing during walking, yet few studies have explored balance enhancement through active prosthesis control. We previously used a dynamical model to show that prosthetic ankle push-off work affects both sagittal and frontal plane dynamics, and that appropriate step-by-step control of push-off work can improve stability. We hypothesized that this approach could be applied to a robotic prosthesis to partially fulfill the active balance requirements of human walking, thereby reducing balance-related activity and associated effort for the person using the device. We conducted experiments on human participants (N = 10) with simulated amputation. Prosthetic ankle push-off work was varied on each step in ways expected to either stabilize, destabilize or have no effect on balance. Average ankle push-off work, known to affect effort, was kept constant across conditions. Stabilizing controllers commanded more push-off work on steps when the mediolateral velocity of the center of mass was lower than usual at the moment of contralateral heel strike. Destabilizing controllers enforced the opposite relationship, while a neutral controller maintained constant push-off work regardless of body state. A random disturbance to landing foot angle and a cognitive distraction task were applied, further challenging participants' balance. We measured metabolic rate, foot placement kinematics, center of pressure kinematics, distraction task performance, and user preference in each condition. We expected the stabilizing controller to reduce active control of balance and balance-related effort for the user, improving user preference. The best stabilizing controller lowered metabolic rate by 5.5% (p = 0.003) and 8.5% (p = 0.02), and step width variability by 10.0% (p = 0.009) and 10.7% (p = 0.03) compared to conditions with no control and destabilizing control, respectively. Participants tended to prefer stabilizing controllers. These effects were not due to differences in average push-off work, which was unchanged across conditions, or to average gait mechanics, which were also unchanged. Instead, benefits were derived from step-by-step adjustments to prosthesis behavior in response to variations in mediolateral velocity at heel strike. Once-per-step control of prosthetic ankle push-off work can reduce both active control of foot placement and balance-related metabolic energy use during walking.

Cost-effectiveness analysis of total ankle arthroplasty.

PubMed

SooHoo, Nelson F; Kominski, Gerald

2004-11-01

There is renewed interest in total ankle arthroplasty as an alternative to ankle fusion in the treatment of end-stage ankle arthritis. Despite a lack of long-term data on the clinical outcomes associated with these implants, the use of ankle arthroplasty is expanding. The purpose of this cost-effectiveness analysis was to evaluate whether the currently available literature justifies the emerging use of total ankle arthroplasty. This study also identifies thresholds for the durability and function of ankle prostheses that, if met, would support more widespread dissemination of this new technology. A decision model was created for the treatment of ankle arthritis. The literature was reviewed to identify possible outcomes and their probabilities following ankle fusion and ankle arthroplasty. Each outcome was weighted for quality of life with use of a utility factor, and effectiveness was expressed in units of quality-adjusted life years. Gross costs were estimated from Medicare charge and reimbursement data for the relevant codes. The effect of the uncertainty of estimates of costs and effectiveness was assessed with sensitivity analysis. The reference case of our model assumed a ten-year duration of survival of the prosthesis, resulting in an incremental cost-effectiveness ratio for ankle arthroplasty of $18,419 per quality-adjusted life year gained. This reflects a gain of 0.52 quality-adjusted life years at a cost of $9578 when ankle arthroplasty is chosen over fusion. This ratio compares favorably with the cost-effectiveness of other medical and surgical interventions. Sensitivity analysis determined that the cost per quality-adjusted life year gained with ankle arthroplasty rises above $50,000 if the prosthesis is assumed to fail before seven years. Treatment options with ratios above $50,000 per quality-adjusted life year are commonly considered to have limited cost-effectiveness. This threshold is also crossed when the theoretical functional advantages of ankle arthroplasty are eliminated in sensitivity analysis. The currently available literature has not yet shown that total ankle arthroplasty predictably results in levels of durability and function that make it cost-effective at this time. However, the reference case of this analysis does demonstrate that total ankle arthroplasty has the potential to be a cost-effective alternative to ankle fusion. This reference case assumes that the theoretical functional advantages of ankle arthroplasty over ankle fusion will be borne out in future clinical studies. Performance of total ankle replacement will be better justified if these thresholds are met in published long-term clinical trials.

Volitional control of ankle plantar flexion in a powered transtibial prosthesis during stair-ambulation.

PubMed

Kannape, Oliver A; Herr, Hugh M

2014-01-01

Although great advances have been made in the design and control of lower extremity prostheses, walking on different terrains, such as ramps or stairs, and transitioning between these terrains remains a major challenge for the field. In order to generalize biomimetic behaviour of active lower-limb prostheses top-down volitional control is required but has until recently been deemed unfeasible due to the difficulties involved in acquiring an adequate electromyographic (EMG) signal. In this study, we hypothesize that a transtibial amputee can extend the functionality of a hybrid controller, designed for level ground walking, to stair ascent and descent by volitionally modulating powered plantar-flexion of the prosthesis. We here present data illustrating that the participant is able to reproduce ankle push-off behaviour of the intrinsic controller during stair ascent as well as prevent inadvertent push-off during stair descent. Our findings suggest that EMG signal from the residual limb muscles can be used to transition between level-ground walking and stair ascent/descent within a single step and significantly improve prosthesis performance during stair-ambulation.

[Eleven-Year Experience with Total Ankle Arthroplasty].

PubMed

Popelka, S; Sosna, A; Vavřík, P; Jahoda, D; Barták, V; Landor, I

2016-01-01

PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015. The prostheses used included the Ankle Evolutive System (AES) in 52 patients, Mobility Total Ankle System (DePuy) in 24 patients and, recently, Rebalance Total Ankle Replacement implant in 53 patients. Three patients allergic to metal received the Taric prosthesis. Revision arthroplasty using the Hintegra prosthesis was carried out in four patients. The outcome of arthroplasty was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. Indications for total ankle arthroplasty included post-traumatic arthritis in 83 patients, rheumatoid arthritis in 37 and primary arthritis in 12 patients. There were 78 women and 54 men, with an average age of 55.6 years at the time of surgery. RESULTS The average follow-up was 6.1 years (1-11 years). The average AOFAS score of the whole group increased from 33.2 before surgery to 82.5 after it. The primary indication had an important role. Arthroplasty outcomes were poorer in patients with post-traumatic arthritis than in those with rheumatoid arthritis or primary arthritis. In patients with post-traumatic arthritis, the average AOFAS score rose to 78.6 due to restricted motion of the ankle, and some patients continued to have pain when walking. The average AOFAS score in a total of 49 patients who had rheumatoid arthritis or primary arthritis reached a value of 86.4. Post-operative complications were recorded in ten patients (7.6%) in whom part of the wound was healing by second intention. Ossification was also a frequent complication and had to be removed in six patients (4.5%). No early infection was recorded and late infection was treated in three patients. The prosthesis had to be removed and ankle arthrodesis performed in seven patients (5.3%). All had necrosis of the talus with ankle instability. In five, the retrograde nail Medin was used and extensive defects remaining after talar necrosis were filled with massive bone grafts obtained from a bone bank. One patient required tibio-calcaneal arthrodesis with external fixator; surgery in one case involved the use of a Zimmer Trabecular Metal Ankle Fusion Spacer with retrograde nail fixation. The development of cystic radiolucencies adjacent to tibial or talar components presents another post-operative complication. It was recorded mostly in the patients after AES implantation, in whom eight of 52 (15.3%) had these findings. DISCUSSION Total ankle arthroplasty is a complicated surgical procedure potentially associated with various technical problems. The occurrence of complications is indirectly related to the experience of the orthopaedist performing surgery; literature data show that the number of complication decreases with an increased frequency of ankle replacements done. CONCLUSIONS Total ankle arthroplasty, as every orthopaedic surgery, has its advantages and disadvantages. The positive aspects are pain relief and improved mobility of the ankle allowing for physiological gait. However, it shows a lower survivorship rate that the other large joint replacements. A successful outcome depends on the correct indication. The ankle should be stable, the talus without signs of necrosis and valgus or varus deviations of the ankle should not exceed 10 to 15 degrees. total ankle arthroplasty, re-implantation, aseptic loosening, retrograde nail, Trabecular Metal spacer, revision arthroplasty.

Short-Term Effect of Prosthesis Transforming Sensory Modalities on Walking in Stroke Patients with Hemiparesis

PubMed Central

Sekiguchi, Yusuke; Honda, Keita; Ishiguro, Akio

2016-01-01

Sensory impairments caused by neurological or physical disorders hamper kinesthesia, making rehabilitation difficult. In order to overcome this problem, we proposed and developed a novel biofeedback prosthesis called Auditory Foot for transforming sensory modalities, in which the sensor prosthesis transforms plantar sensations to auditory feedback signals. This study investigated the short-term effect of the auditory feedback prosthesis on walking in stroke patients with hemiparesis. To evaluate the effect, we compared four conditions of auditory feedback from plantar sensors at the heel and fifth metatarsal. We found significant differences in the maximum hip extension angle and ankle plantar flexor moment on the affected side during the stance phase, between conditions with and without auditory feedback signals. These results indicate that our sensory prosthesis could enhance walking performance in stroke patients with hemiparesis, resulting in effective short-term rehabilitation. PMID:27547456

[Endoprosthesis of the ankle joint. Indications and long-term results].

PubMed

Endrich, B; Terbrüggen, D

1991-10-01

The treatment of a post-traumatic, progressively more painful ankle joint causes increasing disablement. It might require alternatives to conventional surgery if a patient does not consent to ankle arthrodesis to alleviate the pain. Therefore, we report on a retrospective study of 10 patients (age 25-73 years at the time of surgery). All of them refused arthrodesis; thus 10 total ankle arthroplasties were performed between 1982 and 1989. 5 women and 5 men were treated who have been suffering from severe post-traumatic arthrosis for 3-46 years. Since performance of a single-axis arthroplasty (ICLH prosthesis) in each patient, the mean follow-up has been 4.6 years. One year after surgery, the results could be considered good or excellent in 9 of the 10 patients; only 1 person experienced local wound infection, which led to removal of the implant 4 months later and ultimately to arthrodesis. Two years later, 7 patients are eligible for follow-up because 1 underwent surgery in February 1989. Another patient experienced aseptic loosening after 18 months; he was admitted to our hospital for arthrodesis. Three years after endoprosthetic surgery, all except 1 woman with occasional pain and stiffness were found to have satisfactory results on follow-up. The relief of pain was gratifying in all patients, with ankle function well maintained (at least 0-0-30 degrees). At present, the prosthesis is still functional in 6 patients (surgery 1.5-8 years ago). They can go about their usual daily business without apparent pain and with appropriate function; 2 of them, however, show radiolucent lines on standard X-rays of the ankle, suggesting some loosening.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of a flat prosthetic foot rocker section on balance and mobility.

PubMed

Hansen, Andrew; Nickel, Eric; Medvec, Joseph; Brielmaier, Steven; Pike, Alvin; Weber, Marilyn

2014-01-01

Previous studies have shown that the effective rocker shape of the physiologic ankle-foot system during standing and fore-aft swaying is much flatter than that used during walking, which indicates a more stable base of support for the standing/swaying activity. Previous work suggests that flat regions within the effective rocker shapes of prosthetic ankle-foot systems could provide enhanced stability for standing balance tasks. An experimental prosthetic foot was altered to provide three different flat region lengths within its effective rocker shape. It was hypothesized that longer flat regions of the effective rocker shape would lead to improved standing balance outcomes and reduced walking performance for unilateral transtibial prosthesis users. However, no significant changes were seen in the balance and mobility outcomes of 12 unilateral transtibial prosthesis users when using the three prosthetic foot conditions. Subjects in the study significantly preferred prosthetic feet with relatively low to moderate flat regions over those with long flat regions. All the subjects without loss of light touch or vibratory sensation selected the prosthetic foot with the shortest flat region. More work is needed to investigate the effects of prosthetic foot properties on balance and mobility of prosthesis users.

Effects of positioning on radiographic measurements of ankle morphology: a computerized tomography-based simulation study

PubMed Central

2013-01-01

Background Measurements of the morphology of the ankle joint, performed mostly for surgical planning of total ankle arthroplasty and for collecting data for total ankle prosthesis design, are often made on planar radiographs, and therefore can be very sensitive to the positioning of the joint during imaging. The current study aimed to compare ankle morphological measurements using CT-generated 2D images with gold standard values obtained from 3D CT data; to determine the sensitivity of the 2D measurements to mal-positioning of the ankle during imaging; and to quantify the repeatability of the 2D measurements under simulated positioning conditions involving random errors. Method Fifty-eight cadaveric ankles fixed in the neutral joint position (standard pose) were CT scanned, and the data were used to simulate lateral and frontal radiographs under various positioning conditions using digitally reconstructed radiographs (DRR). Results and discussion In the standard pose for imaging, most ankle morphometric parameters measured using 2D images were highly correlated (R > 0.8) to the gold standard values defined by the 3D CT data. For measurements made on the lateral views, the only parameters sensitive to rotational pose errors were longitudinal distances between the most anterior and the most posterior points of the tibial mortise and the tibial profile, which have important implications for determining the optimal cutting level of the bone during arthroplasty. Measurements of the trochlea tali width on the frontal views underestimated the standard values by up to 31.2%, with only a moderate reliability, suggesting that pre-surgical evaluations based on the trochlea tali width should be made with caution in order to avoid inappropriate selection of prosthesis sizes. Conclusions While highly correlated with 3D morphological measurements, some 2D measurements were affected by the bone poses in space during imaging, which may affect surgical decision-making in total ankle arthroplasty, including the amount of bone resection and the selection of the implant sizes. The linear regression equations for the relationship between 2D and 3D measurements will be helpful for correcting the errors in 2D morphometric measurements for clinical applications. PMID:24359413

Whole-body angular momentum during stair walking using passive and powered lower-limb prostheses.

PubMed

Pickle, Nathaniel T; Wilken, Jason M; Aldridge, Jennifer M; Neptune, Richard R; Silverman, Anne K

2014-10-17

Individuals with a unilateral transtibial amputation have a greater risk of falling compared to able-bodied individuals, and falling on stairs can lead to serious injuries. Individuals with transtibial amputations have lost ankle plantarflexor muscle function, which is critical for regulating whole-body angular momentum to maintain dynamic balance. Recently, powered prostheses have been designed to provide active ankle power generation with the goal of restoring biological ankle function. However, the effects of using a powered prosthesis on the regulation of whole-body angular momentum are unknown. The purpose of this study was to use angular momentum to evaluate dynamic balance in individuals with a transtibial amputation using powered and passive prostheses relative to able-bodied individuals during stair ascent and descent. Ground reaction forces, external moment arms, and joint powers were also investigated to interpret the angular momentum results. A key result was that individuals with an amputation had a larger range of sagittal-plane angular momentum during prosthetic limb stance compared to able-bodied individuals during stair ascent. There were no significant differences in the frontal, transverse, or sagittal-plane ranges of angular momentum or maximum magnitude of the angular momentum vector between the passive and powered prostheses during stair ascent or descent. These results indicate that individuals with an amputation have altered angular momentum trajectories during stair walking compared to able-bodied individuals, which may contribute to an increased fall risk. The results also suggest that a powered prosthesis provides no distinct advantage over a passive prosthesis in maintaining dynamic balance during stair walking. Copyright © 2014 Elsevier Ltd. All rights reserved.

Prosthetics in antiquity-An early medieval wearer of a foot prosthesis (6th century AD) from Hemmaberg/Austria.

PubMed

Binder, M; Eitler, J; Deutschmann, J; Ladstätter, S; Glaser, F; Fiedler, D

2016-03-01

Even though the earliest prosthetic devices date to the Ancient Egyptian Empire and iconographic sources attest their use in the Greco-Roman world, archaeological evidence for this practice prior to 2nd millennium AD is very scant. In 2013, a skeleton dating to the Frankish period (6th century AD) was excavated at the Hemmaberg in southern Austria. The middle adult male was missing his left foot from above the ankle. In its place, an iron-ring and wooden remains were recovered and interpreted as a prosthesis replacing the lost foot. This represents one of the oldest examples of prosthetic limb replacement associated with the skeleton of its wearer in Europe to date. Analysis through macroscopic assessment, radiography and CT-scanning revealed healing of the lesion even though it may have initially been complicated by osteomyelitis. Atrophy of the left lower leg further indicates immobilisation and suggests survival of several years. Osteoarthritis in the knees and shoulder girdle provides tentative indications towards the functionality of the prosthesis, perhaps aided through a crutch. These findings are set against the historic, archaeological, bioarchaeological and social context of the man in order to discuss whether removal of the foot was due to medical, punitive or traumatic causes. Copyright © 2015 Elsevier Inc. All rights reserved.

The AES total ankle arthroplasty analysis of failures and survivorship at ten years.

PubMed

Di Iorio, Alexandre; Viste, Anthony; Fessy, Michel Henry; Besse, Jean Luc

2017-12-01

AES mobile-bearing total ankle replacement was developed from the Buechel Pappas model. It was withdrawn in 2009, after identification of a higher than expected complication rate. The purpose of the current study was to analyse clinical outcomes, failures and survival of the initial series of 50 AES published in 2009. In this single-centre continuous prospective study (2003-2006), 50 AES prostheses were included. Pre-operative osteoarthritis was mainly post-traumatic (50%) and secondary to instability (36%). All patients were assessed with clinical and radiographic follow-up at six months, one year, two years and every two to three years thereafter. A CT-scan was systematically performed before procedure, and at two years, five years and ten years. At last follow-up, all patients with TAR had a functional (SF 36, AOFAS) and clinical assessment. All complications or surgical events were analysed. The mean follow-up was ten ± two years (range, 9-13). The mean AOFAS score was 75 points (range, 26-100). The mean SF 36 score was 69 points (range, 35-97). There was a significant deterioration in AOFAS score at five years and at last follow-up (p < 0.05). Fifteen TARs underwent reoperation for cyst curettage-graft because of development of periprosthetic lesions. Six of them ended up with prosthesis removal-arthrodesis. At the last follow-up, 14 TARs were removed for arthrodesis. Of the 30 prostheses seen at last follow-up, four are awaiting prosthesis removal-arthrodesis and one for cyst curettage-graft. The ten year survivorships free of any prosthesis removal or arthrodesis and free of any reoperation were 68% (95% CI, 55-85) and 57% (95% CI, 44-74), respectively. Our data suggested a high rate of reoperation. Overall ten year survival was lower than with other designs, particularly due to cyst lesions. Level IV, prospective case series.

Design and Control of a Pneumatically Actuated Transtibial Prosthesis.

PubMed

Zheng, Hao; Shen, Xiangrong

2015-04-01

This paper presents the design and control of a pneumatically actuated transtibial prosthesis, which utilizes a pneumatic cylinder-type actuator to power the prosthetic ankle joint to support the user's locomotion. The pneumatic actuator has multiple advantages over the traditional electric motor, such as light weight, low cost, and high power-to-weight ratio. The objective of this work is to develop a compact and lightweight transtibial prosthesis, leveraging the multiple advantages provided by this highly competitive actuator. In this paper, the design details of the prosthesis are described, including the determination of performance specifications, the layout of the actuation mechanism, and the calculation of the torque capacity. Through the authors' design calculation, the prosthesis is able to provide sufficient range of motion and torque capacity to support the locomotion of a 75 kg individual. The controller design is also described, including the underlying biomechanical analysis and the formulation of the finite-state impedance controller. Finally, the human subject testing results are presented, with the data indicating that the prosthesis is able to generate a natural walking gait and sufficient power output for its amputee user.

Design and Control of a Pneumatically Actuated Transtibial Prosthesis

PubMed Central

Zheng, Hao; Shen, Xiangrong

2015-01-01

This paper presents the design and control of a pneumatically actuated transtibial prosthesis, which utilizes a pneumatic cylinder-type actuator to power the prosthetic ankle joint to support the user's locomotion. The pneumatic actuator has multiple advantages over the traditional electric motor, such as light weight, low cost, and high power-to-weight ratio. The objective of this work is to develop a compact and lightweight transtibial prosthesis, leveraging the multiple advantages provided by this highly competitive actuator. In this paper, the design details of the prosthesis are described, including the determination of performance specifications, the layout of the actuation mechanism, and the calculation of the torque capacity. Through the authors’ design calculation, the prosthesis is able to provide sufficient range of motion and torque capacity to support the locomotion of a 75 kg individual. The controller design is also described, including the underlying biomechanical analysis and the formulation of the finite-state impedance controller. Finally, the human subject testing results are presented, with the data indicating that the prosthesis is able to generate a natural walking gait and sufficient power output for its amputee user. PMID:26146497

Recycling energy to restore impaired ankle function during human walking.

PubMed

Collins, Steven H; Kuo, Arthur D

2010-02-17

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. 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%. 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.

Virtual prototyping of a semi-active transfemoral prosthetic leg.

PubMed

Lui, Zhen Wei; Awad, Mohammed I; Abouhossein, Alireza; Dehghani-Sanij, Abbas A; Messenger, Neil

2015-05-01

This article presents a virtual prototyping study of a semi-active lower limb prosthesis to improve the functionality of an amputee during prosthesis-environment interaction for level ground walking. Articulated ankle-foot prosthesis and a single-axis semi-active prosthetic knee with active and passive operating modes were considered. Data for level ground walking were collected using a photogrammetric method in order to develop a base-line simulation model and with the hip kinematics input to verify the proposed design. The simulated results show that the semi-active lower limb prosthesis is able to move efficiently in passive mode, and the activation time of the knee actuator can be reduced by approximately 50%. Therefore, this semi-active system has the potential to reduce the energy consumption of the actuators required during level ground walking and requires less compensation from the amputee due to lower deviation of the vertical excursion of body centre of mass. © IMechE 2015.

Survival of the Scandinavian total ankle replacement (STAR): results of ten to nineteen years follow-up.

PubMed

Frigg, Arno; Germann, Ursula; Huber, Martin; Horisberger, Monika

2017-10-01

The purpose of this study was to evaluate survival and clinical outcome of the Scandinavian total ankle replacement (STAR) prosthesis after a minimum of ten years up to a maximum of 19 years. Fifty STAR prostheses in 46 patients with end stage ankle osteoarthritis operated between 1996 and 2006 by the same surgeon (MH) were included. Minimal follow-up was ten years (median 14.6 years, 95% confidence interval [CI] 12.9-16.4). Clinical (Kofoed score) and radiological assessments were taken before the operation and at one, ten (+2), and 16 (±3) years after implantation. The primary endpoint was defined as exchange of the whole prosthesis or conversion to arthrodesis (def. 1), exchange of at least one metallic component (def. 2), or exchange of any component including the inlay (due to breakage or wear) (def. 3). Survival was estimated according to Kaplan-Meier. Further reoperations related to STAR were also recorded. The ten year survival rate was (def. 1) 94% (CI 82-98%), (def. 2) 90% (CI, 77-96%), and (def. 3) 78% (CI 64-87%). The 19-year survival rate was (def. 1) 91% (CI 78-97%), (def. 2) 75% (CI 53-88%), and (def. 3) 55% (CI 34-71%). Considering any re-operations related to STAR, 52% (26/50) of prostheses were affected by re-operations. Mean pre-operative Kofoed score was 49, which improved to 84 after one year (n = 50), to 90 after ten years (n = 46), and to 89 after 16 years (n = 28). The survival rate for def. 1 and 2 was high. However, re-operations occurred in 52% of all STAR prosthesis. Retrospective cohort study, evidence Level 4.

Stabilization of a three-dimensional limit cycle walking model through step-to-step ankle control.

PubMed

Kim, Myunghee; Collins, Steven H

2013-06-01

Unilateral, below-knee amputation is associated with an increased risk of falls, which may be partially related to a loss of active ankle control. If ankle control can contribute significantly to maintaining balance, even in the presence of active foot placement, this might provide an opportunity to improve balance using robotic ankle-foot prostheses. We investigated ankle- and hip-based walking stabilization methods in a three-dimensional model of human gait that included ankle plantarflexion, ankle inversion-eversion, hip flexion-extension, and hip ad/abduction. We generated discrete feedback control laws (linear quadratic regulators) that altered nominal actuation parameters once per step. We used ankle push-off, lateral ankle stiffness and damping, fore-aft foot placement, lateral foot placement, or all of these as control inputs. We modeled environmental disturbances as random, bounded, unexpected changes in floor height, and defined balance performance as the maximum allowable disturbance value for which the model walked 500 steps without falling. Nominal walking motions were unstable, but were stabilized by all of the step-to-step control laws we tested. Surprisingly, step-by-step modulation of ankle push-off alone led to better balance performance (3.2% leg length) than lateral foot placement (1.2% leg length) for these control laws. These results suggest that appropriate control of robotic ankle-foot prosthesis push-off could make balancing during walking easier for individuals with amputation.

The AES total ankle replacement: A mid-term analysis of 93 cases.

PubMed

Henricson, Anders; Knutson, Kaj; Lindahl, Johan; Rydholm, Urban

2010-06-01

There are few studies concerning specific total ankle arthroplasties. This study reports mid-term survival data for the AES prosthesis. Ninety-three AES ankle arthroplasties were performed by the senior authors. The mean follow-up was 3.5 years. The 5-year survivorship and also the number of simultaneous procedures, reoperations, additional procedures and revisions are analyzed. The 5-year survivorship with revision for any reason as end-point was 90%. Simultaneous procedures were performed in 25 patients, deltoid release and subtalar fusion being the most common. There were seven revisions, one due to loosening, and two due to infection, instability and fractures, respectively. Twenty-seven reoperations or additional procedures were performed in 23 patients with a procedure for malleolar impingement being the most common reoperation, and correction of hindfoot varus being the most common reason for an additional procedure. The AES total ankle replacement seems to be a reasonably safe procedure in experienced hands. Copyright 2009 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Preliminary Experiments with a Unified Controller for a Powered Knee-Ankle Prosthetic Leg Across Walking Speeds

PubMed Central

Villarreal, Dario J.; Gregg, Robert D.

2016-01-01

This paper presents the experimental validation of a novel control strategy that unifies the entire gait cycle of a powered knee-ankle prosthetic leg without the need to switch between controllers for different periods of gait. Current control methods divide the gait cycle into several sequential periods each with independent controllers, resulting in many patient-specific control parameters and switching rules that must be tuned for a specific walking speed. The single controller presented is speed-invariant with a minimal number of control parameters to be tuned. A single, periodic virtual constraint is derived that exactly characterizes the desired actuated joint motion as a function of a mechanical phase variable across walking cycles. A single sensor was used to compute a phase variable related to the residual thigh angle’s phase plane, which was recently shown to robustly represent the phase of non-steady human gait. This phase variable allows the prosthesis to synchronize naturally with the human user for intuitive, biomimetic behavior. A custom powered knee-ankle prosthesis was designed and built to implement the control strategy and validate its performance. A human subject experiment was conducted across multiple walking speeds (1 to 3 miles/hour) in a continuous sequence with the single phase-based controller, demonstrating its adaptability to the user’s intended speed. PMID:28392969

Effects of Design Variants in Lower-Limb Prostheses on Gait Synergy

PubMed Central

Pitkin, Mark R.

2016-01-01

A lower-limb prosthesis is the mechanical device with which an amputee’s residual limb interacts with the walking surface. The pressure and shear forces that affect the residuum due to prosthesis use are the sources of pain, residual-limb skin problems and gait deviations. Direct approaches to reducing these problems include improving fit, alignment technique and socket design as well as increasing cushioning with socket liners. A summary of typical malalignments and their consequences is presented. The malalignments are considered sources of excessive moments applied to the residuum, which simplifies the analysis of a patient’s gait. A better design of prosthetic joints could improve prosthetic gait. This article addresses the key mechanical parameter of prosthetic joints, namely the dependence “moment of resistance/angle of deflection.” A mathematical model has been developed that links stresses on the residuum in transtibial amputees with the moment of resistance in the prosthetic ankle at the critical gait phases. Analysis of the model yields a substantial decrease in stresses on the residuum during the most demanding, load-bearing phase of stance if the moment of resistance in the ankle is similar to that seen in the biological ankle joint. Gait study shows use of the experimental rolling-joint prosthetic foot more closely simulates normal gait synergy than the SACH foot. PMID:27087763

Bionic ankle–foot prosthesis normalizes walking gait for persons with leg amputation

PubMed Central

Herr, Hugh M.; Grabowski, Alena M.

2012-01-01

Over time, leg prostheses have improved in design, but have been incapable of actively adapting to different walking velocities in a manner comparable to a biological limb. People with a leg amputation using such commercially available passive-elastic prostheses require significantly more metabolic energy to walk at the same velocities, prefer to walk slower and have abnormal biomechanics compared with non-amputees. A bionic prosthesis has been developed that emulates the function of a biological ankle during level-ground walking, specifically providing the net positive work required for a range of walking velocities. We compared metabolic energy costs, preferred velocities and biomechanical patterns of seven people with a unilateral transtibial amputation using the bionic prosthesis and using their own passive-elastic prosthesis to those of seven non-amputees during level-ground walking. Compared with using a passive-elastic prosthesis, using the bionic prosthesis decreased metabolic cost by 8 per cent, increased trailing prosthetic leg mechanical work by 57 per cent and decreased the leading biological leg mechanical work by 10 per cent, on average, across walking velocities of 0.75–1.75 m s−1 and increased preferred walking velocity by 23 per cent. Using the bionic prosthesis resulted in metabolic energy costs, preferred walking velocities and biomechanical patterns that were not significantly different from people without an amputation. PMID:21752817

Bilateral electromyogram response latency following platform perturbation in unilateral transtibial prosthesis users: influence of weight distribution and limb position.

PubMed

Rusaw, David; Hagberg, Kerstin; Nolan, Lee; Ramstrand, Nerrolyn

2013-01-01

Appropriate muscular response following an external perturbation is essential in preventing falls. Transtibial prosthesis users lack a foot-ankle complex and associated sensorimotor structures on the side with the prosthesis. The effect of this lack on rapid responses of the lower limb to external surface perturbations is unknown. The aim of the present study was to compare electromyogram (EMG) response latencies of otherwise healthy, unilateral, transtibial prosthesis users (n = 23, mean +/- standard deviation [SD] age = 48 +/- 14 yr) and a matched control group (n = 23, mean +/- SD age = 48 +/- 13 yr) following sudden support-surface rotations in the pitch plane (toes-up and toes-down). Perturbations were elicited in various weight-bearing and limb-perturbed conditions. The results indicated that transtibial prosthesis users have delayed responses of multiple muscles of the lower limb following perturbation, both in the intact and residual limbs. Weight-bearing had no influence on the response latency in the residual limb, but did on the intact limb. Which limb received the perturbation was found to influence the muscular response, with the intact limb showing a significantly delayed response when the perturbation was received only on the side with a prosthesis. These delayed responses may represent an increased risk of falling for individuals who use transtibial prostheses.

Optimal design and control of an electromechanical transfemoral prosthesis with energy regeneration.

PubMed

Rohani, Farbod; Richter, Hanz; van den Bogert, Antonie J

2017-01-01

In this paper, we present the design of an electromechanical above-knee active prosthesis with energy storage and regeneration. The system consists of geared knee and ankle motors, parallel springs for each motor, an ultracapacitor, and controllable four-quadrant power converters. The goal is to maximize the performance of the system by finding optimal controls and design parameters. A model of the system dynamics was developed, and used to solve a combined trajectory and design optimization problem. The objectives of the optimization were to minimize tracking error relative to human joint motions, as well as energy use. The optimization problem was solved by the method of direct collocation, based on joint torque and joint angle data from ten subjects walking at three speeds. After optimization of controls and design parameters, the simulated system could operate at zero energy cost while still closely emulating able-bodied gait. This was achieved by controlled energy transfer between knee and ankle, and by controlled storage and release of energy throughout the gait cycle. Optimal gear ratios and spring parameters were similar across subjects and walking speeds.

High rate of osteolytic lesions in medium-term followup after the AES total ankle replacement.

PubMed

Kokkonen, Ari; Ikävalko, Mikko; Tiihonen, Raine; Kautiainen, Hannu; Belt, Eero A

2011-02-01

Some previous studies have shown a high percentage of early-onset and rapidly progressing osteolysis associated with total ankle arthroplasty (TAA) by the Ankle Evolutive System (AES). The purpose of our study was to analyze medium-term results at our institution. Altogether 38 TAAs using AES prostheses were carried out between 2003 and 2007. Diagnoses were rheumatoid arthritis (71%), post-traumatic and idiopathic osteoarthritis (29%). The mean age was 54 years, followup 28 months. Tibial and talar components had hydroxyapatite coating on metal (Co-Cr) components (HA-coated). Since 2005 the design was changed and components were porous coated with titanium and hydroxyapatite (dual-coated). Two-year survival was 79% (95% CI: 56 to 98). At followup 34 (89%) primary tibial and talar components were preserved. In 19 (50%) TAAs osteolysis (more than or equal to 2 mm) occurred in the periprosthetic bone area and in nine (24%) comprised large "cyst-like osteolysis''. In HA-coated prostheses radiolucent lines (less than or equal to 2 mm) or osteolysis (more than or equal to 2 mm) were detected in 11 (100%) cases and in dual-coated prostheses in 19 (74%) (p = 0.08). On the other hand there was more large "cyst-like osteolysis'' around the dual-coated prosthesis and lesions were larger (p = 0.017). In rheumatoid arthritis osteolysis was detected in 14 (52%) and large "cyst-like osteolysis'' in seven (26%) prostheses and in the group of traumatic and idiopathic osteoarthritis in six (55%) and two (18%), respectively. This study showed a high frequency of osteolysis in medium-term followup after the AES ankle replacement. The outcome was not sufficiently beneficial and we have discontinued use of this prosthesis.

Evaluation of a Powered Ankle-Foot Prosthesis during Slope Ascent Gait

PubMed Central

2016-01-01

Passive prosthetic feet lack active plantarflexion and push-off power resulting in gait deviations and compensations by individuals with transtibial amputation (TTA) during slope ascent. We sought to determine the effect of active ankle plantarflexion and push-off power provided by a powered prosthetic ankle-foot (PWR) on lower extremity compensations in individuals with unilateral TTA as they walked up a slope. We hypothesized that increased ankle plantarflexion and push-off power would reduce compensations commonly observed with a passive, energy-storing-returning prosthetic ankle-foot (ESR). We compared the temporal spatial, kinematic, and kinetic measures of ten individuals with TTA (age: 30.2 ± 5.3 yrs) to matched abled-bodied (AB) individuals during 5° slope ascent. The TTA group walked with an ESR and separately with a PWR. The PWR produced significantly greater prosthetic ankle plantarflexion and push-off power generation compared to an ESR and more closely matched AB values. The PWR functioned similar to a passive ESR device when transitioning onto the prosthetic limb due to limited prosthetic dorsiflexion, which resulted in similar deviations and compensations. In contrast, when transitioning off the prosthetic limb, increased ankle plantarflexion and push-off power provided by the PWR contributed to decreased intact limb knee extensor power production, lessening demand on the intact limb knee. PMID:27977681

Evaluation of a Powered Ankle-Foot Prosthesis during Slope Ascent Gait.

PubMed

Rábago, Christopher A; Aldridge Whitehead, Jennifer; Wilken, Jason M

2016-01-01

Passive prosthetic feet lack active plantarflexion and push-off power resulting in gait deviations and compensations by individuals with transtibial amputation (TTA) during slope ascent. We sought to determine the effect of active ankle plantarflexion and push-off power provided by a powered prosthetic ankle-foot (PWR) on lower extremity compensations in individuals with unilateral TTA as they walked up a slope. We hypothesized that increased ankle plantarflexion and push-off power would reduce compensations commonly observed with a passive, energy-storing-returning prosthetic ankle-foot (ESR). We compared the temporal spatial, kinematic, and kinetic measures of ten individuals with TTA (age: 30.2 ± 5.3 yrs) to matched abled-bodied (AB) individuals during 5° slope ascent. The TTA group walked with an ESR and separately with a PWR. The PWR produced significantly greater prosthetic ankle plantarflexion and push-off power generation compared to an ESR and more closely matched AB values. The PWR functioned similar to a passive ESR device when transitioning onto the prosthetic limb due to limited prosthetic dorsiflexion, which resulted in similar deviations and compensations. In contrast, when transitioning off the prosthetic limb, increased ankle plantarflexion and push-off power provided by the PWR contributed to decreased intact limb knee extensor power production, lessening demand on the intact limb knee.

The effects of prosthetic foot roll-over shape arc length on the gait of trans-tibial prosthesis users.

PubMed

Hansen, Andrew H; Meier, Margrit R; Sessoms, Pinata H; Childress, Dudley S

2006-12-01

The Shape&Roll prosthetic foot was used to examine the effect of roll-over shape arc length on the gait of 14 unilateral trans-tibial prosthesis users. Simple modifications to the prosthetic foot were used to alter the effective forefoot rocker length, leaving factors such as alignment, limb length, and heel and mid-foot characteristics unchanged. Shortening the roll-over shape arc length caused a significant reduction in the maximum external dorsiflexion moment on the prosthetic side at all walking speeds (p < 0.001 for main effect of arc length), due to a reduction in forefoot leverage (moment arm) about the ankle. Roll-over shape arc length significantly affected the initial loading on the sound limb at normal and fast speeds (p = 0.001 for the main effect of arc length), with participants experiencing larger first peaks of vertical ground reaction forces on their sound limbs when using the foot with the shortest effective forefoot rocker arc length. Additionally, the difference between step lengths on the sound and prosthetic limbs was larger with the shortest arc length condition, although this difference was not statistically significant (p = 0.06 for main effect). It appears that prosthesis users may experience a drop-off effect at the end of single limb stance on prosthetic feet with short roll-over shape arc lengths, leading to increased loading and/or a shortened step on the contralateral limb.

The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review.

PubMed

van Heiningen, Jacqueline; Vliet Vlieland, Thea P M; van der Heide, Huub J L

2013-10-26

While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis. Studies were obtained from Pubmed, Embase and Web of Science (January 1980-June 2011) and additional manual search. original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04). 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other.

A universal ankle-foot prosthesis emulator for human locomotion experiments.

PubMed

Caputo, Joshua M; Collins, Steven H

2014-03-01

Robotic prostheses have the potential to significantly improve mobility for people with lower-limb amputation. Humans exhibit complex responses to mechanical interactions with these devices, however, and computational models are not yet able to predict such responses meaningfully. Experiments therefore play a critical role in development, but have been limited by the use of product-like prototypes, each requiring years of development and specialized for a narrow range of functions. Here we describe a robotic ankle-foot prosthesis system that enables rapid exploration of a wide range of dynamical behaviors in experiments with human subjects. This emulator comprises powerful off-board motor and control hardware, a flexible Bowden cable tether, and a lightweight instrumented prosthesis, resulting in a combination of low mass worn by the human (0.96 kg) and high mechatronic performance compared to prior platforms. Benchtop tests demonstrated closed-loop torque bandwidth of 17 Hz, peak torque of 175 Nm, and peak power of 1.0 kW. Tests with an anthropomorphic pendulum "leg" demonstrated low interference from the tether, less than 1 Nm about the hip. This combination of low worn mass, high bandwidth, high torque, and unrestricted movement makes the platform exceptionally versatile. To demonstrate suitability for human experiments, we performed preliminary tests in which a subject with unilateral transtibial amputation walked on a treadmill at 1.25 ms-1 while the prosthesis behaved in various ways. These tests revealed low torque tracking error (RMS error of 2.8 Nm) and the capacity to systematically vary work production or absorption across a broad range (from -5 to 21 J per step). These results support the use of robotic emulators during early stage assessment of proposed device functionalities and for scientific study of fundamental aspects of human-robot interaction. The design of simple, alternate end-effectors would enable studies at other joints or with additional degrees of freedom.

Fixed and mobile-bearing total ankle prostheses: Effect on tibial bone strain.

PubMed

Terrier, Alexandre; Fernandes, Caroline Sieger; Guillemin, Maïka; Crevoisier, Xavier

2017-10-01

Total ankle replacement is associated to a high revision rate. To improve implant survival, the potential advantage of prostheses with fixed bearing compared to mobile bearing is unclear. The objective of this study was to test the hypothesis that fixed and mobile bearing prostheses are associated with different biomechanical quantities typically associated to implant failure. With a validated finite element model, we compared three cases: a prosthesis with a fixed bearing, a prosthesis with a mobile bearing in a centered position, and a prosthesis with mobile bearing in an eccentric position. Both prostheses were obtained from the same manufacturer. They were tested on seven tibias with maximum axial compression force during walking. We tested the hypothesis that there was a difference of bone strain, bone-implant interfacial stress, and bone support between the three cases. We also evaluated, for the three cases, the correlations between bone support, bone strain and bone-implant interfacial stress. There were no statistically significant differences between the three cases. Overall, bone support was mainly trabecular, and less effective in the posterior side. Bone strain and bone-implant interfacial stress were strongly correlated to bone support. Even if slight differences are observed between fixed and mobile bearing, it is not enough to put forward the superiority of one of these implants regarding their reaction to axial compression. When associated to the published clinical results, our study provides no argument to warn surgeons against the use of two-components fixed bearing implants. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impact of a stance phase microprocessor-controlled knee prosthesis on level walking in lower functioning individuals with a transfemoral amputation.

PubMed

Eberly, Valerie J; Mulroy, Sara J; Gronley, JoAnne K; Perry, Jacquelin; Yule, William J; Burnfield, Judith M

2014-12-01

For individuals with transfemoral amputation, walking with a prosthesis presents challenges to stability and increases the demand on the hip of the prosthetic limb. Increasing age or comorbidities magnify these challenges. Computerized prosthetic knee joints improve stability and efficiency of gait, but are seldom prescribed for less physically capable walkers who may benefit from them. To compare level walking function while wearing a microprocessor-controlled knee (C-Leg Compact) prosthesis to a traditionally prescribed non-microprocessor-controlled knee prosthesis for Medicare Functional Classification Level K-2 walkers. Crossover. Stride characteristics, kinematics, kinetics, and electromyographic activity were recorded in 10 participants while walking with non-microprocessor-controlled knee and Compact prostheses. Walking with the Compact produced significant increase in velocity, cadence, stride length, single-limb support, and heel-rise timing compared to walking with the non-microprocessor-controlled knee prosthesis. Hip and thigh extension during late stance improved bilaterally. Ankle dorsiflexion, knee extension, and hip flexion moments of the prosthetic limb were significantly improved. Improvements in walking function and stability on the prosthetic limb were demonstrated by the K-2 level walkers when using the C-Leg Compact prosthesis. Understanding the impact of new prosthetic designs on gait mechanics is essential to improve prescription guidelines for deconditioned or older persons with transfemoral amputation. Prosthetic designs that improve stability for safety and walking function have the potential to improve community participation and quality of life. © The International Society for Prosthetics and Orthotics 2013.

Online adaptive neural control of a robotic lower limb prosthesis

NASA Astrophysics Data System (ADS)

Spanias, J. A.; Simon, A. M.; Finucane, S. B.; Perreault, E. J.; Hargrove, L. J.

2018-02-01

Objective. The purpose of this study was to develop and evaluate an adaptive intent recognition algorithm that continuously learns to incorporate a lower limb amputee’s neural information (acquired via electromyography (EMG)) as they ambulate with a robotic leg prosthesis. Approach. We present a powered lower limb prosthesis that was configured to acquire the user’s neural information and kinetic/kinematic information from embedded mechanical sensors, and identify and respond to the user’s intent. We conducted an experiment with eight transfemoral amputees over multiple days. EMG and mechanical sensor data were collected while subjects using a powered knee/ankle prosthesis completed various ambulation activities such as walking on level ground, stairs, and ramps. Our adaptive intent recognition algorithm automatically transitioned the prosthesis into the different locomotion modes and continuously updated the user’s model of neural data during ambulation. Main results. Our proposed algorithm accurately and consistently identified the user’s intent over multiple days, despite changing neural signals. The algorithm incorporated 96.31% [0.91%] (mean, [standard error]) of neural information across multiple experimental sessions, and outperformed non-adaptive versions of our algorithm—with a 6.66% [3.16%] relative decrease in error rate. Significance. This study demonstrates that our adaptive intent recognition algorithm enables incorporation of neural information over long periods of use, allowing assistive robotic devices to accurately respond to the user’s intent with low error rates.

Design, analysis and verification of a knee joint oncological prosthesis finite element model.

PubMed

Zach, Lukáš; Kunčická, Lenka; Růžička, Pavel; Kocich, Radim

2014-11-01

The aim of this paper was to design a finite element model for a hinged PROSPON oncological knee endoprosthesis and to verify the model by comparison with ankle flexion angle using knee-bending experimental data obtained previously. Visible Human Project CT scans were used to create a general lower extremity bones model and to compose a 3D CAD knee joint model to which muscles and ligaments were added. Into the assembly the designed finite element PROSPON prosthesis model was integrated and an analysis focused on the PEEK-OPTIMA hinge pin bushing stress state was carried out. To confirm the stress state analysis results, contact pressure was investigated. The analysis was performed in the knee-bending position within 15.4-69.4° hip joint flexion range. The results showed that the maximum stress achieved during the analysis (46.6 MPa) did not exceed the yield strength of the material (90 MPa); the condition of plastic stability was therefore met. The stress state analysis results were confirmed by the distribution of contact pressure during knee-bending. The applicability of our designed finite element model for the real implant behaviour prediction was proven on the basis of good correlation of the analytical and experimental ankle flexion angle data. Copyright © 2014 Elsevier Ltd. All rights reserved.

Motor adaptation to prosthetic cycling in people with trans-tibial amputation

PubMed Central

Childers, W. Lee; Prilutsky, Boris I.; Gregor, Robert J.

2014-01-01

The neuromusculoskeletal system interacts with the external environment via end-segments, e.g. feet. A person with trans-tibial amputation (TTAmp) has lost a foot and ankle; hence the residuum with prosthesis becomes the new end-segment. We investigated changes in kinetics and muscle activity in TTAmps during cycling with this altered interface with the environment. Nine unilateral TTAmps and nine subjects without amputation (NoAmp) pedaled at a constant torque of 15Nm and a constant cadence of 90rpm (~150watts). Pedal forces and limb kinematics were used to calculate resultant joint moments. Electromyographic activity was recorded to determine its magnitude and timing. Biomechanical and EMG variables of the amputated limb were compared to those of the TTAmp sound limb and to the dominant limb in the NoAmp group using a one-way ANOVA. Results showed maximum angular displacement between the residuum and prosthesis was 4.8 ± 1.8deg. The amputated limb compared to sound limb and NoAmp group produced lower extensor moments averaged over the cycle about the ankle (13 ± 2.3, 20 ± 5.7, and 19 ± 5.3Nm, respectfully) and knee (8.4 ± 5.0, 15 ± 4.5, and 12.7 ± 5.9Nm, respectfully) (p<0.05). Gastrocnemius and rectus femoris peak activity in the TTAmps shifted to later in the crank cycle (by 36° and 75°, respectfully; p<0.05). These data suggest gastrocnemius was utilized as a one-joint knee flexor in combination with rectus femoris for prosthetic socket control and highlight prosthetic control as an interaction between the residuum, prosthesis and external environment. PMID:24818794

Scandinavian Total Ankle Replacement: 15-Year Follow-up.

PubMed

Palanca, Ariel; Mann, Roger A; Mann, Jeffrey A; Haskell, Andrew

2018-02-01

Over the past decade, total ankle arthroplasty (TAA) has become a mainstay in the treatment of end-stage ankle arthritis. Currently in its fourth generation, the Scandanavian Total Ankle Replacement (STAR) is the only 3-piece mobile bearing ankle prosthesis available in the United States. Our current study reports implant survivorship at 15 years and patient outcomes for a subset of these survivors available for study. Eighty-four TAAs were performed between 1998 and 2000. Metal component survivorship at 15 years was calculated with a Kaplan-Meier curve. Twenty-four (29%) of 84 patients were available for participation with a minimum 15-year follow-up. Any radiographic changes were documented. All additional procedures and complications were recorded. Clinical findings, self-reported performance and pain evaluations, and AOFAS ankle/hindfoot scores were noted. Metal implant survival was 73% at 15 years. Of the 24 patients available for clinical evaluation, 18 of 24 patients (70.7%) had no change in prosthetic alignment from the immediate postoperative radiograph. Only 1 subtalar fusion was required for symptomatic adjacent joint arthritis. Three patients sustained a broken polyethylene component. AOFAS scores improved from an average of 39.6 points preoperatively, to an average of 71.6. More than half (52.4%) of patients with retained implants required an additional surgical procedure; 3 required 2 additional procedures. The average time to subsequent procedure was 10.2 years. Our small cohort demonstrated STAR ankles with retention at 9 years were highly likely to survive to 15 years, and patients continued to have significant improvement in pain relief and minimal decrease in function. At 15 years from TAA, metal survivorship was 73%. As with all ankle replacements, supplementary procedures were common. Level IV, case series.

Spring Ankle with Regenerative Kinetics to Build a New Generation of Transtibial Prostheses

DTIC Science & Technology

2009-07-01

fiber keel. This feature can provide an alternative if the electronics fail in a field condition. We are focused on developing the most durable...step forward in design of new prosthesis 22 14. Discovery Channel, 2008, “Toad research could leapfrog to new muscle model”, show was called...turning on the proportional myoelectric control. The pneumatic muscles supplied 36% plantar flexor torque and 123% dorsi flexor torque. Challenges

Sensitivity of biomechanical outcomes to independent variations of hindfoot and forefoot stiffness in foot prostheses.

PubMed

Adamczyk, Peter Gabriel; Roland, Michelle; Hahn, Michael E

2017-08-01

Many studies have reported the effects of different foot prostheses on gait, but most results cannot be generalized because the prostheses' properties are seldom reported. We varied hindfoot and forefoot stiffness in an experimental foot prosthesis, in increments of 15N/mm, and tested the parametric effects of these variations on treadmill walking in unilateral transtibial amputees, at speeds from 0.7 to 1.5m/s. We computed outcomes such as prosthesis energy return, center of mass (COM) mechanics, ground reaction forces, and joint mechanics, and computed their sensitivity to component stiffness. A stiffer hindfoot led to reduced prosthesis energy return, increased ground reaction force (GRF) loading rate, and greater stance-phase knee flexion and knee extensor moment. A stiffer forefoot resulted in reduced prosthetic-side ankle push-off and COM push-off work, and increased knee extension and knee flexor moment in late stance. The sensitivity parameters obtained from these tests may be useful in clinical prescription and further research into compensatory mechanisms of joint function. Copyright © 2017 Elsevier B.V. All rights reserved.

Validation of the Inverted Pendulum Model in standing for transtibial prosthesis users.

PubMed

Rusaw, David F; Ramstrand, Simon

2016-01-01

Often in balance assessment variables associated with the center of pressure are used to draw conclusions about an individual's balance. Validity of these conclusions rests upon assumptions that movement of the center of pressure is inter-dependent on movement of the center of mass. This dependency is mechanical and is referred to as the Inverted Pendulum Model. The following study aimed to validate this model both kinematically and kinetically, in transtibial prosthesis users and a control group. Prosthesis users (n=6) and matched control participants (n=6) stood quietly while force and motion data were collected under three conditions (eyes-open, eyes-closed, and weight-bearing feedback). Correlation coefficients were used to investigate the relationships between height and excursion of markers and center of masses in mediolateral/anteroposterior-directions, difference between center of pressure and center of mass and the center of mass acceleration in mediolateral/anteroposterior directions, magnitude of mediolateral/anteroposterior-component forces and center of mass acceleration, angular position of ankle and excursion in mediolateral/anteroposterior-directions, and integrated force signals. Results indicate kinematic validity of similar magnitudes (mean (SD) marker-displacement) between prosthesis users and control group for mediolateral- (r=0.77 (0.17); 0.74 (0.19)) and anteroposterior-directions (r=0.88 (0.18); 0.88 (0.19)). Correlation between difference of center of pressure and center of mass and the center of mass acceleration was negligible on the prosthetic side (r = 0.08 (0.06)) vs. control group (r=-0.51(0.13)). Results indicate kinematic validity of the Inverted Pendulum Model in transtibial prosthesis users but kinetic validity is questionable, particularly on the side with a prosthesis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Improvements in survival of the uncemented Nottingham Total Shoulder prosthesis: a prospective comparative study

PubMed Central

Rosenberg, Nahum; Neumann, Lars; Modi, Amit; Mersich, Istvan J; Wallace, Angus W

2007-01-01

Background The uncemented Nottingham Total Shoulder Replacement prosthesis system (Nottingham TSR) was developed from the previous BioModular® shoulder prosthesis taking into consideration the causes of the initial implant's failure. We investigated the impact of changes in the design of Nottingham TSR prosthesis on its survivorship rate. Methods Survivorship analyses of three types of uncemented total shoulder arthroplasty prostheses (BioModular®, initial Nottingham TSR and current Nottingham TSR systems with 11, 8 and 4 year survivorship data respectively) were compared. All these prostheses were implanted for the treatment of disabling pain in the shoulder due to primary and secondary osteoarthritis or rheumatoid arthritis. Each type of the prosthesis studied was implanted in consecutive group of patients – 90 patients with BioModular® system, 103 with the initial Nottingham TSR and 34 patients with the current Nottingham TSR system. The comparison of the annual cumulative survivorship values in the compatible time range between the three groups was done according to the paired t test. Results The 8-year and 11-year survivorship rates for the initially used modified BioModular® uncemented prosthesis were relatively low (75.6% and 71.7% respectively) comparing to the reported survivorship of the conventional cemented implants. The 8-year survivorship for the uncemented Nottingham TSR prosthesis was significantly higher (81.8%), but still not in the desired range of above 90%, that is found in other cemented designs. Glenoid component loosening was the main factor of prosthesis failure in both prostheses and mainly occurred in the first 4 postoperative years. The 4-year survivorship of the currently re-designed Nottingham TSR prosthesis, with hydroxylapatite coating of the glenoid baseplate, was significantly higher, 93.1% as compared to 85.1% of the previous Nottingham TSR. Conclusion The initial Nottingham shoulder prosthesis showed significantly higher survivorship than the BioModular® uncemented prosthesis, but lower than expected. Subsequently re-designed Nottingham TSR system presented a high short term survivorship rate that encourages its ongoing use PMID:17683577

Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis.

PubMed

Stengel, Dirk; Bauwens, Kai; Ekkernkamp, Axel; Cramer, Jörg

2005-03-01

The reputation of total ankle arthroplasty for treating end-stage ankle arthritis of different origin is dubious. Newer generation meniscal-bearing prostheses may have overcome the known problems with earlier implants. There is, however, no systematic approach to the available scientific evidence allowing for a critical appraisal of their benefits and risks. We conducted a systematic review meta-analysis of studies exploring the efficacy of three-component total ankle prostheses. We demanded a minimum sample size of 20 subjects, at least 1 year of follow-up, and a clinically relevant study endpoint (for example, results of ankle scoring, ranges of motion [ROM], complications, and survival rates). We identified citations by electronic medical databases and a manual search. We made no restrictions for language. We used an eight-point quality scale to appraise methodological standards, and modeled outcomes by random-effects meta-regression analysis. Eighteen of 1830 citations including 1086 patients fulfilled our eligibility criteria. Studies met a median of four quality items (interquartile range 2-5). Outcome estimates did not depend on methodological quality. There was no evidence of strong heterogeneity or publication bias. With standardized 100-point ankle and hindfoot scores, formal data pooling was possible for 10 trials (n =497), showing a mean improvement of 45.2 points (95% confidence interval [CI] 39.3-51.1). Overall ROM improved slightly (6.3 degrees, 95%CI 2.2-10.5 degrees ). Weighted complication rates ranged from 1.6% (deep infections) to 14.7% (impingement). Secondary surgery had to be performed in 12.5%, whereas secondary arthrodesis was necessary in 6.3%. The weighted 5-year prosthesis survival rate averaged 90.6%. Ankle arthroplasty improves pain and joint mobility in end-stage ankle arthritis. Its performance in comparison to the current reference standard (that is, ankle fusion) remains to be defined in a properly designed randomized trial.

Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic 'ankle' damping.

PubMed

De Asha, Alan R; Munjal, Ramesh; Kulkarni, Jai; Buckley, John G

2013-10-17

Passive prosthetic devices are set up to provide optimal function at customary walking speed and thus may function less effectively at other speeds. This partly explains why joint kinetic adaptations become more apparent in lower-limb amputees when walking at speeds other than customary. The present study determined whether a trans-tibial prosthesis incorporating a dynamic-response foot that was attached to the shank via an articulating hydraulic device (hyA-F) lessened speed-related adaptations in joint kinetics compared to when the foot was attached via a rigid, non-articulating attachment (rigF). Eight active unilateral trans-tibial amputees completed walking trials at their customary walking speed, and at speeds they deemed to be slow-comfortable and fast-comfortable whilst using each type of foot attachment. Moments and powers at the distal end of the prosthetic shank and at the intact joints of both limbs were compared between attachment conditions. There was no change in the amount of intact-limb ankle work across speed or attachment conditions. As speed level increased there was an increase on both limbs in the amount of hip and knee joint work done, and increases on the prosthetic side were greater when using the hyA-F. However, because all walking speed levels were higher when using the hyA-F, the intact-limb ankle and combined joints work per meter travelled were significantly lower; particularly so at the customary speed level. This was the case despite the hyA-F dissipating more energy during stance. In addition, the amount of eccentric work done per meter travelled became increased at the residual knee when using the hyA-F, with increases again greatest at customary speed. Findings indicate that a trans-tibial prosthesis incorporating a dynamic-response foot reduced speed-related changes in compensatory intact-limb joint kinetics when the foot was attached via an articulating hydraulic device compared to rigid attachment. As differences between attachment conditions were greatest at customary speed, findings indicate a hydraulic ankle-foot device is most effectual at the speed it is set-up for.

Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint.

PubMed

Cenni, Francesco; Leardini, Alberto; Cheli, Andrea; Catani, Fabio; Belvedere, Claudio; Romagnoli, Matteo; Giannini, Sandro

2012-03-01

In some cases of total ankle replacement, perfect alignment of the prosthetic components is not achieved. This study analyses the extent to which component positioning is critical for the final range of motion. Fourteen patients undergoing total ankle replacement were assessed preoperatively and postoperatively at seven and 13 months follow-up. X-ray pictures of the ankle were taken in static double leg stance, i.e. at neutral joint position, and in maximum plantarflexion and dorsiflexion. Measurements were obtained by a specially devised computer program based on anatomical reference points digitised on the radiograms. These allowed calculation of the position and orientation of the components in the sagittal and coronal planes, together with the joint range of motion. The mean range of motion was about 34 degrees at the first follow-up and maintained at the second. Tibial and talar components were more anterior than the mid-tibial shaft in 11 and nine patients, respectively. Mean inclination was about four degrees posterior for the tibial component and nearly one degree anterior for the talar component. A significantly larger range of motion was found in ankles both with the talar component located and inclined more anteriorly than the tibial. Correlation, though weak, was found between motion at the replaced ankle and possible residual subluxation and inclination of the components. However, a satisfactory range of motion was also achieved in those patients where recommended locations for the components could not be reached because of the size of the original joint deformity.

Management of lawn mower injuries to the foot and ankle.

PubMed

Corcoran, J; Zamboni, W A; Zook, E G

1993-09-01

Seventy consecutive patients treated for lawn mower injuries to the foot and ankle were reviewed to determine optimal treatment, functional results, and complications. Injuries were classified into 1 or more functional-anatomical zones (I, digits; II, dorsum; III, plantar nonweight-bearing surface; IV, heel; and V, ankle) for a total of 96 injuries. Thirty-one patients were available for follow-up. Mean age was 36.7 years and 84% were males. Most injuries (67%) involved patients > 16 years old using a push mower; however, 18% involved children < 5 years old, usually caused by riding mowers (70%). Primary closure after adequate irrigation and debridement was the preferred method of treatment except in patients with Zone IV injuries. Antibiotic prophylaxis was used in almost all injuries (93%). A 100% ambulation rate was achieved with 10% of patients requiring a prosthesis. Zone IV (heel) injuries had a 50% complication rate from chronic soft tissue breakdown. The wound infection rate per injury was 12.5% and did not vary significantly between closed (11.4%) and open (17.6%) treatment. Lawn mower injuries to the foot and ankle can be closed primarily after adequate irrigation and debridement without compromise of infection rate or function. Antibiotic prophylaxis is recommended. One-sixth of these injuries involve children < 5 years of age and can be prevented.

A modification of Chopart's amputation with ankle and subtalar arthrodesis by using an intramedullary nail.

PubMed

DeGere, Michael W; Grady, John F

2005-01-01

This study reports on 7 patients who underwent a new technique for Chopart amputation that includes ankle and subtalar arthrodesis using an intramedullary nail. This method affords rigid control to the rearfoot and appears to avoid the most common complications historically associated with Chopart amputations. All 6 surviving patients achieved successful outcomes within 1 year of their surgery. All are community ambulators who are able to walk short distances within the home without a prosthesis. One patient, who had undergone a previous vascular bypass, died in the early postoperative period after developing an infection that required an above-knee amputation. A second patient developed an infection that resolved with intravenous antibiotics. This new technique reintroduces the Chopart-level amputation as a valuable intermediate between the transmetatarsal and below-knee amputation levels.

Intention detection of gait initiation using EMG and kinematic data.

PubMed

Wentink, E C; Beijen, S I; Hermens, H J; Rietman, J S; Veltink, P H

2013-02-01

Gait initiation in transfemoral amputees (TFA) is different from non-amputees. This is mainly caused by the lack of stability and push-off from the prosthetic leg. Adding control and artificial push-off to the prosthesis may therefore be beneficial to TFA. In this study the feasibility of real-time intention detection of gait initiation was determined by mimicking the TFA situation in non-amputees. EMG and inertial sensor data was measured in 10 non-amputees. Only data available in TFA was used to determine if gait initiation can be predicted in time to control a transfemoral prosthesis to generate push-off and stability. Toe-off and heel-strike of the leading limb are important parameters to be detected, to control a prosthesis and to time push-off. The results show that toe-off and heel-strike of the leading limb can be detected using EMG and kinematic data in non-amputees 130-260 ms in advance. This leaves enough time to control a prosthesis. Based on these results we hypothesize that similar results can be found in TFA, allowing for adequate control of a prosthesis during gait initiation. Copyright © 2012 Elsevier B.V. All rights reserved.

Neuromechanical sensor fusion yields highest accuracies in predicting ambulation mode transitions for trans-tibial amputees.

PubMed

Tkach, D C; Hargrove, L J

2013-01-01

Advances in battery and actuator technology have enabled clinical use of powered lower limb prostheses such as the BiOM Powered Ankle. To allow ambulation over various types of terrains, such devices rely on built-in mechanical sensors or manual actuation by the amputee to transition into an operational mode that is suitable for a given terrain. It is unclear if mechanical sensors alone can accurately modulate operational modes while voluntary actuation prevents seamless, naturalistic gait. Ensuring that the prosthesis is ready to accommodate new terrain types at first step is critical for user safety. EMG signals from patient's residual leg muscles may provide additional information to accurately choose the proper mode of prosthesis operation. Using a pattern recognition classifier we compared the accuracy of predicting 8 different mode transitions based on (1) prosthesis mechanical sensor output (2) EMG recorded from residual limb and (3) fusion of EMG and mechanical sensor data. Our findings indicate that the neuromechanical sensor fusion significantly decreases errors in predicting 10 mode transitions as compared to using either mechanical sensors or EMG alone (2.3±0.7% vs. 7.8±0.9% and 20.2±2.0% respectively).

Effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of unilateral transtibial prosthesis users.

PubMed

Klodd, Elizabeth; Hansen, Andrew; Fatone, Stefania; Edwards, Mark

2010-01-01

The investigators conducted a double-blind randomized crossover study to determine the effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of 13 unilateral transtibial prosthesis users. Five experimental feet were fabricated for use in the study: F1, F2, F3, F4, and F5. F1 was most flexible, F5 was least flexible, and F3 was designed to conform to a biomimetic ankle-foot roll-over shape. The experimental feet were modeled after the Shape&Roll prosthetic foot (originally produced by Northwestern University, Chicago, Illinois; now in public domain) but had different numbers of saw cuts within the forefoot members, allowing more or less flexibility during walking. Participants walked at the same comfortable, freely selected speed on the treadmill for 7 min with each foot while energy expenditure was measured. No significant difference was found in oxygen cost (mL O(2)/kg/m) between the different feet (p = 0.17), and the order of use was also not significant (p = 0.94). However, the preference ranking was significantly affected by the flexibility of the feet (p = 0.002), with the most flexible foot (F1) ranking significantly poorer than feet F3 (p = 0.003) and F4 (p = 0.004). Users may prefer prosthetic feet that match the flexibility of an intact ankle-foot system, even though we did not detect an energetic benefit at freely selected speeds.

Pirogow's Amputation: A Modification of the Operation Method

PubMed Central

Bueschges, M.; Muehlberger, T.; Mauss, K. L.; Bruck, J. C.; Ottomann, C.

2013-01-01

Introduction. Pirogow's amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (Ankle Score). Material and Methods. We modified the original method by rotating the calcaneus. To fix the calcaneus to the tibia, Kirschner wire and a 3/0 spongiosa tension screw as well as a Fixateur externe were used. Results. 70% of those questioned who were amputated following the modified Pirogow method indicated an excellent or very good result in total points whereas in the control group (original Pirogow's amputation) only 40% reported excellent or very good result. In addition, the level of pain experienced one year after the completed operation showed different results in favour of the group being operated with the modified way. Furthermore, patients in both groups showed differences in radiological results, postoperative leg length difference, and postoperative mobility. Conclusion. The modified Pirogow amputation presents a valuable alternative to the original amputation method for patients with the corresponding indications. The benefits are found in the significantly reduced pain, difference in reduced radiological complications, the increase in mobility without a prosthesis, and the reduction of postoperative leg length difference. PMID:23606976

In vivo kinematics of the salto total ankle prosthesis.

PubMed

Leszko, Filip; Komistek, Richard D; Mahfouz, Mohamed R; Ratron, Yves-Alain; Judet, Thierry; Bonnin, Michel; Colombier, Jean-Alain; Lin, Sheldon S

2008-11-01

Recent technological advancements in total ankle arthroplasty (TAA) have included the introduction of the mobile bearing concept. This bearing has several advantages, but researchers have questioned whether or not increased mobility sacrifices joint stability or durability of the implant. The present study evaluated the kinematics of this type of prosthesis implanted in patients. Fluoroscopy and 3D-to-2D registration techniques were used to determine the in vivo kinematics for 20 TAA subjects performing two activities: gait and step-up. The motion of the prostheses was described in terms of clinical rotations and as rotation about the helical (screw) axis. Then, the anterior-posterior translation and axial rotation of the mobile bearing insert were determined. Among the clinical rotations, the dorsi-/plantarflexion was the most dominant, revealing the greatest pattern change and the largest magnitude. During gait, the orientation of the prosthetic components changed smoothly from plantarflexion to dorsiflexion. The average range of this motion was 9.2 degrees. For step-up activity, the range was 8.0 degrees. However, between 33% and 66% of stance phase, the talar component's orientation changed from dorsiflexion to plantarflexion. The average absolute range of anterior-posterior translation of the mobile bearing insert was 1.5 mm and 2.3 mm for gait and step-up, respectively. These measured translations were relatively small and may suggest that the rotational portion of the motion was more dominant than translational and provided sufficient mobility.

[Prevention and treatment of perioperative period complication of total ankle replacement].

PubMed

Liao, Xiang; Gao, Zhizeng; Huang, Shanhu; Yang, Shuhua

2008-01-01

To explore the cause of the perioprative period complication of scandinavian total ankle replacement (STAR) and to summarize the experience in the treatment and prevention. From March 1999 to November 2006, 35 patients were given total ankle replacement (TAR) with STAR system. There were 19 males and 16 females with an average age of 50.5 years (27 to 68 years), including 12 cases of posttraumatic arthritis, 8 cases of osteoarthritis and 15 cases of rheumatoid arthritis. All patients had pain of ankle joint, swelling and limitation of joint motion. The disease course was 9-64 months. The curative effect was estimated by Kofoed total ankle scoring system. The mean preoperative ankle score was 29 (6-48); the mean pain score was 18.3 (0-35); the mean function score was 11.7 (6-18); and the mean activity score was 9.2 (3-12). The type of all complications were record, and its cause, prevetion and treatment were analyszed. Thirty-three patients achieved healing by first intention, 2 achieved delayed union because of infection. Twenty-eight patients were followed up 3-80 months (mean 43.5 months). Medial malleolus fracture occurred in 2 cases, unstable ankle joint introversion in 2 cases, limitation of ankle dorsiextension in 1 case and 1 case had hypoesthesia at intermediate dorsal skin of foot and 3rd-5th metatarsal skin without obvious dysfunction; all were treated with symptomatic medication. The postoperative mean ankle score was 85.5 (58-95); the mean pain score was 48.3 (35-50); the mean function score was 20.7 (18-30); the mean activity score was 17.2 (16-20). There were statistically significant differences when compared with preoperative score (P<0.01). The clinical results were excellent in 16 patients, good in 9 patients and fair in 3 patients. The X-ray films showed no loosening and subsidence of prosthesis. Although STAR can retain the functions of the operated joint, it has its special complications. It is important to obey operation principle with proficient operative technique, to strictly control surgical indication and to intensify perioperative period treatment so as to decrease the complications.

Comparison of gait after Syme and transtibial amputation in children: factors that may play a role in function.

PubMed

Jeans, Kelly A; Karol, Lori A; Cummings, Donald; Singhal, Kunal

2014-10-01

Preservation of maximal limb length during amputation is often recommended to maximize the efficiency and symmetry of gait. The goals of this study were to determine (1) whether there are gait differences between children with a Syme (or Boyd) amputation and those with a transtibial-level amputation, and (2) whether the type of prosthetic foot affects gait and PODCI (Pediatric Outcomes Data Collection Instrument) outcomes. Sixty-four patients (age range, 4.7 to 19.2 years) with unilateral below-the-knee prosthesis use (forty-one in the Syme group and twenty-three in the transtibial group) underwent gait analysis and review of data for the involved limb. The twelve prosthetic foot types were categorized as designed for a high, medium, or low activity level (e.g., Flex foot, dynamic response foot, or SACH). Statistical analyses were conducted. Kinematic differences of <4° in total prosthetic ankle motion and 8° in external hip rotation were seen between the Syme and transtibial groups. Ankle power was greater in the transtibial group, whereas the Syme group had greater coronal-plane hip power (p < 0.05). Prosthetic ankle motion was significantly greater in the high compared with the medium and low-performance feet. However, the PODCI happiness score was higher in patients with low compared with medium-performance feet (p < 0.05). Small differences in prosthetic ankle motion and power were found between children with Syme and transtibial amputations. Ankle motion was greater in patients using high-performance feet (9% of the total cohort) compared with medium-performance (59%) and low-performance (31%) feet. Despite the increased ankle motion achieved with high-performance dynamic feet, this advantage was not reflected in peak power of the prosthetic ankle or the PODCI sports/physical functioning subscale. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Contact stresses, pressure and area in a fixed-bearing total ankle replacement: a finite element analysis.

PubMed

Martinelli, Nicolo; Baretta, Silvia; Pagano, Jenny; Bianchi, Alberto; Villa, Tomaso; Casaroli, Gloria; Galbusera, Fabio

2017-11-25

Mobile-bearing ankle implants with good clinical results continued to increase the popularity of total ankle arthroplasty to address endstage ankle osteoarthritis preserving joint movement. Alternative solutions used fixed-bearing designs, which increase stability and reduce the risk of bearing dislocation, but with a theoretical increase of contact stresses leading to a higher polyethylene wear. The purpose of this study was to investigate the contact stresses, pressure and area in the polyethylene component of a new total ankle replacement with a fixed-bearing design, using 3D finite element analysis. A three-dimensional finite element model of the Zimmer Trabecular Metal Total Ankle was developed and assembled based on computed tomography images. Three different sizes of the polyethylene insert were modeled, and a finite element analysis was conducted to investigate the contact pressure, the von Mises stresses and the contact area of the polyethylene component during the stance phase of the gait cycle. The peak value of pressure was found in the anterior region of the articulating surface, where it reached 19.8 MPa at 40% of the gait cycle. The average contact pressure during the stance phase was 6.9 MPa. The maximum von Mises stress of 14.1 MPa was reached at 40% of the gait cycle in the anterior section. In the central section, the maximum von Mises stress of 10.8 MPa was reached at 37% of the gait cycle, whereas in the posterior section the maximum stress of 5.4 MPa was reached at the end of the stance phase. The new fixed-bearing total ankle replacement showed a safe mechanical behavior and many clinical advantages. However, advanced models to quantitatively estimate the wear are need. To the light of the clinical advantages, we conclude that the presented prosthesis is a good alternative to the other products present in the market.

The heterogeneous management of pediatric ankle traumas: A retrospective descriptive study.

PubMed

Voizard, Philippe; Moore, James; Leduc, Stéphane; Nault, Marie-Lyne

2018-06-01

Frequent misdiagnosis of pediatric ankle traumas leads to inappropriate management, which may result in residual pain, instability, slower return to physical activity, and long-term degenerative changes. The purpose of this study was to evaluate the consistency of diagnosis, management, and the treatment of acute lateral pediatric ankle trauma in a tertiary care pediatric hospital. The hypothesis was that the initial diagnosis is often incorrect, and the treatment varies considerably amongst orthopedic surgeons.We conducted a retrospective study of all cases of ankle sprains and Salter-Harris one (SH1) fractures referred to our orthopedic surgery service between May and August 2014. Exclusion criteria included ankle fractures other than SH1 types, and cases where treatment was initially undertaken elsewhere before referral to our service. Primary outcome was the difference between initial and final diagnosis.Among 3047 cases reviewed, 31 matched our inclusion criteria. Initial diagnosis was 20 SH1 fractures, 8 acute ankle sprains, and 3 uncertain, with a change in diagnosis for 48.5% at follow-up.Accurate diagnosis can be difficult in pediatric ankle trauma, with case management and specific treatments varying considerably. This study reinforces the need to evaluate the safety of a general treatment algorithm for all lateral ankle trauma with normal radiographs.Level of evidence III.

Long-term prognosis of acute lateral ankle ligamentous sprains: high incidence of recurrences and residual symptoms.

PubMed

Kemler, Ellen; Thijs, Karin M; Badenbroek, Ilse; van de Port, Ingrid G L; Hoes, Arno W; Backx, Frank J G

2016-12-01

Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional treatment are scarce. To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms. Retrospective cohort study. Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital. Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury. Functional treatment of the initial ALALS. Acute lateral ankle ligamentous sprain recurrences and residual symptoms. A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them. A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Peroneal nerve palsy after ankle sprain: an update.

PubMed

Mitsiokapa, Evanthia; Mavrogenis, Andreas F; Drakopoulos, Dionysis; Mauffrey, Cyril; Scarlat, Marius

2017-01-01

Ankle sprains are extremely common in the general population and the most common injuries in athletes. Although rare, peroneal nerve palsy may occur simultaneously with ankle sprain. The exact incidence of nerve injury after ankle sprain is not known; few cases of peroneal nerve palsy associated with ankle sprains have been reported in the literature. The function of the peroneal nerve should be evaluated in all patients with a history of inversion ankle sprain as part of the initial and follow-up evaluation, even if the initial neurological status is normal, because delayed peroneal nerve palsy is possible. This article discusses the incidence, pathophysiology, evaluation, diagnosis and differential diagnosis, and management of the patients with peroneal nerve palsy after ankle sprain aiming to increase the awareness of the treating physicians for this nerve injury.

The effect of segmental weight of prosthesis on hemodynamic responses and energy expenditure of lower extremity amputees

PubMed Central

Mutlu, Akmer; Kharooty, Mohammad Dawood; Yakut, Yavuz

2017-01-01

[Purpose] The aim of this study was to investigate the effect of segmental weight of the prosthesis on hemodynamic responses and energy expenditure in lower extremity amputees. [Subjects and Methods] Thirteen patients with a mean age of 44 ± 15.84 years and with unilateral transtibial, transfemoral and Syme’s amputation were included to the study. The difference between the lightest and the heaviest prosthesis, 250 g used as the weight. All the patients completed the measurements first without weight and then with 250 g weight on the ankle joint. The blood pressure and heart rate of the patients were recorded before and after Six Minute Walk Test (6MWT) and 10 stairs up & down stairs test. Physiological Cost Index was used to calculate the energy expenditure. [Results] Heart rate and energy expenditure increased significantly when without weight and with weight results compared. [Conclusion] We conclude that the segmental weight of the prosthetic limb has a significant effect on the heart rate and energy expenditure but has no effect on the systolic and diastolic blood pressure of lower limb amputees. In order to generalize our results to lower limb amputees, more patients need to be included in future studies. PMID:28533599

Investigating the anticipatory postural adjustment phase of gait initiation in different directions in chronic ankle instability patients.

PubMed

Ebrahimabadi, Zahra; Naimi, Sedigheh Sadat; Rahimi, Abbas; Sadeghi, Heydar; Hosseini, Seyed Majid; Baghban, Alireza Akbarzadeh; Arslan, Syed Asadullah

2018-01-01

The main objective of the present study was to analyze how supra spinal motor control mechanisms are altered in different directions during anticipatory postural phase of gait initiation in chronic ankle instability patients. It seems that supra spinal pathways modulate anticipatory postural adjustment phase of gait initiation. Yet, there is a dearth of research on the effect of chronic ankle instability on the anticipatory postural adjustment phase of gait initiation in different directions. A total of 20 chronic ankle instability participants and 20 healthy individuals initiated gait on a force plate in forward, 30° lateral, and 30° medial directions. According to the results of the present study, the peak lateral center of pressure shift decreased in forward direction compared to that in other directions in both groups. Also, it was found that the peak lateral center of pressure shift and the vertical center of mass velocity decreased significantly in chronic ankle instability patients, as compared with those of the healthy individuals. According to the results of the present study, it seems that chronic ankle instability patients modulate the anticipatory postural adjustment phase of gait initiation, compared with healthy control group, in order to maintain postural stability. These changes were observed in different directions, too. Copyright © 2017 Elsevier Ltd. All rights reserved.

Hypoalgesic effect of a passive accessory mobilisation technique in patients with lateral ankle pain.

PubMed

Yeo, Hwee Koon; Wright, Anthony

2011-08-01

A randomised, double blind, repeated measures study was conducted to investigate the initial effects of an accessory mobilisation technique applied to the ankle joint in 13 patients with a unilateral sub-acute ankle supination injury. Ankle dorsiflexion range of motion, pressure pain threshold, visual analogue scale rating of pain during functional activity and ankle functional scores were assessed before and after application of treatment, manual contact control and no contact control conditions. There were significant improvements in ankle dorsiflexion range of motion (p = 0.000) and pressure pain threshold (p = 0.000) during the treatment condition. However no significant effects were observed for the other measures. These findings demonstrate that mobilisation of the ankle joint can produce an initial hypoalgesic effect and an improvement in ankle dorsiflexion range of motion. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Outcome of total ankle arthroplasty in patients with rheumatoid arthritis and noninflammatory arthritis. A multicenter cohort study comparing clinical outcome and safety.

PubMed

Pedersen, Elizabeth; Pinsker, Ellie; Younger, Alastair S E; Penner, Murray J; Wing, Kevin J; Dryden, Peter J; Glazebrook, Mark; Daniels, Timothy R

2014-11-05

Patients with rheumatoid arthritis often have degeneration of the ankle and ipsilateral hindfoot joints. Patients with rheumatoid arthritis undergoing total ankle arthroplasty have a higher risk of wound breakdown and infection. We compared intermediate-term clinical outcomes after total ankle arthroplasty in patients with rheumatoid arthritis and patients with noninflammatory arthritis. Fifty patients with rheumatoid arthritis were compared with fifty patients with noninflammatory arthritis (the control group), matched for age within ten years, prosthesis type, and follow-up time. All patients underwent total ankle arthroplasty. Revisions and major complications were noted. Outcome scores included the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) Health Survey. The groups were similar with respect to body mass index and length of follow-up (mean, 63.8 months for the rheumatoid arthritis group and 65.6 months for noninflammatory arthritis group); the rheumatoid arthritis group was younger (mean, 58.5 years compared with 61.2 years). The mean AOS pain scores were significantly different in the rheumatoid arthritis and noninflammatory arthritis groups preoperatively (p < 0.01), but were similar following total ankle arthroplasty (mean and standard deviation, 18.5 ± 17.8 for the rheumatoid arthritis group and 19.7 ± 16.5 for the noninflammatory arthritis group; p = 0.93). Both groups showed significant improvement (p < 0.05) with regard to the AOS scores for pain and disability and SF-36 physical component summary scores following surgery. Postoperatively, AOS disability and SF-36 physical component summary scores were better for patients with noninflammatory arthritis. There were seven revisions in the rheumatoid arthritis group and five in noninflammatory arthritis group. There was one major wound complication in the rheumatoid arthritis cohort and none in the control cohort. Patients with rheumatoid arthritis benefit from total ankle arthroplasty and have similar outcomes to patients with noninflammatory arthritis. The overall pain and disability were worse for patients with rheumatoid arthritis than for those with noninflammatory arthritis preoperatively, but this did not negatively influence their final outcomes. When properly treated, patients with rheumatoid arthritis achieve good results. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Radiographic diagnosis of occult distal fibular avulsion fracture in children with acute lateral ankle sprain.

PubMed

Kwak, Yoon-Hae; Lim, Jae-Young; Oh, Min-Kyung; Kim, Woo-Jin; Park, Kun-Bo

2015-06-01

Skeletally immature children with ankle sprain are presumed to have distal fibula fracture than ligamentous injury. The purpose of this study is to determine the incidence of associated occult avulsion fracture in children with lateral ankle sprain and the efficacy of identifying fractures using anterior talofibular ligament view. Patients who were diagnosed with distal fibular fracture in the initial ankle anteroposterior, lateral, and mortise were excluded and 78 patients (below 16 y of age) who had been initially diagnosed as ankle sprain were included. The initial and 4 weeks' follow-up ankle series and additional anterior talofibular ligament view suggested by Haraguchi were evaluated. Twenty patients were diagnosed with occult distal fibular avulsion fracture. Ten patients were diagnosed in anterior talofibular ligament view and others were diagnosed in the follow-up radiography. Displacement was highest on the anterior talofibular ligament view. This study found 20 (26%) of 78 ankle sprain show occult avulsion fracture in the anterior talofibular ligament view or follow-up radiography. The anterior talofibular ligament view is an appropriate radiologic view for the diagnosis of distal fibular avulsion fracture. Level IV--diagnostic study.

Initial foot contact and related kinematics affect impact loading rate in running.

PubMed

Breine, Bastiaan; Malcolm, Philippe; Van Caekenberghe, Ine; Fiers, Pieter; Frederick, Edward C; De Clercq, Dirk

2017-08-01

This study assessed kinematic differences between different foot strike patterns and their relationship with peak vertical instantaneous loading rate (VILR) of the ground reaction force (GRF). Fifty-two runners ran at 3.2 m · s -1 while we recorded GRF and lower limb kinematics and determined foot strike pattern: Typical or Atypical rearfoot strike (RFS), midfoot strike (MFS) of forefoot strike (FFS). Typical RFS had longer contact times and a lower leg stiffness than Atypical RFS and MFS. Typical RFS showed a dorsiflexed ankle (7.2 ± 3.5°) and positive foot angle (20.4 ± 4.8°) at initial contact while MFS showed a plantar flexed ankle (-10.4 ± 6.3°) and more horizontal foot (1.6 ± 3.1°). Atypical RFS showed a plantar flexed ankle (-3.1 ± 4.4°) and a small foot angle (7.0 ± 5.1°) at initial contact and had the highest VILR. For the RFS (Typical and Atypical RFS), foot angle at initial contact showed the highest correlation with VILR (r = -0.68). The observed higher VILR in Atypical RFS could be related to both ankle and foot kinematics and global running style that indicate a limited use of known kinematic impact absorbing "strategies" such as initial ankle dorsiflexion in MFS or initial ankle plantar flexion in Typical RFS.

The Evolution and Utility of the Small-Carrion Prosthesis, Its Impact, and Progression to the Modern-Day Malleable Penile Prosthesis.

PubMed

Martinez, Daniel R; Terlecki, Ryan; Brant, William O

2015-11-01

Erectile dysfunction has plagued humanity for millennia. For years, treatment had been in the hands of mental health professionals. It was not until the 1970s that urologists created a modality that was marketable, reproducible, and consistently successful at treating impotence, the Small-Carrion Penile Prosthesis. We present the evolution of the malleable/semi-rigid penile prosthesis, concentrating our efforts reviewing and critiquing the pivotal article published by Drs. Michael P. Small, Hernan M. Carrion, and Julian A. Gordon. We then discuss its continued advancement, current-day utilization, and the future of the malleable prosthesis. From the early 1900s, surgeons have been toying with the idea of creating a penile implant. These initial attempts utilized rib cartilage, and eventually synthetic materials, including acrylic, silicone, and polyethylene. In 1975, Drs. Carrion and Small presented their initial experience of 31 patients utilizing their silicone implant. In their manuscript titled, "The Small-Carrion Penile Prosthesis: New Implant for the Management of Impotence," they discuss their technique, perioperative management of complications, and results. The malleable penile prosthesis continued to evolve throughout the years to the current day Genesis and Spectra. Although the current market is dominated by the inflatable penile prosthesis, there are specific situations where the malleable is ideally utilized. The pivotal article by Drs. Carrion and Small helped pave the way for the "New Era" of penile prosthetics and still remains one of the most impactful contributions to the management of erectile dysfunction. © 2015 International Society for Sexual Medicine.

The effect of dual tasking on foot kinematics in people with functional ankle instability.

PubMed

Tavakoli, Sanam; Forghany, Saeed; Nester, Christopher

2016-09-01

Some cases of repeated inversion ankle sprains are thought to have a neurological basis and are termed functional ankle instability (FAI). In addition to factors local to the ankle, such as loss of proprioception, cognitive demands have the ability to influence motor control and may increase the risk of repetitive lateral sprains. The purpose of this study was to investigate the effect of cognitive demand on foot kinematics in physically active people with functional ankle instability. 21 physically active participants with FAI and 19 matched healthy controls completed trials of normal walking (single task) and normal walking while performing a cognitive task (dual task). Foot motion relative to the shank was recorded. Cognitive performance, ankle kinematics and movement variability in single and dual task conditions was characterized. During normal walking, the ankle joint was significantly more inverted in FAI compared to the control group pre and post initial contact. Under dual task conditions, there was a statistically significant increase in frontal plane foot movement variability during the period 200ms pre and post initial contact in people with FAI compared to the control group (p<0.05). Dual task also significantly increased plantar flexion and inversion during the period 200ms pre and post initial contact in the FAI group (p<0.05). participants with FAI demonstrated different ankle movement patterns and increased movement variability during a dual task condition. Cognitive load may increase risk of ankle instability in these people. Copyright © 2016 Elsevier B.V. All rights reserved.

Prosthetic Leg Control in the Nullspace of Human Interaction.

PubMed

Gregg, Robert D; Martin, Anne E

2016-07-01

Recent work has extended the control method of virtual constraints, originally developed for autonomous walking robots, to powered prosthetic legs for lower-limb amputees. Virtual constraints define desired joint patterns as functions of a mechanical phasing variable, which are typically enforced by torque control laws that linearize the output dynamics associated with the virtual constraints. However, the output dynamics of a powered prosthetic leg generally depend on the human interaction forces, which must be measured and canceled by the feedback linearizing control law. This feedback requires expensive multi-axis load cells, and actively canceling the interaction forces may minimize the human's influence over the prosthesis. To address these limitations, this paper proposes a method for projecting virtual constraints into the nullspace of the human interaction terms in the output dynamics. The projected virtual constraints naturally render the output dynamics invariant with respect to the human interaction forces, which instead enter into the internal dynamics of the partially linearized prosthetic system. This method is illustrated with simulations of a transfemoral amputee model walking with a powered knee-ankle prosthesis that is controlled via virtual constraints with and without the proposed projection.

Free microvascular rotationplasty with nerve repair for rhabdomyosarcoma in a 18-month-old patient.

PubMed

Pérez-García, Alberto; Salom, Marta; Villaverde-Doménech, María Eloísa; Baixauli, Francisco; Simón-Sanz, Eduardo

2017-05-01

Rotationplasty is a limb-sparing surgical option in lower limb malignancies. Sciatic or tibial nerve encasement has been considered an absolute contraindication to this procedure. We report a case of an 18-month-old girl with a rhabdomyosarcoma that affected the leg and popliteal fossa, with neurovascular involvement. Knee and proximal leg intercalary resection was performed followed by reconstruction with free microvascular rotationplasty and neurorraphy from tibial division of sciatic nerve to sural and tibial nerves, and from saphenous nerve to superficial peroneal nerve. Postoperative course was uneventful and ambulation with a provisional prosthesis was restarted during the sixth week after surgery. Bone consolidation was observed after two months. Eighteen months later, the patient had a good gait pattern with a below-knee prosthesis and had recovered sensation in the whole foot and ankle area. This case shows that rotationplasty with nerve repair may provide a sensate stump, which is vital for successful prosthetic adaptation. We believe it may be considered as an alternative to above-knee amputation in tumors with sciatic involvement. © 2017 Wiley Periodicals, Inc.

Ankle Dorsiflexion Displacement During Landing is Associated With Initial Contact Kinematics but not Joint Displacement.

PubMed

Begalle, Rebecca L; Walsh, Meghan C; McGrath, Melanie L; Boling, Michelle C; Blackburn, J Troy; Padua, Darin A

2015-08-01

The ankle, knee, and hip joints work together in the sagittal plane to absorb landing forces. Reduced sagittal plane motion at the ankle may alter landing strategies at the knee and hip, potentially increasing injury risk; however, no studies have examined the kinematic relationships between the joints during jump landings. Healthy adults (N = 30; 15 male, 15 female) performed jump landings onto a force plate while three-dimensional kinematic data were collected. Joint displacement values were calculated during the loading phase as the difference between peak and initial contact angles. No relationship existed between ankle dorsiflexion displacement during landing and three-dimensional knee and hip displacements. However, less ankle dorsiflexion displacement was associated with landing at initial ground contact with larger hip flexion, hip internal rotation, knee flexion, knee varus, and smaller plantar flexion angles. Findings of the current study suggest that restrictions in ankle motion during landing may contribute to contacting the ground in a more flexed position but continuing through little additional motion to absorb the landing. Transverse plane hip and frontal plane knee positioning may also occur, which are known to increase the risk of lower extremity injury.

Neuromuscular Control Mechanisms During Single-Leg Jump Landing in Subacute Ankle Sprain Patients: A Case Control Study.

PubMed

Allet, Lara; Zumstein, Franziska; Eichelberger, Patric; Armand, Stéphane; Punt, Ilona M

2017-03-01

Optimal neuromuscular control mechanisms are essential for preparing, maintaining, and restoring functional joint stability during jump landing and to prevent ankle injuries. In subacute ankle sprain patients, neither muscle activity nor kinematics during jump landing has previously been assessed. To compare neuromuscular control mechanisms and kinematics between subacute ankle sprain patients and healthy persons before and during the initial contact phase of a 25-cm single-leg jump. Case-control study. University hospital. Fifteen patients with grade I or II acute ankle sprains were followed up after 4 weeks of conservative management not involving physical therapy. Subjects performed alternately 3 single-leg forward jumps of 25 cm (toe-to-heel distance) barefoot. Their results were compared with the data of 15 healthy subjects. Electromyographic (EMG) activity of the musculus (m.) gastrocnemius lateralis, m. tibialis anterior, and m. peroneus longus as well as kinematics for ankle, knee, and hip joint were recorded for pre-initial contact (IC) phase, post-initial contact phase, and reflex-induced phase. The results showed that EMG activity of the 3 muscles did not differ between ankle sprain patients (n = 15) and healthy persons (n = 15) for any of the analyzed time intervals (all P > .05). However, during the pre-IC phase, ankle sprain patients presented less plantar flexion, as well as during the post-IC phase after jump landing, compared to healthy persons (P < .05). Taken together, these kinematic alterations of the ankle joint can lead to neuromuscular control mechanism disturbances through which functional instability might arise. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Joint mobilization acutely improves landing kinematics in chronic ankle instability.

PubMed

Delahunt, Eamonn; Cusack, Kim; Wilson, Laura; Doherty, Cailbhe

2013-03-01

The objective of this study is to examine the acute effect of ankle joint mobilizations akin to those performed in everyday clinical practice on sagittal plane ankle joint kinematics during a single-leg drop landing in participants with chronic ankle instability (CAI). Fifteen participants with self-reported CAI (defined as <24 on the Cumberland Ankle Instability Tool) performed three single-leg drop landings under two different conditions: 1) premobilization and, 2) immediately, postmobilization. The mobilizations performed included Mulligan talocrural joint dorsiflexion mobilization with movement, Mulligan inferior tibiofibular joint mobilization, and Maitland anteroposterior talocrural joint mobilization. Three CODA cx1 units (Charnwood Dynamics Ltd., Leicestershire, UK) were used to provide information on ankle joint sagittal plane angular displacement. The dependent variable under investigation was the angle of ankle joint plantarflexion at the point of initial contact during the drop landing. There was a statistically significant acute decrease in the angle of ankle joint plantarflexion from premobilization (34.89° ± 4.18°) to postmobilization (31.90° ± 5.89°), t(14) = 2.62, P < 0.05 (two-tailed). The mean decrease in the angle of ankle joint plantarflexion as a result of the ankle joint mobilization was 2.98° with a 95% confidence interval ranging from 0.54 to 5.43. The eta squared statistic (0.32) indicated a large effect size. These results indicate that mobilization acted to acutely reduce the angle of ankle joint plantarflexion at initial contact during a single-leg drop landing. Mobilization applied to participants with CAI has a mechanical effect on the ankle joint, thus facilitating a more favorable positioning of the ankle joint when landing from a jump.

Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures.

PubMed

Alparslan, Leyla; Chiodo, Christopher P

2008-12-01

Chronic ankle instability has been defined as the development of recurrent ankle sprains and persistent symptoms after initial lateral ankle sprain. The diagnosis of ankle instability is usually established on the patient's history, physical examination, and radiographic assessment. Patients have signs of both functional and mechanical instability, and the repetitive, chronic nature of the injury may lead to intra-articular and periarticular pathologies. This article discusses the incidence, etiology, and magnetic resonance (MR) imaging of these pathologies, reviews the surgical treatment procedures for lateral ankle instability, and presents the postoperative MR imaging findings.

Single-Surgeon Experience and Complications of a Fixed-Bearing Total Ankle Arthroplasty.

PubMed

Pangrazzi, Garett J; Baker, Erin A; Shaheen, Phillip J; Okeagu, Chikezie N; Fortin, Paul T

2018-01-01

Total ankle arthroplasty (TAA) has historically resulted in inferior survivorship rates compared with total hip and knee arthroplasty, because of technical issues unique to ankle anatomy. In this study, a single-surgeon series of intra- and postoperative complications as well as resultant reoperations/revisions of the Tornier Salto Talaris, a fixed-bearing TAA prosthesis, were reviewed. Medical records from index procedure to latest follow-up of primary TAA were reviewed. Complications were categorized according to the Glazebrook classification; additional complications were documented. Concurrent procedures were recorded, and radiographs were analyzed for alignment, subsidence, and cyst formation. Time to complication onset and learning curve analyses were performed. One hundred four Salto Talaris TAA prostheses (96 patients), with an average follow-up of 46 months, were included. Thirty-five complications were identified in 32 ankles with a 34% complication rate, resulting in 11 reoperations (5 TAA revisions). Technical error (n = 12), wound healing (n = 9), and aseptic loosening (n = 4) were the most common complications, and there were no statistically significant differences in demographics or follow-up duration between cases with versus without complications. In both the cohorts with and without complications, there were moderate, negative correlations between radiographically observed keel osteopenia and lucency (ρ = -0.548, P = .00125, and ρ = -0.416, P = .000303, respectively); also, in the complication cohort, a weak, positive correlation between subsidence and lucency (ρ = 0.357, P = .0450) was found. Salto Talaris TAA survivorship and reoperation rates in our series were comparable with previous reports, using either the same or similar mobile-bearing prostheses; new information regarding complication, radiographic, and learning curve analyses was presented. Level IV, retrospective case series.

Different corticospinal control between discrete and rhythmic movement of the ankle.

PubMed

Goto, Yumeno; Jono, Yasutomo; Hatanaka, Ryota; Nomura, Yoshifumi; Tani, Keisuke; Chujo, Yuta; Hiraoka, Koichi

2014-01-01

We investigated differences in corticospinal and spinal control between discrete and rhythmic ankle movements. Motor evoked potentials (MEPs) in the tibialis anterior and soleus muscles and soleus H-reflex were elicited in the middle of the plantar flexion phase during discrete ankle movement or in the initial or later cycles of rhythmic ankle movement. The H-reflex was evoked at an intensity eliciting a small M-wave and MEPs were elicited at an intensity of 1.2 times the motor threshold of the soleus MEPs. Only trials in which background EMG level, ankle angle, and ankle velocity were similar among the movement conditions were included for data analysis. In addition, only trials with a similar M-wave were included for data analysis in the experiment evoking H-reflexes. Results showed that H reflex and MEP amplitudes in the soleus muscle during discrete movement were not significantly different from those during rhythmic movement. MEP amplitude in the tibialis anterior muscle during the later cycles of rhythmic movement was significantly larger than that during the initial cycle of the rhythmic movement or during discrete movement. Higher corticospinal excitability in the tibialis anterior muscle during the later cycles of rhythmic movement may reflect changes in corticospinal control from the initial cycle to the later cycles of rhythmic movement.

Different corticospinal control between discrete and rhythmic movement of the ankle

PubMed Central

Goto, Yumeno; Jono, Yasutomo; Hatanaka, Ryota; Nomura, Yoshifumi; Tani, Keisuke; Chujo, Yuta; Hiraoka, Koichi

2014-01-01

We investigated differences in corticospinal and spinal control between discrete and rhythmic ankle movements. Motor evoked potentials (MEPs) in the tibialis anterior and soleus muscles and soleus H-reflex were elicited in the middle of the plantar flexion phase during discrete ankle movement or in the initial or later cycles of rhythmic ankle movement. The H-reflex was evoked at an intensity eliciting a small M-wave and MEPs were elicited at an intensity of 1.2 times the motor threshold of the soleus MEPs. Only trials in which background EMG level, ankle angle, and ankle velocity were similar among the movement conditions were included for data analysis. In addition, only trials with a similar M-wave were included for data analysis in the experiment evoking H-reflexes. Results showed that H reflex and MEP amplitudes in the soleus muscle during discrete movement were not significantly different from those during rhythmic movement. MEP amplitude in the tibialis anterior muscle during the later cycles of rhythmic movement was significantly larger than that during the initial cycle of the rhythmic movement or during discrete movement. Higher corticospinal excitability in the tibialis anterior muscle during the later cycles of rhythmic movement may reflect changes in corticospinal control from the initial cycle to the later cycles of rhythmic movement. PMID:25126066

Modeling initial contact dynamics during ambulation with dynamic simulation.

PubMed

Meyer, Andrew R; Wang, Mei; Smith, Peter A; Harris, Gerald F

2007-04-01

Ankle-foot orthoses are frequently used interventions to correct pathological gait. Their effects on the kinematics and kinetics of the proximal joints are of great interest when prescribing ankle-foot orthoses to specific patient groups. Mathematical Dynamic Model (MADYMO) is developed to simulate motor vehicle crash situations and analyze tissue injuries of the occupants based multibody dynamic theories. Joint kinetics output from an inverse model were perturbed and input to the forward model to examine the effects of changes in the internal sagittal ankle moment on knee and hip kinematics following heel strike. Increasing the internal ankle moment (augmentation, equivalent to gastroc-soleus contraction) produced less pronounced changes in kinematic results at the hip, knee and ankle than decreasing the moment (attenuation, equivalent to gastroc-soleus relaxation). Altering the internal ankle moment produced two distinctly different kinematic curve morphologies at the hip. Decreased internal ankle moments increased hip flexion, peaking at roughly 8% of the gait cycle. Increasing internal ankle moments decreased hip flexion to a lesser degree, and approached normal at the same point in the gait cycle. Increasing the internal ankle moment produced relatively small, well-behaved extension-biased kinematic results at the knee. Decreasing the internal ankle moment produced more substantial changes in knee kinematics towards flexion that increased with perturbation magnitude. Curve morphologies were similar to those at the hip. Immediately following heel strike, kinematic results at the ankle showed movement in the direction of the internal moment perturbation. Increased internal moments resulted in kinematic patterns that rapidly approach normal after initial differences. When the internal ankle moment was decreased, differences from normal were much greater and did not rapidly decrease. This study shows that MADYMO can be successfully applied to accomplish forward dynamic simulations, given kinetic inputs. Future applications include predicting muscle forces and decomposing external kinetics.

Limb Salvage After Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy.

PubMed

Vaudreuil, Nicholas J; Fourman, Mitchell S; Wukich, Dane K

2017-03-01

Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level III, retrospective case series.

Effects of footwear on lead limb knee and ankle joint kinematics in a fast bowler with a history of posterior ankle joint impingement-a case report.

PubMed

Bishop, Chris; Bartold, Simon; Thewlis, Dominic

2013-11-01

This case study reports the kinematic effect of 2 different cricket shoes on a fast bowler who reports a history of posterior ankle joint impingement. The participant bowled 6 trials in 2 pairs of cricket shoes. The 3-dimensional kinematics of the joints of the front leg was quantified during stance phase of the delivery stride. Wearing the high-cut shoe resulted in the ankle being 7.7-degree angle more plantarflexed at initial contact compared with the low-cut shoe. Again, when wearing the high-cut shoe compared with the low-cut shoe, the ankle joint was 15.5-degree angle more adducted and the knee was 4.1-degree angle less externally rotated at initial contact. This case study identifies the bowler's preferred shoe (high-cut shoe) as a potential contributing factor to the symptoms he was experiencing.

Ankle instability.

PubMed

Ferran, Nicholas A; Oliva, Francesco; Maffulli, Nicola

2009-06-01

Acute ankle sprains are common, and if inadequately treated may result in chronic instability. Lateral ankle injuries are most common, with deltoid injuries rare and associated with ankle fractures/dislocation. Medial ankle instability is rare. Functional management of acute lateral ankle sprains is the treatment of choice, with acute ligament repair reserved for athletes. Chronic lateral ankle instability is initially managed conservatively, however, failure of rehabilitation is an indication for surgical management. Nonanatomic tenodesis reconstructions have poor long-term results, sacrifice peroneal tendons, and disrupt normal ankle and hindfoot biomechanics. Anatomic repair of the anterior talofibular and calcaneofibular ligaments is recommended when the quality of the ruptured ligaments permits. Anatomic reconstruction with autograft or allograft should be performed when ligaments are attenuated. The role of arthroscopic reconstruction is evolving. Ankle arthroscopy should be performed at the time of repair or reconstruction and should address any other intra-articular causes of pain.

Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation.

PubMed

Thomason, Katherine; Ramesh, Ashwanth; McGoldrick, Niall; Cove, Richard; Walsh, James C; Stephens, Michael M

2014-01-01

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Neuromuscular control and rehabilitation of the unstable ankle

PubMed Central

Hung, You-jou

2015-01-01

Lateral ankle sprain is a common orthopedic injury with a very high recurrence rate in athletes. After decades of research, it is still unclear what contributes to the high recurrence rate of ankle sprain, and what is the most effective intervention to reduce the incident of initial and recurrent injuries. In addition, clinicians often implement balance training as part of the rehabilitation protocol in hopes of enhancing the neuromuscular control and proprioception of the ankle joint. However, there is no consensus on whether the neuromuscular control and proprioception are compromised in unstable ankles. To reduce the prevalence of ankle sprains, the effectiveness of engaging balance training to enhance the neuromuscular control and proprioception of the ankle joint is also questionable. PMID:26085985

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

PubMed Central

Kaminski, Thomas W.; Hertel, Jay; Amendola, Ned; Docherty, Carrie L.; Dolan, Michael G.; Hopkins, J. Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available. PMID:23855363

National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes.

PubMed

Kaminski, Thomas W; Hertel, Jay; Amendola, Ned; Docherty, Carrie L; Dolan, Michael G; Hopkins, J Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

Implementation of the Ottawa Ankle Rules by nurses working in an accident and emergency department.

PubMed Central

Salt, P; Clancy, M

1997-01-01

OBJECTIVE: To assess whether accident and emergency (A&E) nurses using the Ottawa Ankle Rules could detect all ankle fractures. DESIGN: Prospective observational study. SETTING: A&E department of a university teaching hospital. SUBJECTS: All patients who presented with ankle injuries who were initially assessed by a nurse taught the Ottawa Ankle Rules. OUTCOME MEASURES: (1) The numbers of patients referred by the nurse for ankle radiography; (2) of these, the number with ankle fractures; (3) of those not sent for radiography initially by the nurse, the number who subsequently had x rays (ordered by the doctor) and had a fracture; (4) of those having no x rays, the number who reattended later. RESULTS: 324 patients were eligible; 238 had x rays at the request of the nurse (73%); 48 of these (20%) were diagnosed as having a fracture. Of those 86 patients not sent for radiography by the nurse, 19 subsequently had x ray examinations at the request of a doctor and no fracture was detected. Of the 67 not sent for radiography, none returned within the subsequent eight weeks. CONCLUSIONS: Nurses can apply the Ottawa Ankle Rules safely without missing acute fractures; that is, of those who were not sent for radiography by nurses, none subsequently reattended the A&E department or the trauma service of the Bristol Royal Infirmary during the following two months. PMID:9413774

Adjuvant Maneuvers for Residual Curvature Correction During Penile Prosthesis Implantation in Men with Peyronie's Disease.

PubMed

Berookhim, Boback M; Karpman, Edward; Carrion, Rafael

2015-11-01

The surgical treatment of comorbid erectile dysfunction and Peyronie's disease has long included the implantation of an inflatable penile prosthesis as well as a number of adjuvant maneuvers to address residual curvature after prosthesis placement. To review the various surgical options for addressing curvature after prosthesis placement, with specific attention paid to an original article by Wilson et al. reporting on modeling over a penile prosthesis for the management of Peyronie's disease. A literature review was performed analyzing articles reporting the management of penile curvature in patients undergoing implantation of an inflatable penile prosthesis. Reported improvement in Peyronie's deformity as well as the complication rate associated with the various surgical techniques described. Modeling is a well-established treatment modality among patients with Peyronie's disease undergoing penile prosthesis implantation. A variety of other adjuvant maneuvers to address residual curvature when modeling alone is insufficient has been presented in the literature. Over 20 years of experience with modeling over a penile prosthesis have proven the efficacy and safety of this treatment option, providing the surgeon a simple initial step for the management of residual curvature after penile implantation which allows for the use of additional adjuvant maneuvers in those with significant deformities. © 2015 International Society for Sexual Medicine.

Ankle Distraction Arthroplasty: Indications, Technique, and Outcomes.

PubMed

Bernstein, Mitchell; Reidler, Jay; Fragomen, Austin; Rozbruch, S Robert

2017-02-01

Ankle distraction is an alternative to ankle arthrodesis or total ankle arthroplasty in younger patients with arthritis. Ankle distraction involves the use of external fixation to mechanically unload the ankle joint, which allows for stable, congruent range of motion in the setting of decreased mechanical loading, potentially promoting cartilage repair. Adjunct surgical procedures are frequently done to address lower-extremity malalignment, ankle equinus contractures, and impinging tibiotalar osteophytes. Patients can bear full weight during the treatment course. The distraction frame frequently uses a hinge, and patients are encouraged to do daily range-of-motion exercises. Although the initial goal of the procedure is to delay arthrodesis, many patients achieve lasting clinical benefits, obviating the need for total ankle arthroplasty or fusion. Complications associated with external fixation are common, and patients should be counseled that clinical improvements occur slowly and often are not achieved until at least 1 year after frame removal.

Effects of 2 ankle destabilization devices on electromyography measures during functional exercises in individuals with chronic ankle instability.

PubMed

Donovan, Luke; Hart, Joseph M; Hertel, Jay

2015-03-01

Randomized crossover laboratory study. To determine the effects of ankle destabilization devices on surface electromyography (sEMG) measures of selected lower extremity muscles during functional exercises in participants with chronic ankle instability. Ankle destabilization devices are rehabilitation tools that can be worn as a boot or sandal to increase lower extremity muscle activation during walking in healthy individuals. However, they have not been tested in a population with pathology. Fifteen adults with chronic ankle instability participated. Surface electromyography electrodes were located over the anterior tibialis, fibularis longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius. The activity level of these muscles was recorded in a single testing session during unipedal stance with eyes closed, the Star Excursion Balance Test, lateral hops, and treadmill walking. Each task was performed under 3 conditions: shod, ankle destabilization boot, and ankle destabilization sandal. Surface electromyography signal amplitudes were measured for each muscle during each exercise for all 3 conditions. Participants demonstrated a significant increase, with moderate to large effect sizes, in sEMG signal amplitude of the fibularis longus in the ankle destabilization boot and ankle destabilization sandal conditions during the unipedal eyes-closed balance test, the Star Excursion Balance Test in the anterior and posteromedial directions, lateral hops, and walking, when compared to the shod condition. Both devices also resulted in an increase in sEMG signal amplitudes, with large effect sizes of the lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius during the unipedal-stance-with-eyes-closed test, compared to the shod condition. Wearing ankle destabilization devices caused greater muscle activation during functional exercises in individuals with chronic ankle instability. Based on the magnitude of the effect, there were consistent increases in fibularis longus sEMG amplitudes during the unipedal eyes-closed balance test, the Star Excursion Balance Test in the anterior and posteromedial directions, and pre-initial contact and post-initial contact during lateral hops and walking.

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.

Elective removal of convexo-concave Björk-Shiley valves.

PubMed

Rajesh, P B; Smith, G H; Lawford, P V; Black, M M

1994-08-01

Replacement has been an accepted method for treating advanced cardiac valvular disease for more than 25 years. However, the perfect prosthesis has yet to be developed, judging by the number of devices available. A prosthesis that initially appears promising may cause problems in due course, and indeed some devices have been modified or withdrawn from clinical use. A notable example of a prosthetic valve that has give problems is the Björk-Shiley convexo-concave prosthesis, some models of which have undergone mechanical failure due to strut fracture. We report the elective removal of such a valve and the subsequent examination of the prosthesis. The results of this examination suggest that a policy of elective removal is justified.

Skull defect reconstruction based on a new hybrid level set.

PubMed

Zhang, Ziqun; Zhang, Ran; Song, Zhijian

2014-01-01

Skull defect reconstruction is an important aspect of surgical repair. Historically, a skull defect prosthesis was created by the mirroring technique, surface fitting, or formed templates. These methods are not based on the anatomy of the individual patient's skull, and therefore, the prosthesis cannot precisely correct the defect. This study presented a new hybrid level set model, taking into account both the global optimization region information and the local accuracy edge information, while avoiding re-initialization during the evolution of the level set function. Based on the new method, a skull defect was reconstructed, and the skull prosthesis was produced by rapid prototyping technology. This resulted in a skull defect prosthesis that well matched the skull defect with excellent individual adaptation.

Effect of the sagittal ankle angle at initial contact on energy dissipation in the lower extremity joints during a single-leg landing.

PubMed

Lee, Jinkyu; Song, Yongnam; Shin, Choongsoo S

2018-05-01

During landing, the ankle angle at initial contact (IC) exhibits relatively wide individual variation compared to the knee and hip angles. However, little is known about the effect of different IC ankle angles on energy dissipation. The purpose of this study was to investigate the relationship between individual ankle angles at IC and energy dissipation in the lower extremity joints. Twenty-seven adults performed single-leg landings from a 0.3-m height. Kinetics and kinematics of the lower extremity joints were measured. The relationship between ankle angles at IC and negative work, range of motion, the time to peak ground reaction force, and peak loading rate were analyzed. The ankle angle at IC was positively correlated with ankle negative work (r = 0.80, R 2  = 0.64, p < 0.001) and the contribution of the ankle to total (ankle, knee and hip joint) negative work (r = 0.84, R 2  = 0.70, p < 0.001), but the ankle angle was negatively correlated with hip negative work (r = -0.46, R 2  = 0.21, p = 0.01) and the contribution of the hip to total negative work (r = -0.61, R 2  = 0.37, p < 0.001). The knee negative work and the contribution of the knee to total negative work were not correlated with the ankle angle at IC. The ankle angle at IC was positively correlated with total negative work (r = 0.50, R 2  = 0.25, p < 0.01) and negatively correlated with the peak loading rate (r = -0.76, R 2  = 0.57, p < 0.001). These results indicated that landing mechanics changed as the ankle angle at IC increased, such that the ankle energy dissipation increased and redistributed the energy dissipation in the ankle and hip joints. Further, these results suggest that increased ankle energy dissipation with a higher IC plantar flexion angle may be a potential landing technique for reducing the risk of injury to the anterior cruciate ligament and hip musculature. Copyright © 2018 Elsevier B.V. All rights reserved.

Impulsive ankle push-off powers leg swing in human walking.

PubMed

Lipfert, Susanne W; Günther, Michael; Renjewski, Daniel; Seyfarth, Andre

2014-04-15

Rapid unloading and a peak in power output of the ankle joint have been widely observed during push-off in human walking. Model-based studies hypothesize that this push-off causes redirection of the body center of mass just before touch-down of the leading leg. Other research suggests that work done by the ankle extensors provides kinetic energy for the initiation of swing. Also, muscle work is suggested to power a catapult-like action in late stance of human walking. However, there is a lack of knowledge about the biomechanical process leading to this widely observed high power output of the ankle extensors. In our study, we use kinematic and dynamic data of human walking collected at speeds between 0.5 and 2.5 m s(-1) for a comprehensive analysis of push-off mechanics. We identify two distinct phases, which divide the push-off: first, starting with positive ankle power output, an alleviation phase, where the trailing leg is alleviated from supporting the body mass, and second, a launching phase, where stored energy in the ankle joint is released. Our results show a release of just a small part of the energy stored in the ankle joint during the alleviation phase. A larger impulse for the trailing leg than for the remaining body is observed during the launching phase. Here, the buckling knee joint inhibits transfer of power from the ankle to the remaining body. It appears that swing initiation profits from an impulsive ankle push-off resulting from a catapult without escapement.

Brodie Abscess

DTIC Science & Technology

2007-10-01

swelling and tenderness to palpation at the medial ankle and the patient was treated for an ankle sprain . The patient returned to clinic due to...lacking an inciting traumatic event and systemic symptoms. While radiographs are the initial diagnostic modality, Magnetic Resonance (MR) imaging...became manifest. History: A 15 year old white male presented to clinic due to six months of right ankle pain. The physical examination revealed mild

The effects of repetitive drop jumps on impact phase joint kinematics and kinetics.

PubMed

Weinhandl, Joshua T; Smith, Jeremy D; Dugan, Eric L

2011-05-01

The purpose of the study was to investigate the effects of fatigue on lower extremity joint kinematics, and kinetics during repetitive drop jumps. Twelve recreationally active males (n = 6) and females (n = 6) (nine used for analysis) performed repetitive drop jumps until they could no longer reach 80% of their initial drop jump height. Kinematic and kinetic variables were assessed during the impact phase (100 ms) of all jumps. Fatigued landings were performed with increased knee extension, and ankle plantar flexion at initial contact, as well as increased ankle range of motion during the impact phase. Fatigue also resulted in increased peak ankle power absorption and increased energy absorption at the ankle. This was accompanied by an approximately equal reduction in energy absorption at the knee. While the knee extensors were the muscle group primarily responsible for absorbing the impact, individuals compensated for increased knee extension when fatigued by an increased use of the ankle plantar flexors to help absorb the forces during impact. Thus, as fatigue set in and individuals landed with more extended lower extremities, they adopted a landing strategy that shifted a greater burden to the ankle for absorbing the kinetic energy of the impact.

Squat exercise to estimate knee megaprosthesis rehabilitation: a pilot study

PubMed Central

Lovecchio, Nicola; Zago, Matteo; Sciumè, Luciana; Lopresti, Maurizio; Sforza, Chiarella

2015-01-01

[Purpose] This study evaluated a specific rehabilitation protocol using a half squat after total knee reconstruction with distal femur megaprosthesis and tibial allograft-prosthesis composite. [Subject and Methods] Squat execution was recorded by a three-dimensional system before and after a specific rehabilitation program on a 28-year-old patient. Squat duration, body center of mass trajectory, and vertical range of motion were determined. Step width and joint angles and symmetry (hip flexion, extension, and rotation, knee flexion, and ankle dorsal and plantar flexion) were estimated. Knee and hip joint symmetry was computed using a bilateral cyclogram technique. [Results] After rehabilitation, the squat duration was longer (75%), step width was similar, and vertical displacement was higher. Hip flexion increased by over 20%, and ankle dorsiflexion diminished by 14%. The knee had the highest symmetry gain (4.1–3.4%). Angle-angle plot subtended areas decreased from 108° to 40°2 (hip) and from 204° to 85°2 (knee), showing improvement in movement symmetry. [Conclusion] We concluded that the squat is an effective multifactorial exercise to estimate rehabilitation outcomes after megaprosthesis, also considering that compressive and shear forces are minimal up to 60–70° of knee flexion. PMID:26311992

Disintegration of porous polyethylene prostheses.

PubMed

Kerr, A G; Riley, D N

1999-06-01

A Plastipore (porous polyethylene) Total Ossicular Replacement Prosthesis gave an excellent initial hearing result which was maintained for 14 years. Hearing then began to deteriorate and revision surgery showed disintegration of the prosthesis and a defect in the stapes footplate. Histological examination confirmed previous findings in porous polyethylene with multinucleated foreign body giant cells and breakdown of the material.

Lower limb joint motion during a cross cutting movement differs in individuals with and without chronic ankle instability.

PubMed

Koshino, Yuta; Yamanaka, Masanori; Ezawa, Yuya; Ishida, Tomoya; Kobayashi, Takumi; Samukawa, Mina; Saito, Hiroshi; Takeda, Naoki

2014-11-01

To compare the kinematics of lower limb joints between individuals with and without chronic ankle instability (CAI) during cross-turn and -cutting movements. Cross-sectional study. Motion analysis laboratory. Twelve subjects with CAI and twelve healthy controls. Hip flexion, adduction, and internal rotation, knee flexion, and ankle dorsiflexion and inversion angles were calculated in the 200 ms before initial ground contact and from initial ground contact to toe-off (stance phase) in a cross-turn movement during gait and a cross-cutting movement from a forward jump, and compared across the two groups. In the cross-cutting movement, the CAI group exhibited greater hip and knee flexion than the control group during the stance phase, and more hip abduction during the period before initial contact and the stance phase. In the cross-turn movement the joint kinematics were similar in the two groups. CAI subjects exhibited an altered pattern of the proximal joint kinematics during a cross-cutting movement. It is important for clinicians to assess the function of the hip and knee as well as the ankle, and to incorporate coordination training for the entire lower limb into rehabilitation after lateral ankle sprains. Copyright © 2013 Elsevier Ltd. All rights reserved.

Categorization of compensatory motions in transradial myoelectric prosthesis users.

PubMed

Hussaini, Ali; Zinck, Arthur; Kyberd, Peter

2017-06-01

Prosthesis users perform various compensatory motions to accommodate for the loss of the hand and wrist as well as the reduced functionality of a prosthetic hand. Investigate different compensation strategies that are performed by prosthesis users. Comparative analysis. A total of 20 able-bodied subjects and 4 prosthesis users performed a set of bimanual activities. Movements of the trunk and head were recorded using a motion capture system and a digital video recorder. Clinical motion angles were calculated to assess the compensatory motions made by the prosthesis users. The video recording also assisted in visually identifying the compensations. Compensatory motions by the prosthesis users were evident in the tasks performed (slicing and stirring activities) as compared to the benchmark of able-bodied subjects. Compensations took the form of a measured increase in range of motion, an observed adoption of a new posture during task execution, and prepositioning of items in the workspace prior to initiating a given task. Compensatory motions were performed by prosthesis users during the selected tasks. These can be categorized into three different types of compensations. Clinical relevance Proper identification and classification of compensatory motions performed by prosthesis users into three distinct forms allows clinicians and researchers to accurately identify and quantify movement. It will assist in evaluating new prosthetic interventions by providing distinct terminology that is easily understood and can be shared between research institutions.

Comparison of custom-moulded ankle orthosis with hinged joints and off-the-shelf ankle braces in preventing ankle sprain in lateral cutting movements.

PubMed

Lee, Winson C C; Kobayashi, Toshiki; Choy, Barton T S; Leung, Aaron K L

2012-06-01

A custom moulded ankle orthosis with hinged joints potentially offers a better control over the subtalar joint and the ankle joint during lateral cutting movements, due to total contact design and increase in material strength. To test the above hypothesis by comparing it to three other available orthoses. Repeated measures. Eight subjects with a history of ankle sprains (Grade 2), and 11 subjects without such history performed lateral cutting movements in four test conditions: 1) non-orthotic, 2) custom-moulded ankle orthosis with hinges, 3) Sport-Stirrup, and 4) elastic ankle sleeve with plastic support. A VICON motion analysis system was used to study the motions at the ankle and subtalar joints. The custom-moulded ankle orthosis significantly lowered the inversion angle at initial contact (p = 0.006) and the peak inversion angle (p = 0.000) during lateral cutting movements in comparison to non-orthotic condition, while the other two orthoses did not. The three orthoses did not affect the plantarflexion motions, which had been suggested by previous studies to be important in shock wave attenuation. The custom-moulded ankle orthosis with hinges could better control inversion and thus expected to better prevent ankle sprain in lateral cutting movements. Custom-moulded ankle orthoses are not commonly used in preventing ankle sprains. This study raises the awareness of the use of custom-moulded ankle orthoses which are expected to better prevent ankle sprains.

Treatment based on the type of infected TKA improves infection control.

PubMed

Kim, Young-Hoo; Choi, Yoowang; Kim, Jun-Shik

2011-04-01

A classification system with four types of infected TKAs has been commonly used to determine treatment, especially with regard to whether the prosthesis should be removed or retained. We asked whether (1) the classification-dictated treatment of the four types of infection after TKA would control infection and maintain functional TKA; (2) repeated débridement and two-stage TKA would further improve the infection control rate after initial treatment; and (3) fixation of TKA prosthesis to the host bone was achieved. We retrospectively reviewed 114 patients with 116 infected TKAs. We determined the infection control rate after initial treatment, repeated débridement and two-stage TKA. We evaluated the functional and radiographic results using the Knee Society and Hospital for Special Surgery knee scoring systems. The minimum followup was 2 years (mean, 5.6 years; range, 2-8 years). The overall infection control rate was 100% in all patients. All patients with early superficial postoperative infection, 94% of patients with early deep postoperative infection, 96% of patients with late chronic infection, and 86% of patients with acute hematogenous infection maintained functioning knee prosthesis at the final followup. One hundred nine of the 114 patients could walk with no or only slight pain and maintained functioning knee prostheses. These 109 patients had stable fixation of the TKA prosthesis to host bone. The techniques proposed by the classification effectively controlled infection and maintained functional TKA with firm fixation of the TKA prosthesis in most patients. Repeated débridement and two-stage TKA further improved the control of infection and functional TKA after initial treatment. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Relevance of adjacent joint imaging in the evaluation of ankle fractures.

PubMed

Antoci, Valentin; Patel, Shaun P; Weaver, Michael J; Kwon, John Y

2016-10-01

Routinely obtaining adjacent joint radiographs when evaluating patients with ankle fractures may be of limited clinical utility and an unnecessary burden, particularly in the absence of clinical suspicion for concomitant injuries. One thousand, three hundred and seventy patients who sustained ankle fractures over a 5-year period presenting to two level 1 trauma centers were identified. Medical records were retrospectively reviewed for demographics, physical examination findings, and radiographic information. Analyses included descriptive statistics along with sensitivity and predictive value calculations for the presence of adjacent joint fracture. Adjacent joint imaging (n=1045 radiographs) of either the knee or foot was obtained in 873 patients (63.7%). Of those, 75/761 patients (9.9%) demonstrated additional fractures proximal to the ankle joint, most commonly of the proximal fibula. Twenty-two of 284 (7.7%) demonstrated additional fractures distal to the ankle joint, most commonly of the metatarsals. Tenderness to palpation demonstrated sensitivities of 0.92 and 0.77 and positive predictive values of 0.94 and 0.89 for the presence of proximal and distal fractures, respectively. Additionally, 19/22 (86.4%) of patients sustaining foot fractures had their injury detectable on initial ankle X-rays. Overall, only 5.5% (75/1370) of patients sustained fractures proximal to the ankle and only 0.2% (3/1370) of patients had additional foot fractures not evident on initial ankle X-rays. The addition of adjacent joint imaging for the evaluation of patients sustaining ankle fractures is low yield. As such, patient history, physical examination, and clinical suspicion should direct the need for additional X-rays. Level IV. Copyright © 2016 Elsevier Ltd. All rights reserved.

Plantar-flexion of the ankle joint complex in terminal stance is initiated by subtalar plantar-flexion: A bi-planar fluoroscopy study.

PubMed

Koo, Seungbum; Lee, Kyoung Min; Cha, Young Joo

2015-10-01

Gross motion of the ankle joint complex (AJC) is a summation of the ankle and subtalar joints. Although AJC kinematics have been widely used to evaluate the function of the AJC, the coordinated movements of the ankle and subtalar joints are not well understood. The purpose of this study was to accurately quantify the individual kinematics of the ankle and subtalar joints in the intact foot during ground walking by using a bi-planar fluoroscopic system. Bi-planar fluoroscopic images of the foot and ankle during walking and standing were acquired from 10 healthy subjects. The three-dimensional movements of the tibia, talus, and calcaneus were calculated with a three-dimensional/two-dimensional registration method. The skeletal kinematics were quantified from 9% to 86% of the full stance phase because of the limited camera speed of the X-ray system. At the beginning of terminal stance, plantar-flexion of the AJC was initiated in the subtalar joint on average at 75% ranging from 62% to 76% of the stance phase, and plantar-flexion of the ankle joint did not start until 86% of the stance phase. The earlier change to plantar-flexion in the AJC than the ankle joint due to the early plantar-flexion in the subtalar joint was observed in 8 of the 10 subjects. This phenomenon could be explained by the absence of direct muscle insertion on the talus. Preceding subtalar plantar-flexion could contribute to efficient and stable ankle plantar-flexion by locking the midtarsal joint, but this explanation needs further investigation. Copyright © 2015 Elsevier B.V. All rights reserved.

When can I start pointe work? Guidelines for initiating pointe training.

PubMed

Weiss, David S; Rist, Rachel Anne; Grossman, Gayanne

2009-01-01

The initiation of pointe training for dance students should be determined after careful evaluation of a number of factors. These include: the dance student's stage of physical development; the quality of her (or his) trunk, abdominal and pelvic control ("core" stability); the alignment of her legs (hip-knee-ankle-foot); the strength and flexibility of her feet and ankles; and the duration and frequency of her dance training. For students who meet the requirements related to all of these factors, began ballet training at age eight or later, and who are taking ballet class at least twice per week, pointe work should be initiated in the fourth year of training. Students with poor core stability or hypermobility of the feet and ankles may require additional strengthening to allow them to safely begin pointe training. For those who are only taking ballet classes once per week, or who are not truly pre-professional, pointe training should be discouraged. No student with insufficient ankle and foot plantar flexion range of motion or with poor lower extremity alignment should be allowed to do pointe work.

Voluntary Control of Residual Antagonistic Muscles in Transtibial Amputees: Feedforward Ballistic Contractions and Implications for Direct Neural Control of Powered Lower Limb Prostheses.

PubMed

Huang, Stephanie; Huang, He

2018-04-01

Discrete, rapid (i.e., ballistic like) muscle activation patterns have been observed in ankle muscles (i.e., plantar flexors and dorsiflexors) of able-bodied individuals during voluntary posture control. This observation motivated us to investigate whether transtibial amputees are capable of generating such a ballistic-like activation pattern accurately using their residual ankle muscles in order to assess whether the volitional postural control of a powered ankle prosthesis using proportional myoelectric control via residual muscles could be feasible. In this paper, we asked ten transtibial amputees to generate ballistic-like activation patterns using their residual lateral gastrocnemius and residual tibialis anterior to control a computer cursor via proportional myoelectric control to hit targets positioned at 20% and 40% of maximum voluntary contraction of the corresponding residual muscle. During practice conditions, we asked amputees to hit a single target repeatedly. During testing conditions, we asked amputees to hit a random sequence of targets. We compared movement time to target and end-point accuracy. We also examined motor recruitment synchronization via time-frequency representations of residual muscle activation. The result showed that median end-point error ranged from -0.6% to 1% maximum voluntary contraction across subjects during practice, which was significantly lower compared to testing ( ). Average movement time for all amputees was 242 ms during practice and 272 ms during testing. Motor recruitment synchronization varied across subjects, and amputees with the highest synchronization achieved the fastest movement times. End-point accuracy was independent of movement time. Results suggest that it is feasible for transtibial amputees to generate ballistic control signals using their residual muscles. Future work on volitional control of powered power ankle prostheses might consider anticipatory postural control based on ballistic-like residual muscle activation patterns and direct continuous proportional myoelectric control.

Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis

PubMed Central

Pröbsting, Eva; Kannenberg, Andreas; Zacharias, Britta

2016-01-01

Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p = .001), paretic limb health (p = .04), sounds (p = .02), and well-being (p = .01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety. PMID:27151648

Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis.

PubMed

Pröbsting, Eva; Kannenberg, Andreas; Zacharias, Britta

2017-02-01

There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation ( p = .001), paretic limb health ( p = .04), sounds ( p = .02), and well-being ( p = .01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.

Ankle Joint Angle and Lower Leg Musculotendinous Unit Responses to Cryotherapy.

PubMed

Akehi, Kazuma; Long, Blaine C; Warren, Aric J; Goad, Carla L

2016-09-01

Akehi, K, Long, BC, Warren, AJ, and Goad, CL. Ankle joint angle and lower leg musculotendinous unit responses to cryotherapy. J Strength Cond Res 30(9): 2482-2492, 2016-The use of cold application has been debated for its influence on joint range of motion (ROM) and stiffness. The purpose of this study was to determine whether a 30-minute ice bag application to the plantarflexor muscles or ankle influences passive ankle dorsiflexion ROM and lower leg musculotendinous stiffness (MTS). Thirty-five recreationally active college-aged individuals with no history of lower leg injury 6 months before data collection volunteered. On each testing day, we measured maximum passive ankle dorsiflexion ROM (°) and plantarflexor torque (N·m) on an isokinetic dynamometer to calculate the passive plantarflexor MTS (N·m per degree) at 4 joint angles before, during, and after a treatment. Surface electromyography amplitudes (μV), and skin surface and ambient air temperature (°C) were also measured. Subjects received an ice bag to the posterior lower leg, ankle joint, or nothing for 30 minutes in different days. Ice bag application to the lower leg and ankle did not influence passive ROM (F(12,396) = 0.67, p = 0.78). Passive torque increased after ice bag application to the lower leg (F(12,396) = 2.21, p = 0.011). Passive MTS at the initial joint angle increased after ice bag application to the lower leg (F(12,396) = 2.14, p = 0.014) but not at the other joint angles (p > 0.05). Surface electromyography amplitudes for gastrocnemius and soleus muscles increased after ice application to the lower leg (F(2,66) = 5.61, p = 0.006; F(12,396) = 3.60, p < 0.001). Ice bag application to the lower leg and ankle joint does not alter passive dorsiflexion ROM but increases passive ankle plantarflexor torque in addition to passive ankle plantarflexor MTS at the initial joint angle.

Peroneus longus stretch reflex amplitude increases after ankle brace application

PubMed Central

Cordova, M; Ingersoll, C

2003-01-01

Background: The use of external ankle support is widespread throughout sports medicine. However, the application of ankle bracing to a healthy ankle over a long period has been scrutinised because of possible neuromuscular adaptations resulting in diminished dynamic support offered by the peroneus longus. Objective: To investigate the immediate and chronic effects of ankle brace application on the amplitude of peroneus longus stretch reflex. Methods: Twenty physically active college students (mean (SD) age 23.6 (1.7) years, height 168.7 (8.4) cm, and mass 69.9 (12.0) kg) who had been free from lower extremity pathology for the 12 months preceding the study served as subjects. None had been involved in a strength training or conditioning programme in the six months preceding the study. A 3 x 3 x 2 (test condition x treatment condition x time) design with repeated measures on the first and third factor was used. The peroneus longus stretch reflex (% of maximum amplitude) during sudden foot inversion was evaluated under three ankle brace conditions (control, lace up, and semi-rigid) before and after eight weeks of ankle brace use. Results: A 3 x 3 x 2 repeated measures analysis of variance showed that peroneus longus stretch reflex amplitude increased immediately after application of a lace up brace (67.1 (4.4)) compared with the semi-rigid (57.9 (4.3)) and control (59.0 (5.2)) conditions (p<0.05). Peroneus longus stretch reflex also increased after eight weeks of use of the semi-rigid brace compared with the lace up and control conditions (p<0.05). Conclusions: Initial application of a lace up style ankle brace and chronic use of a semi-rigid brace facilitates the amplitude of the peroneus longus stretch reflex. It appears that initial and long term ankle brace use does not diminish the magnitude of this stretch reflex in the healthy ankle. PMID:12782553

Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium.

PubMed

Delahunt, Eamonn; Bleakley, Chris M; Bossard, Daniela S; Caulfield, Brian M; Docherty, Carrie L; Doherty, Cailbhe; Fourchet, François; Fong, Daniel T; Hertel, Jay; Hiller, Claire E; Kaminski, Thomas W; McKeon, Patrick O; Refshauge, Kathryn M; Remus, Alexandria; Verhagen, Evert; Vicenzino, Bill T; Wikstrom, Erik A; Gribble, Phillip A

2018-06-09

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Lower limb ice application alters ground reaction force during gait initiation.

PubMed

Muniz, Thiago B; Moraes, Renato; Guirro, Rinaldo R J

2015-01-01

Cryotherapy is a widely used technique in physical therapy clinics and sports. However, the effects of cryotherapy on dynamic neuromuscular control are incompletely explained. To evaluate the effects of cryotherapy applied to the calf, ankle and sole of the foot in healthy young adults on ground reaction forces during gait initiation. This study evaluated the gait initiation forces, maximum propulsion, braking forces and impulses of 21 women volunteers through a force platform, which provided maximum and minimum ground reaction force values. To assess the effects of cooling, the task--gait initiation--was performed before ice application, immediately after and 30 minutes after removal of the ice pack. Ice was randomly applied on separate days to the calf, ankle and sole of the foot of the participants. It was demonstrated that ice application for 30 minutes to the sole of the foot and calf resulted in significant changes in the vertical force variables, which returned to their pre-application values 30 minutes after the removal of the ice pack. Ice application to the ankle only reduced propulsion impulse. These results suggest that although caution is necessary when performing activities that require good gait control, the application of ice to the ankle, sole of the foot or calf in 30-minute intervals may be safe even preceding such activities.

A prospective 24 months follow-up of a three component press-fit prosthesis for hallux rigidus.

PubMed

Wassink, S; Burger, B J; Saragas, N P; Asunción Márquez, J; Trtik, L; Harlaar, J

2017-09-01

The aim of this study was to evaluate the results following total first metatarsophalangeal (FMTP) joint replacement arthroplasty using a modular three component press fit prosthesis at two year follow up. All patient data was collected in a prospective way in four study centres. Both preoperative and postoperative evaluation consisted of an assessment using the AOFAS-HMI score, visual analogue scale for pain, evaluation of the range of motion and patient satisfaction scores. Postoperative X-rays were reviewed for loosening and radiolucency up to two years. Fifty-five feet were available for analysis at 24 months. Two implants were removed during the study. Six more feet had additional surgery due to stiffness or malalignment. Postoperative AOFAS-HMI scores improved significantly by 32.4 points at two year follow-up (p<0.001). The visual analogue scale for pain improved significantly from 6.8 (std 1,6) preoperatively to 1.6 (std 1,9) postoperatively (p<0.0001). Mean dorsiflexion improved from 12.6 (std 10,1) degrees preoperatively to 31.2 (std 16,8) degrees postoperatively. Eighty-seven percent of patients were moderately to well satisfied with the end result. Eighteen prostheses showed radiolucency at 24 months. Implantation of a Metis ® modular three component press fit prosthesis for the metatarsophalangeal joint in hallux rigidus shows significant improvement in AOFAS-HMI scores and a decrease in pain. Concerns remain with regard to early reoperation rate (14.5%) and long term survival of the implant. Future studies will have to address these aspects. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Minimum reporting standards for copers in chronic ankle instability research.

PubMed

Wikstrom, Erik A; Brown, Cathleen N

2014-02-01

Lateral ankle sprains (LASs) are among the most common sports-related injuries and a high percentage of individuals who sprain their ankle go on to develop chronic ankle instability (CAI). The condition of CAI is often classified as having pain, loss of function, and a restriction of, or failure to, return to levels of previous activity. Historically, uninjured healthy controls are used as a comparison group to study the biomechanical and neuromuscular consequences of CAI. However, this model is not ideal to determine why a portion of the population experiencing an ankle sprain does not recover. A more appropriate comparison may be individuals who had an ankle sprain, and thus the exposure, but did not go on to develop CAI (i.e., copers). Thus, the purpose of this review was to determine the existing discrepancies and common standards in definitions of, terminology used for, and the inclusionary/exclusionary criteria used to describe copers within the CAI literature. Multiple databases were searched by keywords and specific authors. Potential studies were screened independently by both authors. Inclusion criteria consisted of an explicit definition of copers and explicit inclusionary/exclusionary criteria. A total of 21 studies were included in the current study and had four outcomes extracted: (1) the definition of copers; (2) the terminology used; (3) specific inclusionary/exclusionary criteria; and (4) injury characteristics of the copers. Based on the included operational definitions, it is recommend that future operational definitions of copers include three key components: (1) an initial LAS; (2) subsequent lack of CAI symptoms (i.e., no complaints of disability or giving way); and (3) a time since injury component. The term coper was overwhelming used within the existing literature (n = 15) and is thus recommended to be used in future studies when describing individuals who have suffered an LAS but failed to develop CAI. Minimal inclusionary criteria should consist of three things: (1) an initial LAS severe enough to warrant either the use of a protective device (e.g., ankle brace) for at least 1 week or immobilization and/or non-weight bearing for at least 3 days, or both; (2) a return to at least moderate levels of weight-bearing physical activity for at least 12 months without recurrent injury, episodes of giving way, and/or feelings of instability; and (3) minimal, if any, level of self-reported disability. Acute head and/or lower extremity injuries that occurred ≤3 months prior to testing, a history of ankle fractures and/or surgeries, and the presence of pain (constant or intermittent) should be used as minimal exclusionary criteria in future investigations dealing with copers. Finally, at least seven items should be reported to better contextualize copers across investigations. These items should include the initial mechanism of injury, the presence of mechanical laxity, number of days immobilized and/or non-weight bearing after the initial ankle sprain, time since the latest ankle sprain, percentage of coper participants with a recurrent ankle sprain or giving way episode, current physical activity levels, and whether copers attended formal rehabilitation for their involved ankle.

Ankle sprain complications: MRI evaluation.

PubMed

Martin, Barney

2008-04-01

Sprains are disruptions of the ligamentous anatomy about a joint. The ankle sprain is one of the most common injuries seen in podiatric and orthopedic practice. It usually is incurred from an inversion force on the ankle, but eversion forces also can traumatize the ankle. Many times, this injury is taken for granted because of the frequency of its presentation. The patient usually is given appropriate initial care, but the patient can experience continued or residual pain. Podiatrists have found this problem is common and have come to recognize that secondary or accessory injuries occur that slow the natural recovery of this injury.

Contributing factors to chronic ankle instability.

PubMed

Hubbard, Tricia J; Kramer, Lauren C; Denegar, Craig R; Hertel, Jay

2007-03-01

The development of repetitive ankle sprains and persistent symptoms after initial ankle sprain has been termed chronic ankle instability (CAI). There is no clear indication of which measures are most important in discriminating between individuals with and without CAI. Thirty subjects with unilateral CAI and controls had measures of ankle laxity and hypomobility, static and dynamic balance, ankle and hip strength, lower extremity alignments, and flexibility taken on both limbs. Based on comparisons of CAI ankles and side-matched limbs in controls, the measures significantly predictive of CAI were increased inversion laxity (r(2) change = 0.203), increased anterior laxity (r(2) change = 0.11), more missed balance trials (r(2) change = 0.094), and lower plantarflexion to dorsiflexion peak torque (r(2) change = 0.052). Symmetry indices comparing the side-to-side differences of each measure also were calculated for each dependent variable and compared between groups. The measures significantly predictive of CAI were decreased anterior reach (r(2) change = 0.185), decreased plantarflexion peak torque (r(2) change = 0.099), decreased posterior medial reach (r(2) change = 0.094), and increased inversion laxity (r(2) change = 0.041). The results of this study elucidate the specific measures that best discriminate between individuals with and without CAI. Both mechanical (anterior and inversion laxity) and functional (strength, dynamic balance) insufficiencies significantly contribute to the etiology of CAI. Prevention of CAI may be possible with proper initial management of the acute injury with rehabilitation aimed at those factors that best discriminate between individuals with and without CAI.

Treating Intractable Post-Amputation Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks

DTIC Science & Technology

2016-01-01

Upper ☐Lower Side of amputation: ☐Right ☐Left Level of original amputation (distal to…): ☐wrist/ ankle ☐elbow/knee...Right ☐Left Level of original amputation (distal to…): ☐wrist/ ankle ☐elbow/knee ☐shoulder/hip Initial Amputation Etiology...extremity: ☐Upper ☐Lower Side of amputation: ☐Right ☐Left Level of original amputation (distal to…): ☐wrist/ ankle ☐elbow/knee

Complications of ankle fracture in patients with diabetes.

PubMed

Chaudhary, Saad B; Liporace, Frank A; Gandhi, Ankur; Donley, Brian G; Pinzur, Michael S; Lin, Sheldon S

2008-03-01

Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.

Fitting a hand-glove prosthesis to enhance the reconstructed mutilated hand.

PubMed

Leow, M E; Kour, A K; Pereira, B P; Pho, R W

1998-03-01

Microsurgical reconstruction of the severely mutilated hand aimed at improving prehensile functions often does not address the esthetic aspects of the hand. The poor appearance of the reconstructed hand affects its active display and use. A hand-glove prosthesis may be prescribed in this instance to enhance the overall form and function of the mutilated hand. We reviewed 16 cases of mutilating hand injuries in which surgical reconstructions were performed and the patients were subsequently fitted with a hand-glove prosthesis to augment the outcome. An improved appearance was achieved in all patients fitted with the prosthesis. The patients' sense of confidence was also enhanced, which in turn promoted the active and open use of the reconstructed hands. While prescribed primarily to improve the appearance of the reconstructed hands, these prostheses were documented to enhance the physical hand functions in 11 cases by increasing the span of the hand and providing an opposable post and a palmar base for holding and for anchorage. The prosthesis enhanced assistive functions of the reconstructed hands and freed the contralateral normal hand for use in bimanual activities, such as holding a wallet and taking out money, supporting a note pad for writing, and holding a plate at buffet receptions. At the 18-month follow-up visit, 13 (87%) of the patients continued to use their prosthesis. Wear and tear were problems associated with the frequent use of the prosthesis. The expected life span of the prosthesis with daily use ranged from 2 to 3 years. All the patients acknowledged that the prosthesis played a role in their rehabilitation and that it helped them to overcome the initial psychological trauma and to come to terms with their physical loss.

The relationship between foot and ankle symptoms and risk of developing knee osteoarthritis: data from the osteoarthritis initiative.

PubMed

Paterson, K L; Kasza, J; Hunter, D J; Hinman, R S; Menz, H B; Peat, G; Bennell, K L

2017-05-01

To investigate whether foot and/or ankle symptoms increase the risk of developing (1) knee symptoms and (2) symptomatic radiographic knee osteoarthritis (OA). 1020 Osteoarthritis Initiative (OAI) participants who were at-risk of knee OA, but were without knee symptoms or radiographic knee OA, were investigated. Participants indicated the presence and laterality of foot/ankle symptoms at baseline. The main outcome was development of knee symptoms (pain, aching or stiffness in and around the knee on most days of the month for at least 1 month in the past year). A secondary outcome was development of symptomatic radiographic knee OA (symptoms plus Kellgren and Lawrence [KL] grade ≥2), over the subsequent 4 years. Associations between foot/ankle symptoms and study outcomes were assessed by logistic regression models. Foot/ankle symptoms in either or both feet significantly increased the odds of developing knee symptoms (adjusted odds ratio (OR) 1.55, 95% confidence interval (CI) 1.10 to 2.19), and developing symptomatic radiographic knee OA (adjusted OR 3.28, 95% CI 1.69 to 6.37). Based on laterality, contralateral foot/ankle symptoms were associated with developing both knee symptoms (adjusted OR 1.68, 95% CI 1.05 to 2.68) and symptomatic radiographic knee OA (adjusted OR 3.08, 95% CI 1.06 to 8.98), whilst bilateral foot/ankle symptoms were associated with developing symptomatic radiographic knee OA (adjusted OR 4.02, 95% CI 1.76 to 9.17). In individuals at-risk of knee OA, the presence of contralateral foot/ankle symptoms in particular increases risk of developing both knee symptoms and symptomatic radiographic knee OA. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The relationship between foot and ankle symptoms and risk of developing knee osteoarthritis: data from the osteoarthritis initiative

PubMed Central

Paterson, Kade L; Kasza, Jessica; Hunter, David J; Hinman, Rana S; Menz, Hylton B; Peat, George; Bennell, Kim L

2016-01-01

Objective To investigate whether foot and/or ankle symptoms increase the risk of developing (i) knee symptoms and (ii) symptomatic radiographic knee osteoarthritis (OA). Design 1020 Osteoarthritis Initiative participants who were at-risk of knee OA, but were without knee symptoms or radiographic knee OA, were investigated. Participants indicated the presence and laterality of foot/ankle symptoms at baseline. The main outcome was development of knee symptoms (pain, aching or stiffness in and around the knee on most days of the month for at least one month in the past year). A secondary outcome was development of symptomatic radiographic knee OA (symptoms plus Kellgren and Lawrence [KL] grade ≥2), over the subsequent four years. Associations between foot/ankle symptoms and study outcomes were assessed by logistic regression models. Results Foot/ankle symptoms in either or both feet significantly increased the odds of developing knee symptoms (adjusted odds ratio (OR) 1.55, 95% confidence interval (CI) 1.10 to 2.19), and developing symptomatic radiographic knee OA (adjusted OR 3.28, 95% CI 1.69 to 6.37). Based on laterality, contralateral foot/ankle symptoms were associated with developing both knee symptoms (adjusted OR 1.68, 95% CI 1.05 to 2.68) and symptomatic radiographic knee OA (adjusted OR 3.08, 95% CI 1.06 to 8.98), whilst bilateral foot/ankle symptoms were associated with developing symptomatic radiographic knee OA (adjusted OR 4.02, 95% CI 1.76 to 9.17). Conclusion In individuals at-risk of knee OA, the presence of contralateral foot/ankle symptoms in particular increases risk of developing both knee symptoms and symptomatic radiographic knee OA. PMID:27939621

Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review.

PubMed

Rivera, Matthew J; Winkelmann, Zachary K; Powden, Cameron J; Games, Kenneth E

2017-11-01

Reference:  Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-244.   Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population?   The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof.   Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates.   Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate.   Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to prevent ankle sprains regardless of history (n = 3654), (2) to prevent recurrent ankle sprains (n = 1542), or (3) as the primary preventive measure for those without a history of ankle sprain (n = 946). Regardless of a history of ankle sprain, participants had a reduction in ankle-sprain rates (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.55, 0.77; numbers needed to treat [NNT] = 17, 95% CI = 11, 33). For individuals with a history of ankle sprains, proprioceptive training demonstrated a reduction in repeat ankle sprains (RR = 0.64, 95% CI = 0.51, 0.81; NNT = 13, 95% CI = 7, 100). Proprioceptive training as a primary preventive measure demonstrated significant results (RR = 0.57, 95% CI = 0.34, 0.97; NNT = 33, 95% CI = 16, 1000).   Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains.

Effects of mid-foot contact area ratio on lower body kinetics/kinematics in sagittal plane during stair descent in women.

PubMed

Lee, Jinkyu; Hong, Yoon No Gregory; Shin, Choongsoo S

2016-07-01

The mid-foot contact area relative to the total foot contact area can facilitate foot arch structure evaluation. A stair descent motion consistently provides initial fore-foot contact and utilizes the foot arch more actively for energy absorption. The purpose of this study was to compare ankle and knee joint angle, moment, and work in sagittal plane during stair descending between low and high Mid-Foot-Contact-Area (MFCA) ratio group. The twenty-two female subjects were tested and classified into two groups (high MFCA and low MFCA) using their static MFCA ratios. The ground reaction force (GRF) and kinematics of ankle and knee joints were measured while stair descending. During the period between initial contact and the first peak in vertical GRF (early absorption phase), ankle negative work for the low MFCA ratio group was 33% higher than that for the high MFCA ratio group (p<0.05). However, ankle negative work was not significantly different between the two groups during the period between initial contact and peak dorsiflexion angle (early absorption phase+late absorption phase). The peak ankle dorsiflexion angle was smaller in the low MFCA ratio group (p<0.05). Our results suggest that strategy of energy absorption at the ankle and foot differs depending upon foot arch types classified by MFCA. The low MFCA ratio group seemed to absorb more impact energy using strain in the planar fascia during early absorption phase, whereas the high MFCA ratio group absorbed more impact energy using increased dorsiflexion during late absorption phase. Copyright © 2016 Elsevier B.V. All rights reserved.

[Tracheobronchial prosthesis in Mounier-Kuhn syndrome: New perspectives].

PubMed

Sauvage, M; Tiffet, O; Vergnon, J-M

2015-05-01

Mounier-Kuhn syndrome or tracheobronchomegaly is a rare congenital condition, the management of which is complex. We report the case of a patient who was treated with interventional endoscopy. We describe the case of a 74-year-old man with a diagnosis of tracheobronchomegaly who was admitted in 2003 with a background of deteriorating respiratory status and the occurrence of postural syncope. He initially received a tracheobronchial silicone Y prosthesis, extended with metal prostheses at the tracheal and bronchial level. This arrangement remained stable until 2011. He then began to develop episodes of asphyxia related to posterior dislocation of the tracheobronchial prosthesis, after breakage of the metallic mesh tracheal prosthesis. A new tracheobronchial prosthesis Y was then placed, custom-made from a 3D model of the airways. This was clinically and functionally effective. This case describes the management of a patient with Mounier-Kuhn syndrome by interventional bronchoscopy, with the adaptation of prosthetic materials, on an individual basis, to the anatomy of the patient's airway. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Effectiveness of emergency nurses' use of the Ottawa Ankle Rules to initiate radiographic tests on improving healthcare outcomes for patients with ankle injuries: A systematic review.

PubMed

Ho, Jonathan Ka-Ming; Chau, Janita Pak-Chun; Cheung, Nancy Man-Ching

2016-11-01

The Ottawa Ankle Rules provide guidelines for clinicians on the recommendation of radiographic tests to verify fractures in patients with ankle injuries. The use of the Ottawa Ankle Rules by emergency nurses has been suggested to minimise unnecessary radiographic-test requests and reduce patients' length of stay in emergency departments. However, the findings of studies in this area are inconsistent. A systematic review was conducted to synthesise the most accurate evidence available on the extent to which emergency nurses' use of the Ottawa Ankle Rules to initiate radiographic tests improves healthcare outcomes for patients with ankle injuries. The systematic review attempted to identify all relevant published and unpublished studies in English and Chinese from databases such as Ovid MEDLINE, EMBASE, ProQuest Health and Medical Complete, EBM Reviews, SPORTDiscus, CINAHL Plus, the British Nursing Index, Scopus, the Chinese Biomedical Literature Database, China Journal Net, WanFang Data, the National Central Library Periodical Literature System, HyRead, the Digital Dissertation Consortium, MedNar and Google Scholar. Two reviewers independently assessed the eligibility of all of the studies identified during the search, based on their titles and abstracts. If a study met the criteria for inclusion, or inconclusive information was available in its title and abstract, the full text was retrieved for further analysis. The methodological quality of all of the eligible studies was assessed independently by the two reviewers. The search of databases and other sources yielded 1603 records. The eligibility of 17 full-text articles was assessed, and nine studies met the inclusion criteria. All nine studies were subjected to narrative analysis, and five were meta-analysed. All of the studies investigated the use of the refined Ottawa Ankle Rules. The results indicated that emergency nurses' use of the refined Ottawa Ankle Rules minimised unnecessary radiographic-test requests and reduced patients' length of stay in emergency departments. However, the use of these rules in urgent-care departments did not reduce unnecessary radiographic-test requests or patients' length of stay. The implementation of the refined Ottawa Ankle Rules by emergency nurses with different backgrounds, including nurse practitioners or general emergency nurses was found to reduce patients' length of stay in emergency departments. The results of the systematic review suggested that a nurse-initiated radiographic test protocol should be introduced as standard practice in emergency departments. Copyright © 2016 Elsevier Ltd. All rights reserved.

Frontal plane landing mechanics in high-arched compared with low-arched female athletes.

PubMed

Powell, Douglas W; Hanson, Nicholas J; Long, Benjamin; Williams, D S Blaise

2012-09-01

To examine ground reaction forces (GRFs); frontal plane hip, knee, and ankle joint angles; and moments in high-arched (HA) and low-arched (LA) athletes during landing. Experimental study. Controlled research laboratory. Twenty healthy female recreational athletes (10 HA and 10 LA). Athletes performed 5 barefoot drop landings from a height of 30 cm. Frontal plane ankle, knee, and hip joint angles (in degrees) at initial contact, peak vertical GRF, and peak knee flexion; peak ankle, knee, and hip joint moments in the frontal plane. Vertical GRF profiles were similar between HA and LA athletes (P = 0.78). The HA athletes exhibited significantly smaller peak ankle inversion angles than the LA athletes (P = 0.01) at initial contact. At peak vertical GRF, HA athletes had significantly greater peak knee (P = 0.01) and hip abduction angles than LA athletes (P = 0.02). There were no significant differences between HA and LA athletes in peak joint moments (hip: P = 0.68; knee: P = 0.71; ankle: P = 0.15). These findings demonstrate that foot type is associated with altered landing mechanics, which may underlie lower extremity injuries. The ankle-driven strategy previously reported in female athletes suggests that foot function may have a greater relationship with lower extremity injury than that in male athletes. Future research should address the interaction of foot type and gender during landing tasks.

Pre-impact lower extremity posture and brake pedal force predict foot and ankle forces during an automobile collision.

PubMed

Hardin, E C; Su, A; van den Bogert, A J

2004-12-01

The purpose of this study was to determine how a driver's foot and ankle forces during a frontal vehicle collision depend on initial lower extremity posture and brake pedal force. A 2D musculoskeletal model with seven segments and six right-side muscle groups was used. A simulation of a three-second braking task found 3647 sets of muscle activation levels that resulted in stable braking postures with realistic pedal force. These activation patterns were then used in impact simulations where vehicle deceleration was applied and driver movements and foot and ankle forces were simulated. Peak rearfoot ground reaction force (F(RF)), peak Achilles tendon force (FAT), peak calcaneal force (F(CF)) and peak ankle joint force (F(AJ)) were calculated. Peak forces during the impact simulation were 476 +/- 687 N (F(RF)), 2934 +/- 944 N (F(CF)) and 2449 +/- 918 N (F(AJ)). Many simulations resulted in force levels that could cause fractures. Multivariate quadratic regression determined that the pre-impact brake pedal force (PF), knee angle (KA) and heel distance (HD) explained 72% of the variance in peak FRF, 62% in peak F(CF) and 73% in peak F(AJ). Foot and ankle forces during a collision depend on initial posture and pedal force. Braking postures with increased knee flexion, while keeping the seat position fixed, are associated with higher foot and ankle forces during a collision.

The effects of obesity on balance recovery using an ankle strategy.

PubMed

Matrangola, Sara L; Madigan, Michael L

2011-06-01

Obesity is associated with an increased risk of falls. The purpose of this study was to investigate the effects of obesity on balance recovery using an ankle strategy. In addition, computer simulations to understand how increased inertia and weight associated with obesity independently influence balance recovery. Ten normal weight (BMI: 22.7±0.6 kg/m(2)) and ten obese (BMI: 32.2±2.2 kg/m(2)) adult male subjects participated in the study. Subjects recovered balance using an ankle strategy after three types of postural perturbations: an initial angular displacement, an initial angular velocity from the natural stance, and an initial angular velocity from a prescribed position. Balance recovery was quantified by the largest initial angular displacement or angular velocity from which balance could be recovered. Obesity impaired balance recovery from perturbations involving an initial angular velocity, but not from an initial angular displacement. Similarly, computer simulations determined that increased inertia is beneficial to balance recovery when there is little to no initial angular velocity. These findings indicate that the effects of obesity on balance recovery are dependent on the type of perturbation, and that increased inertia associated with obesity can be beneficial for perturbations that involve little to no initial angular velocity. Copyright © 2011 Elsevier B.V. All rights reserved.

Functional ankle instability as a risk factor for osteoarthritis: using T2-mapping to analyze early cartilage degeneration in the ankle joint of young athletes.

PubMed

Golditz, T; Steib, S; Pfeifer, K; Uder, M; Gelse, K; Janka, R; Hennig, F F; Welsch, G H

2014-10-01

The aim of this study was to investigate, using T2-mapping, the impact of functional instability in the ankle joint on the development of early cartilage damage. Ethical approval for this study was provided. Thirty-six volunteers from the university sports program were divided into three groups according to their ankle status: functional ankle instability (FAI, initial ankle sprain with residual instability); ankle sprain Copers (initial sprain, without residual instability); and controls (without a history of ankle injuries). Quantitative T2-mapping magnetic resonance imaging (MRI) was performed at the beginning ('early-unloading') and at the end ('late-unloading') of the MR-examination, with a mean time span of 27 min. Zonal region-of-interest T2-mapping was performed on the talar and tibial cartilage in the deep and superficial layers. The inter-group comparisons of T2-values were analyzed using paired and unpaired t-tests. Statistical analysis of variance was performed. T2-values showed significant to highly significant differences in 11 of 12 regions throughout the groups. In early-unloading, the FAI-group showed a significant increase in quantitative T2-values in the medial, talar regions (P = 0.008, P = 0.027), whereas the Coper-group showed this enhancement in the central-lateral regions (P = 0.05). Especially the comparison of early-loading to late-unloading values revealed significantly decreasing T2-values over time laterally and significantly increasing T2-values medially in the FAI-group, which were not present in the Coper- or control-group. Functional instability causes unbalanced loading in the ankle joint, resulting in cartilage alterations as assessed by quantitative T2-mapping. This approach can visualize and localize early cartilage abnormalities, possibly enabling specific treatment options to prevent osteoarthritis in young athletes. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Common peroneal nerve palsy after grade I inversion ankle sprain.

PubMed

Mitsiokapa, Evanthia A; Mavrogenis, Andreas F; Antonopoulos, Dimitris; Tzanos, George; Papagelopoulos, Panayiotis J

2012-01-01

This case report presents a 28-year-old man with foot drop 48 hours after a grade I inversion ankle sprain. Clinical examination and electrodiagnostic studies showed common peroneal nerve palsy. The patient was managed with conservative treatment and rehabilitation and recovered completely 4 months after the injury. Physicians should be aware of the possibility of delayed peroneal nerve injury after grade I ankle sprain. Function of the peroneal nerve should be evaluated in all patients with inversion ankle sprain as part of initial and follow-up evaluations. Early electrodiagnostic studies are helpful to localize and provide indications of the severity of the injury.

Preparatory co-activation of the ankle muscles may prevent ankle inversion injuries

PubMed Central

DeMers, Matthew S.; Hicks, Jennifer L.; Delp, Scott L.

2018-01-01

Ankle inversion sprains are the most frequent acute musculoskeletal injuries occurring in physical activity. Interventions that retrain muscle coordination have helped rehabilitate injured ankles, but it is unclear which muscle coordination strategies, if any, can prevent ankle sprains. The purpose of this study was to determine whether coordinated activity of the ankle muscles could prevent excessive ankle inversion during a simulated landing on a 30-degree incline. We used a set of musculoskeletal simulations to evaluate the efficacy of two strategies for coordinating the ankle evertor and invertor muscles during simulated landing scenarios: planned co-activation and stretch reflex activation with physiologic latency (60-millisecond delay). A full-body musculoskeletal model of landing was used to generate simulations of a subject dropping onto an inclined surface with each coordination condition. Within each condition, the intensity of evertor and invertor co-activity or stretch reflexes were varied systematically. The simulations revealed that strong preparatory co-activation of the ankle evertors and invertors prior to ground contact prevented ankle inversion from exceeding injury thresholds by rapidly generating eversion moments after initial contact. Conversely, stretch reflexes were too slow to generate eversion moments before the simulations reached the threshold for inversion injury. These results suggest that training interventions to protect the ankle should focus on stiffening the ankle with muscle co-activation prior to landing. The musculoskeletal models, controllers, software, and simulation results are freely available online at http://simtk.org/home/ankle-sprains, enabling others to reproduce the results and explore new injury scenarios and interventions. PMID:28057351

Lower limb ice application alters ground reaction force during gait initiation

PubMed Central

Muniz, Thiago B.; Moraes, Renato; Guirro, Rinaldo R. J.

2015-01-01

BACKGROUND: Cryotherapy is a widely used technique in physical therapy clinics and sports. However, the effects of cryotherapy on dynamic neuromuscular control are incompletely explained. OBJECTIVES: To evaluate the effects of cryotherapy applied to the calf, ankle and sole of the foot in healthy young adults on ground reaction forces during gait initiation. METHOD: This study evaluated the gait initiation forces, maximum propulsion, braking forces and impulses of 21 women volunteers through a force platform, which provided maximum and minimum ground reaction force values. To assess the effects of cooling, the task - gait initiation - was performed before ice application, immediately after and 30 minutes after removal of the ice pack. Ice was randomly applied on separate days to the calf, ankle and sole of the foot of the participants. RESULTS: It was demonstrated that ice application for 30 minutes to the sole of the foot and calf resulted in significant changes in the vertical force variables, which returned to their pre-application values 30 minutes after the removal of the ice pack. Ice application to the ankle only reduced propulsion impulse. CONCLUSIONS: These results suggest that although caution is necessary when performing activities that require good gait control, the application of ice to the ankle, sole of the foot or calf in 30-minute intervals may be safe even preceding such activities. PMID:25993625

Toward Balance Recovery With Leg Prostheses Using Neuromuscular Model Control

PubMed Central

Geyer, Hartmut

2016-01-01

Objective Lower limb amputees are at high risk of falling as current prosthetic legs provide only limited functionality for recovering balance after unexpected disturbances. For instance, the most established control method used on powered leg prostheses tracks local joint impedance functions without taking the global function of the leg in balance recovery into account. Here we explore an alternative control policy for powered transfemoral prostheses that considers the global leg function and is based on a neuromuscular model of human locomotion. Methods We adapt this model to describe and simulate an amputee walking with a powered prosthesis using the proposed control, and evaluate the gait robustness when confronted with rough ground and swing leg disturbances. We then implement and partially evaluate the resulting controller on a leg prosthesis prototype worn by a non-amputee user. Results In simulation, the proposed prosthesis control leads to gaits that are more robust than those obtained by the impedance control method. The initial hardware experiments with the prosthesis prototype show that the proposed control reproduces normal walking patterns qualitatively and effectively responds to disturbances in early and late swing. However, the response to mid-swing disturbances neither replicates human responses nor averts falls. Conclusions The neuromuscular model control is a promising alternative to existing prosthesis controls, although further research will need to improve on the initial implementation and determine how well these results transfer to amputee gait. Significance This work provides a potential avenue for future development of control policies that help improve amputee balance recovery. PMID:26315935

Effect of a 6-week dynamic neuromuscular training programme on ankle joint function: A Case report

PubMed Central

2011-01-01

Background Ankle joint sprain and the subsequent development of chronic ankle instability (CAI) are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. Methods The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed/agility drills. The outcome measures chosen to assess for interventional efficacy were: [1] Cumberland Ankle Instability Tool (CAIT) scores, [2] Star Excursion Balance Test (SEBT) reach distances, [3] ankle joint plantar flexion during drop landing and drop vertical jumping, and [4] ground reaction forces (GRFs) during walking. Results CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. Conclusions The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors. PMID:21658224

Dynamic balance deficits in individuals with chronic ankle instability compared to ankle sprain copers 1 year after a first-time lateral ankle sprain injury.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

To quantify the dynamic balance deficits that characterise a group with chronic ankle instability compared to lateral ankle sprain copers and non-injured controls using kinematic and kinetic outcomes. Forty-two participants with chronic ankle instability and twenty-eight lateral ankle sprain copers were initially recruited within 2 weeks of sustaining a first-time, acute lateral ankle sprain and required to attend our laboratory 1 year later to complete the current study protocol. An additional group of non-injured individuals were also recruited to act as a control group. All participants completed the anterior, posterior-lateral and posterior-medial reach directions of the star excursion balance test. Sagittal plane kinematics of the lower extremity and associated fractal dimension of the centre of pressure path were also acquired. Participants with chronic ankle instability displayed poorer performance in the anterior, posterior-medial and posterior-lateral reach directions compared with controls bilaterally, and in the posterior-lateral direction compared with lateral ankle sprain copers on their 'involved' limb only. These performance deficits in the posterior-lateral and posterior-medial directions were associated with reduced flexion and dorsiflexion displacements at the hip, knee and ankle at the point of maximum reach, and coincided with reduced complexity of the centre of pressure path. In comparison with lateral ankle sprain copers and controls, participants with chronic ankle instability were characterised by dynamic balance deficits as measured using the SEBT. This was attested to reduced sagittal plane motions at the hip, knee and ankle joints, and reduced capacity of the stance limb to avail of its supporting base. III.

Effect of a 6-week dynamic neuromuscular training programme on ankle joint function: A Case report.

PubMed

O'Driscoll, Jeremiah; Kerin, Fearghal; Delahunt, Eamonn

2011-06-09

Ankle joint sprain and the subsequent development of chronic ankle instability (CAI) are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed/agility drills. The outcome measures chosen to assess for interventional efficacy were: 1 Cumberland Ankle Instability Tool (CAIT) scores, 2 Star Excursion Balance Test (SEBT) reach distances, 3 ankle joint plantar flexion during drop landing and drop vertical jumping, and 4 ground reaction forces (GRFs) during walking. CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors.

Ankle Dorsiflexion in Childhood Cancer Patients: A Review of the Literature.

PubMed

Beulertz, Julia; Wurz, Amanda; Culos-Reed, Nicole; Chamorro Viña, Carolina; Bloch, Wilhelm; Baumann, Freerk T

2015-01-01

Improved treatment protocols necessary for survival in pediatric oncology are associated with the development of serious late effects. Of particular importance, especially with regard to physical activity, may be ankle dorsiflexion (DF). This review summarizes the results of observational and exercise intervention studies exploring ankle DF-range of motion (DF-ROM) and/or ankle DF strength in pediatric oncology. PUBMED, Medline, Cochrane library, and SportDiscus were searched by 2 researchers using predefined search terms. The reference lists of included papers and Google scholar were then searched to that ensure all appropriate articles were included. Twelve studies were identified and were observational (n = 8), providing information regarding the status of DF-ROM and/or DF strength, or intervention studies (n = 4) using exercise as a strategy to improve DF function. All observational studies reported some degree of impairment in ankle DF. Two intervention studies found a positive effect of exercise on ankle DF-ROM. The preliminary results suggest that pediatric cancer patients and survivors suffer from limitations in ankle DF with interventions varying in efficacy. It is hoped that this review will enhance the recognition of the limited ankle DF function in pediatric oncology and initiate further research programs focused on targeting and evaluating ankle DF.

Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system.

PubMed

Abdulhasan, Zahraa M; Scally, Andy J; Buckley, John G

2018-05-30

Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its 'ramp-descent' mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis: a prospective randomized controlled trial.

PubMed

Saltzman, Charles L; Hillis, Stephen L; Stolley, Mary P; Anderson, Donald D; Amendola, Annunziato

2012-06-06

Initial reports have shown the efficacy of fixed distraction for the treatment of ankle osteoarthritis. We hypothesized that allowing ankle motion during distraction would result in significant improvements in outcomes compared with distraction without ankle motion. We conducted a prospective randomized controlled trial comparing the outcomes for patients with advanced ankle osteoarthritis who were managed with anterior osteophyte removal and either (1) fixed ankle distraction or (2) ankle distraction permitting joint motion. Thirty-six patients were randomized to treatment with either fixed distraction or distraction with motion. The patients were followed for twenty-four months after frame removal. The Ankle Osteoarthritis Scale (AOS) was the main outcome variable. Two years after frame removal, subjects in both groups showed significant improvement compared with the status before treatment (p < 0.02 for both groups). The motion-distraction group had significantly better AOS scores than the fixed-distraction group at twenty-six, fifty-two, and 104 weeks after frame removal (p < 0.01 at each time point). At 104 weeks, the motion-distraction group had an overall mean improvement of 56.6% in the AOS score, whereas the fixed-distraction group had a mean improvement of 22.9% (p < 0.01). Distraction improved the patient-reported outcomes of treatment of ankle osteoarthritis. Adding ankle motion to distraction showed an early and sustained beneficial effect on outcome.

[The length of the piston in otosclerosis surgery].

PubMed

Portmann, D; Alcantara, M; Vianna, M

2007-01-01

The measurement of the piston is always described as a significant stage of the surgery but its length is never clearly defined. The goal of this work is to determine the length of the prosthesis. From May 2003 to May 2005, 128 patients with otosclerosis, diagnosed on the basis of their clinical history and their audiogram, were included in this prospective study. Some of them were revision surgeries. The prosthesis generally used was the Portmann piston clip (Medtronic Xomed Inc Portmann Piston Clip Stainless Steel/Fluoroplastic). In stapedectomies, a Teflon piston of 0.6 mm of diameter was used (Pouret Company Fluoroplastic Stapes Prosthesis). These prostheses must be trimmed before their installation. The measurement technique is described. The length of the prosthesis was increased by 0.5 mm to include the thickness of the footplate. The Portmann piston clip was used 116 times (100 initial surgeries and 16 revisions surgeries) and the Teflon prosthesis of 0.6 mm of diameter only 13 times (6 primary stapedectomies and 7 revisions stapedectomies). The length of the prosthesis was between 3,5 mm and 5 mm. In the majority of cases, the length of the prosthesis was 4.75 mm (62 patients, 48.1%), followed by 4.5 mm (29 patients, 22.5%) and 5 mm (27 patients, 20.9%). In eleven cases (8.5%) the prosthesis measured less than 4,5 mm. None of the patients in this study experienced a postoperative sensorineural hearing loss. The measurement of the length of the piston is very significant, and in our study the majority of the pistons were cut at 4.75 mm which indicates an incus-footplate measurement of 4.25 mm.

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

Intermediate-term follow-up after ankle distraction for treatment of end-stage osteoarthritis.

PubMed

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

2015-04-01

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. 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. 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. 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. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Sports Medicine and Arthroscopic Treatment of the Foot and Ankle: What Is New and Current in Singapore.

PubMed

Ho, Sean Wei Loong; Thevendran, Gowreeson

2016-06-01

Foot and ankle abnormalities are common in Singapore because of the compulsory conscription, the slipper-wearing culture, and the promotion of healthy living through exercise. The rapidly aging population, lack of elite sportsmen, and social and cultural norms pose unique challenges to foot and ankle surgery. Orthopedic surgery in Singapore has progressed because of the good infrastructure and modern practices executed by fellowship-trained surgeons. Evolving local practices are polarized by practice trends emulated from North America and Europe. The small community of foot and ankle surgeons currently practicing in Singapore allows for easier communication, corroborative educational events, and research initiatives. Copyright © 2016 Elsevier Inc. All rights reserved.

Pigmented villonodular synovitis about the ankle: a review of the literature and presentation in 10 athletic patients.

PubMed

Saxena, Amol; Perez, Hugo

2004-11-01

Pigmented villonodular synovitis (PVNS) is relatively uncommon. The disorder results in increased proliferation of synovium causing villous or nodular changes of synovial-lined joints, bursae and tendon sheaths. This study examines the occurrence of PVNS about the ankle and its association with trauma. Ten patients over a 10-year period were identified as having PVNS of the ankle. The average age was 40.2 (range 27 to 62) years. There were four women and six men. Average followup was 4.5 (range 1 to 11) years from the initial surgery. Four patients had bone involvement. All patients who were athletically active before symptoms arose complained of persistent pain and swelling in the lateral ankle. Their initial clinical symptoms were indistinguishable from commonly associated pathologies with persistent lateral ankle pain (i.e. tenosynovitis, osteochondral defects, os trigonum injury, and tendon tears). All patients had magnetic resonance imaging (MRI) revealing PVNS, which is represented by low-signal appearing masses on T1- and T2-weighted images. All patients' histopathology results revealed multinucleated giant cells and foam cells laden with hemosiderin deposits. All patients had synovectomy and tenosynovectomy. Eight patients were able to return to some sports (range 4 to 12 months); two had continued pain, disability, and inability to return to sports because of recurrence. PVNS should be considered in athletically active patients with persistent lateral ankle pain and swelling, particularly if bone erosions are visible on plain radiographs.

First metatarsophalangeal joint replacement with modular three-component press-fit implant. Preliminary report.

PubMed

Kolodziej, L; Bohatyrewicz, A; Zietek, P

2013-01-01

The aim of this retrospective study was to assess functional and radiographic results of the first metatarsophalangeal joint replacement with use of unconstrained, modular, three components, porous titanium and hydroxyapatite coated, press-fit METIS® prosthesis. According to author's knowledge, results of that type of prosthesis have never been published before. 25 prosthesis were implanted in 24 patients between February 2009 and May 2011. American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI) was used to assess functional results. Patients were also asked if they would undergo procedure again or recommend it to other people. Weight bearing radiographs ware made at final follow up and analyzed for presence of osteolysis and radiolucencies. In 8 patients total joint replacement was introduced as a salvage after failure of previous surgery like Keller resection arthroplasty, failed arthrodesis, avascular necrosis and postoperative arthritis. In 11 patients the reason for prosthetic replacement were hallux rigidus, in 4 cases rheumatoid arthritis and gout in one patient. In two patients additional procedures like Akin phalangeal osteotomy and in one case fifth metatarsal osteotomy, was performed. There were 20 females and 4 males in presented group. The mean age at the operation was 56 years. The average follow up period was 18 months (from 12 to 36 months). The median postoperative value of AOFAS-HMI scores was 88 points (from 75 to 95 points). First metatarsophalangeal joint motion (dorsiflexion plus plantarflexion) was classified according to AOFAS-HMI ranges as: moderately restricted (between 30 to 70 degrees) in 19 patients 80% (20 prosthesis) and severely restricted (less then 30 degrees) in 5 patients (20%). 15 (64%) patients were completely satisfied, 5 (20%) reported moderate satisfaction and (16%) 4 were totally disappointed and would not undergo this procedure again. A limited hallux dorsiflexion was the main dissatisfaction reason. Partial radiolucent line was seen in one patient (4%). Authors noticed two serious complications. In one patient, with rheumatoid arthritis, deep infection occurred 12 months after prosthesis implantation. In second case phalangeal implant was revised due to misalignment. METIS® metatarsophalangeal joint replacement allows alleviate of pain relating to hallux rigidus and partial restoration of joint movement, even in patients after failures of primary metatarsophalangeal joint surgery. AOFAS-HMI results are better than previously reported in the literature in assessment of the first metatarsophalangeal joint replacement. Radiographic results imply satisfactory bone ingrowth into the cementless implants.

Effect of strength and speed of torque development on balance recovery with the ankle strategy.

PubMed

Robinovitch, Stephen N; Heller, Britta; Lui, Andrew; Cortez, Jeffrey

2002-08-01

In the event of an unexpected disturbance to balance, the ability to recover a stable upright stance should depend not only on the magnitude of torque that can be generated by contraction of muscles spanning the lower extremity joints but also on how quickly these torques can be developed. In the present study, we used a combination of experimental and mathematical models of balance recovery by sway (feet in place responses) to test this hypothesis. Twenty-three young subjects participated in experiments in which they were supported in an inclined standing position by a horizontal tether and instructed to recover balance by contracting only their ankle muscles. The maximum lean angle where they could recover balance without release of the tether (static recovery limit) averaged 14.9 +/- 1.4 degrees (mean +/- SD). The maximum initial lean angle where they could recover balance after the tether was unexpectedly released and the ankles were initially relaxed (dynamic recovery limit) averaged 5.9 +/- 1.1 degrees, or 60 +/- 11% smaller than the static recovery limit. Peak ankle torque did not differ significantly between the two conditions (and averaged 116 +/- 32 Nm), indicating the strong effect on recovery ability of latencies in the onset and subsequent rates of torque generation (which averaged 99 +/- 13 ms and 372 +/- 267 N. m/s, respectively). Additional experiments indicated that dynamic recovery limits increased 11 +/- 14% with increases in the baseline ankle torques prior to release (from an average value of 31 +/- 18 to 54 +/- 24 N. m). These trends are in agreement with predictions from a computer simulation based on an inverted pendulum model, which illustrate the specific combinations of baseline ankle torque, rate of torque generation, and peak ankle torque that are required to attain target recovery limits.

A second prosthesis as a procedural rescue option in trans-apical aortic valve implantation.

PubMed

Kempfert, Jörg; Rastan, Ardawan J; Schuler, Gerhard; Linke, Axel; Holzhey, David; van Linden, Arnaud; Mohr, Friedrich-W; Walther, Thomas

2011-07-01

Trans-apical aortic valve implantation (TA-AVI) using the Edwards SAPIEN™ prosthesis has evolved to a routine procedure for selected high-risk elderly patients. In rare cases, misplacement of the SAPIEN™ valve (too low a position), dysfunction of the leaflets or perforation of the interventricular septum (ventricular septal defect, VSD) occurs and requires immediate implantation of a second prosthesis within the first one. Results of this 'bailout' maneuver have not been reported yet. Of 305 TA-AVI procedures, 15 patients required a second prosthesis due to dysfunctional leaflets (n = 6), low position (n = 7), or VSD (n = 2). Mean age was 82.5 ± 1.3 years, mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 45.5 ± 5.4, and Society of Thoracic Surgeons (STS) Score was 13.5 ± 1.5. All second SAPIEN™ valves could be implanted successfully within the first one. The second prosthesis solved leaflet dysfunction, sealed the VSD (lower position of the second prosthesis), or corrected the initial misplacement (higher position of the second prosthesis) in all patients. Within 30 days, four patients died (low cardiac output n = 3, all with preoperative ejection fraction (EF) <35%; intestinal ischemia n = 1). Intra-operative echocardiogram and angiogram revealed mild paravalvular leak in three and none/trace in 12 patients. Transvalvular gradients were low despite the implantation of the second valve (P(max)/mean 13.7 ± 4.3/6.4 ± 2.0). Placement of a second SAPIEN™ valve is a valuable 'bailout' technique in case of VSD, dysfunctional leaflets, or too low placement of the first prosthesis. The technique leads to an excellent functional result with low transvalvular gradients. The simple, straight, tubular stent design of the SAPIEN™ prosthesis may be the ideal design for such valve-in-valve procedures. Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Prosthesis Prescription Protocol of the Arm (PPP-Arm): The implementation of a national prosthesis prescription protocol.

PubMed

Wijdenes, Paula; Brouwers, Michael; van der Sluis, Corry K

2018-02-01

In order to create more uniformity in the prescription of upper limb prostheses by Dutch rehabilitation teams, the development and implementation of a Prosthesis Prescription Protocol of the upper limb (PPP-Arm) was initiated. The aim was to create a national digital protocol to structure, underpin, and evaluate the prescription of upper limb prostheses for clients with acquired or congenital arm defects. Prosthesis Prescription Protocol of the Arm (PPP-Arm) was developed on the basis of the International Classification of Functioning and consisted of several layers. All stakeholders (rehabilitation teams, orthopedic workshops, patients, and insurance companies) were involved in development and implementation. A national project coordinator and knowledge brokers in each team were essential for the project. PPP-Arm was successfully developed and implemented in nine Dutch rehabilitation teams. The protocol improved team collaboration, structure, and completeness of prosthesis prescriptions and treatment uniformity and might be interesting for other countries as well. Clinical relevance A national protocol to prescribe upper limb prostheses can be helpful to create uniformity in treatment of patients with upper limb defects. Such a protocol improves quality of care for all patients in the country.

Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees.

PubMed

Burnfield, Judith M; Eberly, Valerie J; Gronely, Joanne K; Perry, Jacquelin; Yule, William Jared; Mulroy, Sara J

2012-03-01

Microprocessor controlled prosthetic knees (MPK) offer opportunities for improved walking stability and function, but some devices' swing phase features may exceed needs of users with invariable cadence. One MPK offers computerized control of only stance (C-Leg Compact). To assess Medicare Functional Classification Level K2 walkers' ramp negotiation performance, function and balance while using a non-MPK (NMPK) compared to the C-Leg Compact. Crossover. Gait while ascending and descending a ramp (stride characteristics, kinematics, electromyography) and function were assessed in participant's existing NMPK and again in the C-Leg Compact following accommodation. Ramp ascent and descent were markedly faster in the C-Leg Compact compared to the NMPK (p ≤ 0.006), owing to increases in stride length (p ≤ 0.020) and cadence (p ≤ 0.020). Residual limb peak knee flexion and ankle dorsiflexion were significantly greater (12.9° and 4.9° more, respectively) during single limb support while using the C-Leg Compact to descend ramps. Electromyography (mean, peak) did not differ significantly between prosthesis. Function improved in the C-Leg Compact as evidenced by a significantly faster Timed Up and Go and higher functional questionnaire scores. Transfemoral K2 walkers exhibited significantly improved function and balance while using the stance-phase only MPK compared to their traditional NMPK.

Rigid Ankle Foot Orthosis Deteriorates Mediolateral Balance Control and Vertical Braking during Gait Initiation

PubMed Central

Delafontaine, Arnaud; Gagey, Olivier; Colnaghi, Silvia; Do, Manh-Cuong; Honeine, Jean-Louis

2017-01-01

Rigid ankle-foot orthoses (AFO) are commonly used for impeding foot drop during the swing phase of gait. They also reduce pain and improve gait kinematics in patients with weakness or loss of integrity of ankle-foot complex structures due to various pathological conditions. However, this comes at the price of constraining ankle joint mobility, which might affect propulsive force generation and balance control. The present study examined the effects of wearing an AFO on biomechanical variables and electromyographic activity of tibialis anterior (TA) and soleus muscles during gait initiation (GI). Nineteen healthy adults participated in the study. They initiated gait at a self-paced speed with no ankle constraint as well as wearing an AFO on the stance leg, or bilaterally. Constraining the stance leg ankle decreased TA activity ipsilaterally during the anticipatory postural adjustment (APA) of GI, and ipsilateral soleus activity during step execution. In the sagittal plane, the decrease in the stance leg TA activity reduced the backward displacement of the center of pressure (CoP) resulting in a reduction of the forward velocity of the center of mass (CoM) measured at foot contact (FC). In the frontal plane, wearing the AFO reduced the displacement of the CoP in the direction of the swing leg during the APA phase. The mediolateral velocity of the CoM increased during single-stance prompting a larger step width to recover balance. During step execution, the CoM vertical downward velocity is normally reduced in order to lessen the impact of the swing leg with the floor and facilitates the rise of the CoM that occurs during the subsequent double-support phase. The reduction in stance leg soleus activity caused by constraining the ankle weakened the vertical braking of the CoM during step execution. This caused the absolute instantaneous vertical velocity of the CoM at FC to be greater in the constrained conditions with respect to the control condition. From a rehabilitation perspective, passively- or actively-powered assistive AFOs could correct for the reduction in muscle activity and enhance balance control during GI of patients. PMID:28503144

A Canadian Electric-Arm Prosthesis for Children

PubMed Central

Nicholls, Peter B.; Stevenson, David A.; Sherman, E. David; Lippay, Andrew L.; Gingras, Gustave

1967-01-01

The thalidomide tragedy in Canada initiated new efforts to produce functional prosthetic appliances for very young amputees. In 1962, the Rehabilitation Institute of Montreal began to fit 36 babies with adapted conventional and gas-operated devices. Practical experience with the Soviet prosthesis proved the feasibility of myoelectric control, and indicated the possibility of using skin electrodes over an active muscle for control purposes in children. We obtained assistance from the Northern Electric Company, whose research laboratories produced the prototype arms described in this report. An all-electric prosthetic system was developed which carries out four different movements driven by a single motor. Function is effected by switches, but a myoelectric control system could be readily adapted without major changes. In the description of our needs for the proposed arm, we asked for modular construction and a minimum service life of one year between major repairs. Details of design and performance are outlined in this report. Initial clinical experience indicates that the prosthesis is completely accepted by the young patient, in spite of its excessive weight and inconvenient control. Four powered joints give the child greater functional freedom. In future we plan to fit an older child and will study more bilateral installations in the next 14 months. After further use, study and improvement, this device will become a useful prosthesis. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:6021562

Motion Versus Fixed Distraction of the Joint in the Treatment of Ankle Osteoarthritis

PubMed Central

Saltzman, Charles L.; Hillis, Stephen L.; Stolley, Mary P.; Anderson, Donald D.; Amendola, Annunziato

2012-01-01

Background: Initial reports have shown the efficacy of fixed distraction for the treatment of ankle osteoarthritis. We hypothesized that allowing ankle motion during distraction would result in significant improvements in outcomes compared with distraction without ankle motion. Methods: We conducted a prospective randomized controlled trial comparing the outcomes for patients with advanced ankle osteoarthritis who were managed with anterior osteophyte removal and either (1) fixed ankle distraction or (2) ankle distraction permitting joint motion. Thirty-six patients were randomized to treatment with either fixed distraction or distraction with motion. The patients were followed for twenty-four months after frame removal. The Ankle Osteoarthritis Scale (AOS) was the main outcome variable. Results: Two years after frame removal, subjects in both groups showed significant improvement compared with the status before treatment (p < 0.02 for both groups). The motion-distraction group had significantly better AOS scores than the fixed-distraction group at twenty-six, fifty-two, and 104 weeks after frame removal (p < 0.01 at each time point). At 104 weeks, the motion-distraction group had an overall mean improvement of 56.6% in the AOS score, whereas the fixed-distraction group had a mean improvement of 22.9% (p < 0.01). Conclusion: Distraction improved the patient-reported outcomes of treatment of ankle osteoarthritis. Adding ankle motion to distraction showed an early and sustained beneficial effect on outcome. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. PMID:22637202

The effect of a knee ankle foot orthosis incorporating an active knee mechanism on gait of a person with poliomyelitis.

PubMed

Arazpour, Mokhtar; Chitsazan, Ahmad; Bani, Monireh Ahmadi; Rouhi, Gholamreza; Ghomshe, Farhad Tabatabai; Hutchins, Stephen W

2013-10-01

The aim of this case study was to identify the effect of a powered stance control knee ankle foot orthosis on the kinematics and temporospatial parameters of walking by a person with poliomyelitis when compared to a knee ankle foot orthosis. A knee ankle foot orthosis was initially manufactured by incorporating drop lock knee joints and custom molded ankle foot orthoses and fitted to a person with poliomyelitis. The orthosis was then adapted by adding electrically activated powered knee joints to provide knee extension torque during stance and also flexion torque in swing phase. Lower limb kinematic and kinetic data plus data for temporospatial parameters were acquired from three test walks using each orthosis. Walking speed, step length, and vertical and horizontal displacement of the pelvis decreased when walking with the powered stance control knee ankle foot orthosis compared to the knee ankle foot orthosis. When using the powered stance control knee ankle foot orthosis, the knee flexion achieved during swing and also the overall pattern of walking more closely matched that of normal human walking. The reduced walking speed may have caused the smaller compensatory motions detected when the powered stance control knee ankle foot orthosis was used. The new powered SCKAFO facilitated controlled knee flexion and extension during ambulation for a volunteer poliomyelitis person.

Neural Excitability and Joint Laxity in Chronic Ankle Instability, Coper, and Control Groups.

PubMed

Bowker, Samantha; Terada, Masafumi; Thomas, Abbey C; Pietrosimone, Brian G; Hiller, Claire E; Gribble, Phillip A

2016-04-01

Neuromuscular and mechanical deficiencies are commonly studied in participants with chronic ankle instability (CAI). Few investigators have attempted to comprehensively consider sensorimotor and mechanical differences among people with CAI, copers who did not present with prolonged dysfunctions after an initial ankle sprain, and a healthy control group. To determine if differences exist in spinal reflex excitability and ankle laxity among participants with CAI, copers, and healthy controls. Case-control study. Research laboratory. Thirty-seven participants with CAI, 30 participants categorized as copers, and 26 healthy control participants. We assessed spinal reflex excitability of the soleus using the Hoffmann reflex protocol. Participants' ankle laxity was measured with an instrumented ankle arthrometer. The maximum Hoffmann reflex : maximal muscle response ratio was calculated. Ankle laxity was measured as the total displacement in the anterior-posterior directions (mm) and total rotation in the inversion and eversion directions (°). Spinal reflex excitability was diminished in participants with CAI compared with copers and control participants (P = .01). No differences were observed among any of the groups for ankle laxity. Changes in the spinal reflex excitability of the soleus that likely affect ankle stability were seen only in the CAI group, yet no mechanical differences were noted across the groups. These findings support the importance of finding effective ways to increase spinal reflex excitability for the purpose of treating neural excitability dysfunction in patients with CAI.

RMI study and clinical correlations of ankle retinacula damage and outcomes of ankle sprain.

PubMed

Stecco, Antonio; Stecco, Carla; Macchi, Veronica; Porzionato, Andrea; Ferraro, Claudio; Masiero, Stefano; De Caro, Raffaele

2011-12-01

Recent studies reveal the role of the ankle retinacula in proprioception and functional stability of the ankle, but there is no clear evidence of their role in the outcomes of ankle sprain. 25 patients with outcomes of ankle sprain were evaluated by MRI to analyze possible damage to the ankle retinacula. Patients with damage were subdivided into two groups: group A comprised cases with ankle retinacula damage only, and group B those also with anterior talofibular ligament rupture or bone marrow edema. Both groups were examined by VAS, CRTA and static posturography and underwent three treatments of deep connective tissue massage (Fascial Manipulation technique). All evaluations were repeated after the end of treatment and at 1, 3 and 6 months. At MRI, alteration of at least one of the ankle retinacula was evident in 21 subjects, and a further lesion was also identified in 7 subjects. After treatment, VAS and CRTA evaluations showed a statistically significant decrease in values with respect to those before treatment (p < 0.0001). There were also significant improvements (p < 0.05) in stabilometric platform results. No significant difference was found between groups A and B. The initial benefit was generally maintained at follow-up. The alteration of retinacula at MRI clearly corresponds to the proprioceptive damage revealed by static posturography and clinical examination. Treatment focused on the retinacula may improve clinical outcomes and stabilometric data.

Management of complications of open reduction and internal fixation of ankle fractures.

PubMed

Ng, Alan; Barnes, Esther S

2009-01-01

The management of complications resulting from the open reduction and internal fixation of ankle fractures is discussed in detail. The initial radiographic findings of the most common postsurgical complications of ankle fracture reduction are briefly discussed, namely lateral, medial, and posterior malleolar malunion or nonunion, syndesmotic widening, degenerative changes, and septic arthritis with or without concomitant osteomyelitis. Emphasis is placed on the management of these complications, with a review of the treatment options proposed in the literature, a detailed discussion of the authors' recommendations, and an inclusion of different case presentations.

Rehabilitation and return to play after foot and ankle injuries in athletes.

PubMed

Hudson, Zoe

2009-09-01

Rehabilitation after acute ankle injury can be categorized in to early, middle, and late phases. This paper aims to cover some of the key concepts from initial management to end stage rehabilitation that could be applied to many musculoskeletal injuries around the foot and ankle. Pathology specific rehabilitation, functional performance tests, and sports specific and return to play issues are also addressed, as the aim of any rehabilitation programme is to return the athlete to the field of play as quickly as it is safe to do so.

Shoe collar height effect on athletic performance, ankle joint kinematics and kinetics during unanticipated maximum-effort side-cutting performance.

PubMed

Lam, Gilbert Wing Kai; Park, Eun Jung; Lee, Ki-Kwang; Cheung, Jason Tak-Man

2015-01-01

Side-step cutting manoeuvres comprise the coordination between planting and non-planting legs. Increased shoe collar height is expected to influence ankle biomechanics of both legs and possibly respective cutting performance. This study examined the shoe collar height effect on kinematics and kinetics of planting and non-planting legs during an unanticipated side-step cutting. Fifteen university basketball players performed maximum-effort side-step cutting to the left 45° direction or a straight ahead run in response to a random light signal. Seven successful cutting trials were collected for each condition. Athletic performance, ground reaction force, ankle kinematics and kinetics of both legs were analysed using paired t-tests. Results indicated that high-collar shoes resulted in less ankle inversion and external rotation during initial contact for the planting leg. The high-collar shoes also exhibited a smaller ankle range of motion in the sagittal and transverse planes for both legs, respectively. However, no collar effect was found for ankle moments and performance indicators including cutting performance time, ground contact time, propulsion ground reaction forces and impulses. These findings indicated that high-collar shoes altered ankle positioning and restricted ankle joint freedom movements in both legs, while no negative effect was found for athletic cutting performance.

Atypical Chronic Ankle Instability in a Pediatric Population Secondary to Distal Fibula Avulsion Fracture Nonunion.

PubMed

El Ashry, Saad R; El Gamal, Tarek A; Platt, Simon R

Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Hip Kinematics During a Stop-Jump Task in Patients With Chronic Ankle Instability

PubMed Central

Brown, Cathleen N.; Padua, Darin A.; Marshall, Stephen W.; Guskiewicz, Kevin M.

2011-01-01

Context: Chronic ankle instability (CAI) commonly develops after lateral ankle sprain. Movement pattern differences at proximal joints may play a role in instability. Objective: To determine whether people with mechanical ankle instability (MAI) or functional ankle instability (FAI) exhibited different hip kinematics and kinetics during a stop-jump task compared with “copers.” Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Sixty-three recreational athletes, 21 (11 men, 10 women) per group, matched for sex, age, height, mass, and limb dominance. All participants reported a history of a moderate to severe ankle sprain. The participants with MAI and FAI reported 2 or more episodes of giving way at the ankle in the last year and decreased functional ability; copers did not. The MAI group demonstrated clinically positive anterior drawer and talar tilt tests, whereas the FAI group and copers did not. Intervention(s): Participants performed a maximum-speed approach run and a 2-legged stop jump followed by a maximum vertical jump. Main Outcome Measure(s): An electromagnetic tracking device synchronized with a force plate collected data during the stance phase of a 2-legged stop jump. Hip motion was measured from initial contact to takeoff into the vertical jump. Group differences in hip kinematics and kinetics were assessed. Results: The MAI group demonstrated greater hip flexion at initial contact and at maximum (P = .029 and P = .017, respectively) and greater hip external rotation at maximum (P = .035) than the coper group. The MAI group also demonstrated greater hip flexion displacement than both the FAI (P = .050) and coper groups (P = .006). No differences were noted between the FAI and coper groups in hip kinematic variables or among any of the groups in ground reaction force variables. Conclusions: The MAI group demonstrated different hip kinematics than the FAI and coper groups. Proximal joint motion may be affected by ankle joint function and laxity, and clinicians may need to assess proximal joints after repeated ankle sprains. PMID:22488131

Cone-Beam Computed Tomography Evaluation of Horizontal and Vertical Dimensional Changes in Buccal Peri-Implant Alveolar Bone and Soft Tissue: A 1-Year Prospective Clinical Study.

PubMed

Kaminaka, Akihiro; Nakano, Tamaki; Ono, Shinji; Kato, Tokinori; Yatani, Hirofumi

2015-10-01

This study evaluated changes in the horizontal and vertical dimensions of the buccal alveolar bone and soft tissue over a 1-year period following implant prosthesis. Thirty-three participants with no history of guided bone regeneration or soft tissue augmentation underwent dental implant placement with different types of connections. The dimensions of the buccal alveolar bone and soft tissue were evaluated immediately and at 1 year after prosthesis from reconstructions of cross-sectional cone-beam computed tomography images. The vertical and horizontal loss of buccal bone and soft tissue around implants with conical connections were lower than around those with external or internal connections. Statistically significant negative correlations were observed between initial horizontal bone thickness and changes in vertical bone and soft tissue height (p < .05), and between initial horizontal soft tissue thickness and the change in vertical soft tissue height (p < .05). Implants with a conical connection preserve peri-implant alveolar bone and soft tissue more effectively than other connection types. Furthermore, the initial buccal alveolar bone and soft tissue thickness around the implant platform may influence their vertical dimensional changes at 1 year after implant prosthesis. © 2014 Wiley Periodicals, Inc.

Engineering long term clinical success of advanced ceramic prostheses.

PubMed

Rekow, Dianne; Thompson, Van P

2007-01-01

Biocompatability and, in some applications, esthetics make all-ceramic prostheses compelling choices but despite significant improvements in materials properties and toughening mechanisms, these still have significant failure rates. Factors that contribute to the degradation in strength and survival include material selection and prosthesis design which set the upper limit for performance. However, fabrication operations introduce damage that can be exacerbated by environmental conditions and clinical function. Using all-ceramic dental crowns as an example, experimentally derived models provide insight into the relationships between materials properties and initial critical loads to failure. Analysis of fabrication operations suggests strategies to minimize damage. Environmental conditions can create viscoplastic flow of supporting components which can contribute additional stress within the prosthesis. Fatigue is a particularly challenging problem, not only providing the energy to propagate existing damage but, when combined with the wet environment, can create new damage modes. While much is known, the influence of these new damage modes has not been completely elucidated. The role of complex prosthesis geometry and its interaction with other factors on damage initiation and propagation has yet to be well characterized.

Loading rate increases during barefoot running in habitually shod runners: Individual responses to an unfamiliar condition.

PubMed

Tam, Nicholas; Astephen Wilson, Janie L; Coetzee, Devon R; van Pletsen, Leanri; Tucker, Ross

2016-05-01

The purpose of this study was to examine the effect of barefoot running on initial loading rate (LR), lower extremity joint kinematics and kinetics, and neuromuscular control in habitually shod runners with an emphasis on the individual response to this unfamiliar condition. Kinematics and ground reaction force data were collected from 51 habitually shod runners during overground running in a barefoot and shod condition. Joint kinetics and stiffness were calculated with inverse dynamics. Inter-individual initial LR variability was explored by separating individuals by a barefoot/shod ratio to determine acute responders/non-responders. Mean initial LR was 54.1% greater in the barefoot when compared to the shod condition. Differences between acute responders/non-responders were found at peak and initial contact sagittal ankle angle and at initial ground contact. Correlations were found between barefoot sagittal ankle angle at initial ground contact and barefoot initial LR. A large variability in biomechanical responses to an acute exposure to barefoot running was found. A large intra-individual variability was found in initial LR but not ankle plantar-dorsiflexion between footwear conditions. A majority of habitually shod runners do not exhibit previously reported benefits in terms of reduced initial LRs when barefoot. Lastly, runners who increased LR when barefoot reduced LRs when wearing shoes to levels similar seen in habitually barefoot runners who do adopt a forefoot-landing pattern, despite increased dorsiflexion. Copyright © 2016 Elsevier B.V. All rights reserved.

Juxta-articular osteoid osteoma of the talar neck: a case report.

PubMed

Mavrogenis, Andreas F; Dimitriou, Rozalia; Benetos, Ioannis S; Korres, Demetrios S; Papagelopoulos, Panayiotis J

2010-10-01

Juxta-articular osteoid osteomas of the ankle are rare and tend to have an atypical presentation. Because of the proximity to the joint, patients experience symptoms that may delay or mislead the diagnosis. This article presents a 33-year-old man with juxta-articular osteoid osteoma of the talar neck. The correct diagnosis was delayed for 2 years; the patient was initially misdiagnosed and treated for ankle sprain and anterior ankle impingement. Surgical excision of the lesion was performed with excellent results. Juxta-articular osteoid osteomas should be considered in the differential diagnosis of persistent ankle pain in teenagers and young adults who do not respond to treatment directed at more common conditions. Copyright © 2010 Elsevier Inc. All rights reserved.

Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections.

PubMed

Matter-Parrat, V; Ronde-Oustau, C; Boéri, C; Gaudias, J; Jenny, J-Y

2017-04-01

Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Intrinsic Predictive Factors of Noncontact Lateral Ankle Sprain in Collegiate Athletes

PubMed Central

Kobayashi, Takumi; Yoshida, Masahiro; Yoshida, Makoto; Gamada, Kazuyoshi

2013-01-01

Background: Lateral ankle sprain (LAS) is one of the most common injuries in sports. Despite extensive research, intrinsic factors that predict initial and recurrent noncontact LAS remain undefined. Purpose: To identify the predictive factors of initial and recurrent noncontact LAS, focusing on ankle flexibility and/or alignment in collegiate athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 191 athletes were assessed during the preseason for factors predictive of noncontact LAS. The baseline measurements included weightbearing dorsiflexion range of motion (ROM), leg-heel angle, foot internal rotation angle in plantar flexion, classification according to the mortise test, and navicular–medial malleolus (NMM) distance. Occurrence of noncontact LAS and participation in practice and games were prospectively recorded for 11 months. Results: Of the 191 athletes assessed, 169 (145 males, 24 females) completed the study; 125 athletes had a history of ankle sprain. During the observational period, 16 athletes suffered noncontact LAS (0.58 per 1000 athlete-exposures) consisting of 4 initial sprains and 12 recurrences. The hazard ratio estimated by a Cox regression analysis showed that athletes with an NMM distance ≥4.65 cm were 4.14 times more likely to suffer an initial noncontact LAS than were athletes with a shorter NMM distance (95% confidence interval, 1.12-14.30) and that athletes with a weightbearing dorsiflexion ROM >49.5° were 1.12 times as likely to suffer a recurrent noncontact LAS compared with athletes with a lower ROM (95% confidence interval, 1.05-1.20). Conclusion: NMM distance predicts initial noncontact LAS, and weightbearing dorsiflexion ROM predicts recurrent noncontact LAS. PMID:26535263

Effects of Neuromuscular Training on the Rear-foot Angle Kinematics in Elite Women Field Hockey Players with Chronic Ankle Instability

PubMed Central

Kim, Eunkuk; Choi, Hokyung; Cha, Jung-Hoon; Park, Jong-Chul; Kim, Taegyu

2017-01-01

The aims of this study were to investigate the ankle position, the changes and persistence of ankle kinematics after neuromuscular training in athletes with chronic ankle instability (CAI). A total of 21 national women’s field hockey players participated (CAI = 12, control = 9). Ankle position at heel strike (HS), midstance (MS), and toe touch (TT) in the frontal plane during walking, running and landing were measured using 3D motion analysis. A 6-week neuromuscular training program was undertaken by the CAI group. Measurements of kinematic data for both groups were measured at baseline and the changes in kinematic data for CAI group were measured at 6 and 24 weeks. The kinematic data at HS during walking and running demonstrated that the magnitude of the eversion in the CAI group (−5.00° and −4.21°) was less than in the control group (−13.45°and −9.62°). The kinematic data at MS also exhibited less ankle eversion in the CAI group (−9.36° and −8.18°) than in the control group (−18.52° and −15.88°). Ankle positions at TT during landing were comparable between groups. Following the 6-week training, the CAI participants demonstrated a less everted ankle at HS during walking and running (−1.77° and −1.76°) compared to the previous positions. They also showed less ankle eversion at MS (−5.14° and −4.19°). Ankle orientation at TT changed significantly to an inverted ankle position (from −0.26° to 4.11°). The ankle kinematics were restored back to the previous positions at 24 weeks except for landing. It appeared that athletes with unstable ankle had a relatively inverted ankle position, and that 6-week neuromuscular training had an immediate effect on changing ankle orientation toward a less everted direction. The changed ankle kinematics seemed to persist during landing but not during walking and running. Key points Athletes with unstable ankles had a relatively inverted ankle position during the initial contact and midstance. Six-week neuromuscular training for unstable ankles had an immediate effect on changing ankle orientation toward a relatively more inverted direction. The changed ankle kinematics persisted during jump landing but not during walking and running. PMID:28344462

Research and development of a versatile portable speech prosthesis

NASA Technical Reports Server (NTRS)

1981-01-01

The Versatile Portable Speech Prosthesis (VPSP), a synthetic speech output communication aid for non-speaking people is described. It was intended initially for severely physically limited people with cerebral palsy who are in electric wheelchairs. Hence, it was designed to be placed on a wheelchair and powered from a wheelchair battery. It can easily be separated from the wheelchair. The VPSP is versatile because it is designed to accept any means of single switch, multiple switch, or keyboard control which physically limited people have the ability to use. It is portable because it is mounted on and can go with the electric wheelchair. It is a speech prosthesis, obviously, because it speaks with a synthetic voice for people unable to speak with their own voices. Both hardware and software are described.

The effect of ankle-foot orthosis plantarflexion stiffness on ankle and knee joint kinematics and kinetics during first and second rockers of gait in individuals with stroke

PubMed Central

Singer, Madeline L.; Kobayashi, Toshiki; Lincoln, Lucas S.; Orendurff, Michael S.; Foreman, K. Bo

2014-01-01

Background Stiffness of an ankle-foot orthosis plays an important role in improving gait in patients with a history of stroke. To address this, the aim of this case series study was to determine the effect of increasing plantarflexion stiffness of an ankle-foot orthosis on the sagittal ankle and knee joint angle and moment during the first and second rockers of gait. Methods Gait data were collected in 5 subjects with stroke at a self-selected walking speed under two plantarflexion stiffness conditions (0.4 Nm/deg and 1.3 Nm/deg) using a stiffness-adjustable experimental ankle-foot orthosis on a Bertec split-belt fully instrumented treadmill in a 3-dimensional motion analysis laboratory. Findings By increasing the plantarflexion stiffness of the ankle-foot orthosis, peak plantarfexion angle of the ankle was reduced and peak dorsiflexion moment was generally increased in the first rocker as hypothesized. Two subjects demonstrated increases in both peak knee flexion angle and peak knee extension moment in the second rocker as hypothesized. The two subjects exhibited minimum contractility during active plantarflexion, while the other three subjects could actively plantarflex their ankle joint. Interpretation It was suggested that those with the decreased ability to actively plantarflex their ankle could not overcome excessive plantarflexion stiffness at initial contact of gait, and as a result exhibited compensation strategies at the knee joint. Providing excessively stiff ankle-foot orthoses might put added stress on the extensor muscles of the knee joint, potentially creating fatigue and future pathologies in some patients with stroke. PMID:25241248

An animal model to evaluate skin-implant-bone integration and gait with a prosthesis directly attached to the residual limb

PubMed Central

Farrell, Brad J; Prilutsky, Boris I; Kistenberg, Robert S; Dalton, John F; Pitkin, Mark

2014-01-01

Background Despite the number of advantages of bone-anchored prostheses, their use in patients is limited due to the lack of complete skin-implant integration. The objective of the present study was to develop an animal model that would permit both detailed investigations of gait with a bone-anchored limb prosthesis and histological analysis of the skin-implant-bone interface after physiological loading of the implant during standing and walking. Methods Full-body mechanics of walking in two cats was recorded and analyzed before and after implantation of a percutaneous porous titanium pylon into the right tibia and attachment of a prosthesis. The rehabilitation procedures included initial limb casting, progressively increasing loading of implant, and standing and locomotor training. Detailed histological analysis of bone and skin ingrowth into implant was performed at the end of the study. Findings The two animals adopted the bone-anchored prosthesis for standing and locomotion, although loads on the prosthetic limb during walking decreased by 22% and 62%, respectively, 4 months after implantation. The animals shifted body weight to the contralateral side and increased propulsion forces by the contralateral hindlimb. Histological analysis of the limb implants demonstrated bone and skin ingrowth. Interpretation The developed animal model to study prosthetic gait and tissue integration with the implant demonstrated that porous titanium implants may permit bone and skin integration and prosthetic gait with a prosthesis. Future studies with this model will help optimize the implant and prosthesis properties. PMID:24405567

Bacterial colonization of penile prosthesis after its withdrawal due to mechanical failure.

PubMed

Etcheverry-Giadrosich, B; Torremadé-Barreda, J; Pujol-Galarza, L; Vigués-Julià, F

2017-12-01

Prosthetic surgery to treat erectile dysfunction has a risk of infection of up to 3%, but this risk can increase to 18% when the surgery involves replacement. This increased risk of infection is attributed to the bacterial colonization of the prosthesis during the initial surgery. To analyse the presence of germs in the prosthesis that is withdrawn due to mechanical failure (not infection), as well as the surgical results and its progression. A retrospective study was conducted of all replacements performed between 2013 and 2016 at a single centre. We analysed demographic data, prior type of prosthesis, surgical procedure, microbiological study and follow-up. Of the 12 replacement procedures, a microbiological study of the extracted prosthesis was performed in a total of 10 cases. Of the 10 replacements, the cultures were positive in 5 cases (50%). Staphylococcus epidermidis was the most prevalent germ. All patients underwent a flushing procedure, and an antibiotic-coated prosthesis was implanted. We recorded no infections with the new implanted device after a mean follow-up of 27.33 months (SD 4.13; 95% CI 18.22-36.43). In our study population, we observed a high rate of bacterial colonization of the prostheses that were replaced due to mechanical failure. When a flushing procedure was performed during the replacement surgery, there were no more infections than those reported in treatment-naive cases. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture.

PubMed

Beaman, Douglas N; Gellman, Richard

2014-12-01

Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns. (1) How long does it take the fracture to heal and the arthrodesis to fuse when primary ankle arthrodesis is a component of initial fracture management? (2) How do these patients fare clinically in terms of modified American Orthopaedic Foot and Ankle Society (AOFAS) scores and activity levels after this treatment? (3) Does primary ankle arthrodesis heal in an acceptable position when anterior ankle arthrodesis plates are used? During a 2-year period, we performed open fracture reduction and internal fixation in 63 patients. Eleven patients (12 ankles) with severely comminuted high-energy tibial pilon fractures were retrospectively reviewed after surgical treatment with primary ankle arthrodesis and fracture reduction. Average patient age was 58 years, and minimum followup was 6 months (average, 14 months; range, 6-22 months). Anatomically designed anterior ankle arthrodesis plates were used in 10 ankles. Ring external fixation was used in nine ankles with concomitant tibia fracture or in instances requiring additional fixation. Clinical evaluation included chart review, interview, the AOFAS ankle-hindfoot score, and radiographic evaluation. All of the ankle arthrodeses healed at an average of 4.4 months (range, 3-5 months). One patient had a nonunion at the metaphyseal fracture, which healed with revision surgery. The average AOFAS ankle-hindfoot score was 83 with 88% having an excellent or good result. Radiographic and clinical analysis confirmed a plantigrade foot without malalignment. No patients required revision surgery for malunion. Primary ankle arthrodesis combined with fracture reduction for the severely comminuted tibial pilon fracture reliably healed and restored acceptable function in this highly selective patient group. Ring external fixation may be a useful adjunct to internal fixation, and this concept should be further studied. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The "caviar" madreporic knee prosthesis.

PubMed

Kenesi, C

1979-01-01

The madreporic ("caviar") prosthesis is a hinged knee prosthesis that can be inserted without the use of cement. The surfaces of the intramedullary stems are constructed with contiguous spheres one mm in diameter. These spaces are filled by bone trabeculae and haversian bone, providing permanent biologic fixation. Experimental madreporic knee arthroplasties in dogs show that bone probes these surfaces and produces solid attachments. Histologically, the trabeculae remain separated from the metal by a fine layer of fibrous tissue. The method of insertion of the prosthesis is simple. Preparing the epiphyses before any bone resection avoids the possibility of rotational positioning errors. The form of the intramedullary stems offers good positioning in the frontal plane. The analysis of an initial series of 15 cases shows results that are far from outstanding. The 2 deaths, the 2 cases of sepsis, and the recuperation of only mediocre motion can be explained, at least in part, by the advanced age of the patients and the poor bone quality of the rheumatoid patients. Nevertheless, this type of prosthesis has 2 important advantages. It avoids the complications from the use of acrylic cement and allows for a revision operation for cases of failed surface replacement designs. Obviously further experimentation with noncemented designs will continue and definitive studies will be reported later.

Comparison of hearing results of nitinol SMART stapes piston prosthesis with conventional piston prostheses: postoperative results of nitinol stapes prosthesis.

PubMed

Harris, Jeffrey P; Gong, Shusheng

2007-08-01

Recently, a new stapedotomy piston prosthesis, which is a composite metal alloy of nickel and titanium known as nitinol, has been introduced into medical use. This biocompatible alloy has the unique property of shape-memory, which permits tight self-crimping when heat is applied to the wire. To substantiate the favorable initial observations with the SMART piston, this study was undertaken to compare these results (n=26) with those obtained using conventional stainless steel or platinum ribbon prostheses (n=28). Prospective consecutive case review: consecutive cases performed by the same surgeon were analyzed. Tertiary referral center. Fifty-four healthy patients with otosclerosis. Stapedotomy using either SMART prosthesis or conventional prosthesis. Hearing outcomes by audiological assessment. The postoperative hearing mean pure-tone average was 24.81+/-16.20 dBHL for Group 1 (SMART prosthesis) and 27.46+/-15.57 dBHL for Group 2 (conventional prosthesis). Postoperative mean air-bone gap was 7.07+/-8.14 dBHL for Group 1 and 6.38+/-7.54 dBHL for Group 2 using 0.5-, 1-, 2-, and 4-kHz frequencies. When analyzed according to the American Academy of Otolaryngology-Head & Neck Surgery reporting criteria using an estimate of 3 kHz as a mean of the 2-and 4-kHz values, the postoperative mean air-bone gap was 5.42+/-5.4 dBHL for Group 1 SMART and 5.98+/-5.47 dBHL for Group 2 conventional prostheses. Postoperative speech discrimination scores were 96%+/-8.64% and 97%+/-5.9%, respectively. These differences were not shown to be statistically different. Results demonstrate that experienced surgeons may achieve comparable results with both prostheses; however, the ease of self-crimping and the tightness of the crimp may provide advantages that may have long-term benefits. The potential issue of nickel allergy is important when considering patients for this prosthesis.

Review of a single surgeon's stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period.

PubMed

Justicz, Natalie; Strickland, Kaitlyn F; Motamedi, Kevin K; Mattox, Douglas E

2017-04-01

Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes. To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis. A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4 kHz. Average air-bone gaps (ABG) were calculated from pre-operative and post-operative audiograms. Average pre-operative baseline PTA was 56.7 dB in the affected ear. Post-operative PTA was 30.1 dB, a 26.6 dB improvement. Initial average ABG was 29.7 dB, while post-operative ABG averaged 5.4 dB, a 24.2 dB improvement. Surgical success (closure of ABG within 10 dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3).

Transition from a failing dentition to a removable implant-supported prosthesis: a staged approach.

PubMed

Cordaro, Luca; Torsello, Ferruccio; Ribeiro, Carlos Accorsi

2010-05-01

Patients with hopeless dentition often present difficulties in the management of the transitional phase to the final restoration. This article describes a staged approach to achieve a full-arch, implant-supported, removable prosthesis in patients with a hopeless dentition. The approach described allows the clinician to proceed in a staged manner and facilitate prosthetic steps by keeping fixed references for vertical dimension. This technique includes initial conservative periodontal care and, afterward, extraction of some strategic teeth, while others are temporarily maintained. At this point, the implants are positioned, and during the healing period, the remaining natural abutments are used for occlusal reference and to stabilize the removable provisional prosthesis. After osseointegration of the implants, the residual teeth are extracted and the final prosthesis is delivered. The main advantages of the technique include maintenance of function during treatment, stabilization of the removable provisional (especially in the mandibular arch), prosthetic-guided insertion of implants, and easier retrieval of prosthetic references. The main drawbacks are longer treatment time and the need for two surgical steps.

Collar height and heel counter-stiffness for ankle stability and athletic performance in basketball.

PubMed

Liu, Hui; Wu, Zitian; Lam, Wing-Kai

2017-01-01

This study examined the effects of collar height and heel counter-stiffness of basketball shoes on ankle stability during sidestep cutting and athletic performance. 15 university basketball players wore customized shoes with different collar heights (high and low) and heel counter-stiffness (regular, stiffer and stiffest) for this study. Ankle stability was evaluated in sidestep cutting while athletic performance evaluated in jumping and agility tasks. All variables were analysed using two-way repeated ANOVA. Results showed shorter time to peak ankle inversion for both high collar and stiff heel counter conditions (P < 0.05), while smaller initial ankle inversion angle, peak inversion velocity and total range of inversion for wearing high collar shoes (P < 0.05). No shoe differences were found for performance variables. These findings imply that the collar height might play a larger role in lateral stability than heel counter-stiffness, while both collar height and counter-stiffness have no effect on athletic performance.

Acute and Chronic Lateral Ankle Instability Diagnosis, Management, and New Concepts.

PubMed

Shakked, Rachel; Sheskier, Steven

2017-01-01

Lateral ankle instability is a common entity that can result in degenerative arthritis if left untreated. Acute ligament injuries should primarily be treated nonoperatively with a course of physical therapy and functional bracing. Chronic ankle instability is defined as mechanical or functional and can be diagnosed using a combination of history, physical examination, stress radiographs, and magnetic resonance imaging. After failure of nonoperative treatment, surgical treatment with anatomic ligament repair and inferior extensor retinaculum augmentation has the best clinical outcomes. Patients with high athletic demands, ligamentous instability, and failure of initial surgical treatment may do better with an anatomic ligament reconstruction or combined ligament repair with peroneus brevis transfer. Those patients with underlying foot deformity benefit from deformity correction in addition to ligament repair or reconstruction. Ankle arthroscopy is an important component of ankle instability to treat the commonly associated intraarticular lesions; however, all-arthroscopic ligament repair is associated with a high complication rate, and techniques may not be perfected as of yet.

[Treatment of periprosthetic and peri-implant fractures : modern plate osteosynthesis procedures].

PubMed

Raschke, M J; Stange, R; Kösters, C

2012-11-01

Periprosthetic fractures are increasing not only due to the demographic development with high life expectancy, the increase in osteoporosis and increased prosthesis implantation but also due to increased activity of the elderly population. The therapeutic algorithms are manifold but general valid rules for severe fractures are not available. The most commonly occurring periprosthetic fractures are proximal and distal femoral fractures but in the clinical routine fractures of the tibial head, ankle, shoulder, elbow and on the borders to other implants (peri-implant fractures) and complex interprosthetic fractures are being seen increasingly more. It is to be expected that in the mid-term further options, such as cement augmentation of cannulated polyaxial locking screws will extend the portfolio of implants for treatment of periprosthetic fractures. The aim of this review article is to present the new procedures for osteosynthesis of periprosthetic fractures.

[Treatment of periprosthetic and peri-implant fractures : modern plate osteosynthesis procedures].

PubMed

Raschke, M J; Stange, R; Kösters, C

2012-08-01

Periprosthetic fractures are increasing not only due to the demographic development with high life expectancy, the increase in osteoporosis and increased prosthesis implantation but also due to increased activity of the elderly population. The therapeutic algorithms are manifold but general valid rules for severe fractures are not available. The most commonly occurring periprosthetic fractures are proximal and distal femoral fractures but in the clinical routine fractures of the tibial head, ankle, shoulder, elbow and on the borders to other implants (peri-implant fractures) and complex interprosthetic fractures are being seen increasingly more. It is to be expected that in the mid-term further options, such as cement augmentation of cannulated polyaxial locking screws will extend the portfolio of implants for treatment of periprosthetic fractures. The aim of this review article is to present the new procedures for osteosynthesis of periprosthetic fractures.

Anterolateral ankle impingement in adolescents: outcomes of nonoperative and operative treatment.

PubMed

Edmonds, Eric W; Chambers, Reid; Kaufman, Elizabeth; Chambers, Henry G

2010-03-01

Ankle sprains in adolescents usually resolve with conservative management but a few patients may develop ankle impingement syndrome. There have been adult studies addressing surgical treatment of this pathology, but our study evaluated the surgical management of anterolateral ankle impingement in adolescents by comparing their outcomes after nonoperative treatment and subsequent surgical intervention. Thirteen patients (children and adolescents) diagnosed with ankle impingement by history, physical examination, and magnetic resonance imaging during a 9-year period at our institution underwent eventual arthroscopic debridement. A retrospective chart review of these patients was performed and they were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale on 3 separate occasions: (1) initial presentation, (2) termination of nonoperative management, and (3) final postoperative follow-up visit. Thirteen adolescents (11 girls and 2 boys; 14 ankles) with a mean age of 15.6 (11.9-18.3) years met the inclusion criteria; of these, all had arthroscopic surgery. Mean duration of reported symptoms was 9.6 (4-15) months and mean duration of nonoperative management (physical therapy, activity modifications) was 6.9 (2-12) months. The mean AOFAS rating (out of 100 total) at initial presentation was 68.4 (40-84) and after nonoperative management was no better with a mean of 68.2 (63-76). The mean AOFAS rating at final follow-up was 90.6 (52-100), which was statistically significant (P

Effectiveness of exercise therapy and manual mobilisation in ankle sprain and functional instability: a systematic review.

PubMed

van der Wees, Philip J; Lenssen, Anton F; Hendriks, Erik J M; Stomp, Derrick J; Dekker, Joost; de Bie, Rob A

2006-01-01

This study critically reviews the effectiveness of exercise therapy and manual mobilisation in acute ankle sprains and functional instability by conducting a systematic review of randomised controlled trials. Trials were searched electronically and manually from 1966 to March 2005. Randomised controlled trials that evaluated exercise therapy or manual mobilisation of the ankle joint with at least one clinically relevant outcome measure were included. Internal validity of the studies was independently assessed by two reviewers. When applicable, relative risk (RR) or standardised mean differences (SMD) were calculated for individual and pooled data. In total 17 studies were included. In thirteen studies the intervention included exercise therapy and in four studies the effects of manual mobilisation of the ankle joint was evaluated. Average internal validity score of the studies was 3.1 (range 1 to 7) on a 10-point scale. Exercise therapy was effective in reducing the risk of recurrent sprains after acute ankle sprain: RR 0.37 (95% CI 0.18 to 0.74), and with functional instability: RR 0.38 (95% CI 0.23 to 0.62). No effects of exercise therapy were found on postural sway in patients with functional instability: SMD: 0.38 (95% CI -0.15 to 0.91). Four studies demonstrated an initial positive effect of different modes of manual mobilisation on dorsiflexion range of motion. It is likely that exercise therapy, including the use of a wobble board, is effective in the prevention of recurrent ankle sprains. Manual mobilisation has an (initial) effect on dorsiflexion range of motion, but the clinical relevance of these findings for physiotherapy practice may be limited.

Treatment of common deficits associated with chronic ankle instability.

PubMed

Holmes, Alison; Delahunt, Eamonn

2009-01-01

Lateral ankle sprains are amongst the most common injuries incurred by athletes, with the high rate of reoccurrence after initial injury becoming of great concern. Chronic ankle instability (CAI) refers to the development of repetitive ankle sprains and persistent residual symptoms post-injury. Some of the initial symptoms that occur in acute sprains may persist for at least 6 months post-injury in the absence of recurrent sprains, despite the athlete having returned to full functional activity. CAI is generally thought to be caused by mechanical instability (MI) or functional instability (FI), or both. Although previously discussed as separate entities, recent research has demonstrated that deficits associated with both MI and FI may co-exist to result in CAI. For clinicians, the main deficits associated with CAI include deficits in proprioception, neuromuscular control, strength and postural control. Based on the literature reviewed, it does seem that subjects with CAI have a deficit in frontal plane ankle joint positional sense. Subjects with CAI do not appear to exhibit any increased latency in the peroneal muscles in response to an external perturbation. Preliminary data suggest that feed-forward neuromuscular control may be more important than feed-back neuromuscular control and interventions are now required to address deficits in feed-forward neuromuscular control. Balance training protocols have consistently been shown to improve postural stability in subjects with CAI. Subjects with CAI do not experience decreased peroneus longus strength, but instead may experience strength deficits in the ankle joint invertor muscles. These findings are of great clinical significance in terms of understanding the mechanisms and deficits associated with CAI. An appreciation of these is vital to allow clinicians to develop effective prevention and treatment programmes in relation to CAI.

Ankle Ranges of Motion During Extended Activity Periods While Taped and Braced

PubMed Central

Paris, David L.; Kokkaliaris, Jimmy; Vardaxis, Vassilios

1995-01-01

Tape has traditionally been used to support the ankle during activity. More recently, commercial ankle braces have been worn as an alternative. The cumulative information on the effects of taped versus braced ankle support or interbrace comparisons is inconclusive. With few exceptions, ankle brace studies have collected data soon after support conditions were administered. Plantar-dorsiflexion and inversion-eversion ranges of motion (ROM) of 30 subjects were compared under conditions of unsupported, nonelastic adhesivetaped, and Swede-O and Sub Talar Support-braced ankles. We recorded measurements before activity and after periods of 15, 30, 45, and 60 minutes of selected activity on a motorized treadmill. All support conditions significantly reduced preactivity ROM in all directions compared to unsupported ankles. Results showed that the ankle significantly increased in plantarflexion ROM 15 minutes after the initiation of activity with tape or the SubTalar Support-brace, and after 30 minutes with the Swede-O brace. Tape showed further significant increases in plantarflexion ROM after 15-minute intervals of 30, 45, and 60 minutes of activity. All three support conditions had increased significantly in inversion ROM by 15 minutes of activity. The SubTalar Support brace showed a further significant inversion ROM increase between 15 and 30 minutes postactivity. We conclude that the Swede-O and SubTalar Support braces and tape offer significant preactivity ankle support in all four directions of movement. We also conclude that both braces offer longer postactivity support than tape. In inversion ROM and plantarflexion ROM, actions prevalent in ankle sprains, the Swede-O brace retained support longer than the SubTalar Support brace. ImagesFig 1.Fig 2.Fig 3. PMID:16558340

Neural Excitability and Joint Laxity in Chronic Ankle Instability, Coper, and Control Groups

PubMed Central

Bowker, Samantha; Terada, Masafumi; Thomas, Abbey C.; Pietrosimone, Brian G.; Hiller, Claire E.; Gribble, Phillip A.

2016-01-01

Context:  Neuromuscular and mechanical deficiencies are commonly studied in participants with chronic ankle instability (CAI). Few investigators have attempted to comprehensively consider sensorimotor and mechanical differences among people with CAI, copers who did not present with prolonged dysfunctions after an initial ankle sprain, and a healthy control group. Objective:  To determine if differences exist in spinal reflex excitability and ankle laxity among participants with CAI, copers, and healthy controls. Design:  Case-control study. Setting:  Research laboratory. Patients or Other Participants:  Thirty-seven participants with CAI, 30 participants categorized as copers, and 26 healthy control participants. Main Outcome Measure(s):  We assessed spinal reflex excitability of the soleus using the Hoffmann reflex protocol. Participants' ankle laxity was measured with an instrumented ankle arthrometer. The maximum Hoffmann reflex : maximal muscle response ratio was calculated. Ankle laxity was measured as the total displacement in the anterior-posterior directions (mm) and total rotation in the inversion and eversion directions (°). Results:  Spinal reflex excitability was diminished in participants with CAI compared with copers and control participants (P = .01). No differences were observed among any of the groups for ankle laxity. Conclusion:  Changes in the spinal reflex excitability of the soleus that likely affect ankle stability were seen only in the CAI group, yet no mechanical differences were noted across the groups. These findings support the importance of finding effective ways to increase spinal reflex excitability for the purpose of treating neural excitability dysfunction in patients with CAI. PMID:27065189

Comparative gait analysis of ankle arthrodesis and arthroplasty: initial findings of a prospective study.

PubMed

Hahn, Michael E; Wright, Elise S; Segal, Ava D; Orendurff, Michael S; Ledoux, William R; Sangeorzan, Bruce J

2012-04-01

Little is known about functional outcomes of ankle arthroplasty compared with arthrodesis. This study compared pre-surgical and post-surgical gait measures in both patient groups. Eighteen patients with end-stage ankle arthritis participated in an ongoing longitudinal study (pre-surgery, 12 months post-surgery) involving gait analysis, assessment of pain and physical function. Outcome measures included temporal-distance, kinematic and kinetic data, the Short Form 36 (SF-36) body pain score, and average daily step count. A mixed effects linear model was used to detect effects of surgical group (arthrodesis and arthroplasty, n = 9 each) with walking speed as a covariate (α = 0.05). Both groups were similar in demographics and anthropometrics. Followup time was the same for each group. There were no complications in either group. Pain decreased (p < 0.001) and gait function improved (gait velocity, p = 0.02; stride length, p = 0.035) in both groups. Neither group increased average daily step count. Joint range of motion (ROM) differences were observed between groups after surgery (increased hip ROM in arthrodesis, p = 0.001; increased ankle ROM in arthroplasty, p = 0.036). Peak plantar flexor moment increased in arthrodesis patients and decreased in arthroplasty patients (p = 0.042). Initial findings of this ongoing clinical study indicate pain reduction and improved gait function 12 months after surgery for both treatments. Arthroplasty appears to regain more natural ankle joint function, with increased ROM. Long-term follow up should may reveal more clinically meaningful differences.

An articulated ankle-foot orthosis with adjustable plantarflexion resistance, dorsiflexion resistance and alignment: A pilot study on mechanical properties and effects on stroke hemiparetic gait

PubMed Central

Kobayashi, Toshiki; Orendurff, Michael S.; Hunt, Grace; Lincoln, Lucas S.; Gao, Fan; LeCursi, Nicholas; Foreman, K. Bo

2017-01-01

Mechanical properties of an articulated ankle-foot orthosis (AFO) are closely related to gait performance in individuals post-stroke. This paper presents a pilot study on the mechanical properties of a novel articulated AFO with adjustable plantarflexion resistance, dorsiflexion resistance and alignment, and its effect on ankle and knee joint kinematics and kinetics in an individual post-stroke during gait. The mechanical properties of the AFO were quantified. Gait analysis was performed using a 3D motion capture system with a split-belt instrumented treadmill under 12 different settings of the mechanical properties of the AFO [i.e. 4 plantarflexion resistances (P1

Altered Kinematics and Time to Stabilization During Drop-Jump Landings in Individuals With or Without Functional Ankle Instability

PubMed Central

Wright, Cynthia J.; Arnold, Brent L.; Ross, Scott E.

2016-01-01

Context It has been proposed that altered dynamic-control strategies during functional activity such as jump landings may partially explain recurrent instability in individuals with functional ankle instability (FAI). Objective To capture jump-landing time to stabilization (TTS) and ankle motion using a multisegment foot model among FAI, coper, and healthy control individuals. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Participants were 23 individuals with a history of at least 1 ankle sprain and at least 2 episodes of giving way in the past year (FAI), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers), and 23 individuals with no history of ankle sprain or instability in their lifetime (controls). Participants were matched for age, height, and weight (age = 23.3 ± 3.8 years, height = 1.71 ± 0.09 m, weight = 69.0 ± 13.7 kg). Intervention(s) Ten single-legged drop jumps were recorded using a 12-camera Vicon MX motion-capture system and a strain-gauge force plate. Main Outcome Measures Mediolateral (ML) and anteroposterior (AP) TTS in seconds, as well as forefoot and hindfoot sagittal- and frontal-plane angles at jump-landing initial contact and at the point of maximum vertical ground reaction force were calculated. Results For the forefoot and hindfoot in the sagittal plane, group differences were present at initial contact (forefoot: P = .043, hindfoot: P = .004). At the hindfoot, individuals with FAI displayed more dorsiflexion than the control and coper groups. Time to stabilization differed among groups (AP TTS: P < .001; ML TTS: P = .040). Anteroposterior TTS was longer in the coper group than in the FAI or control groups, and ML TTS was longer in the FAI group than in the control group. Conclusions During jump landings, copers showed differences in sagittal-plane control, including less plantar flexion at initial contact and increased AP sway during stabilization, which may contribute to increased dynamic stability. PMID:26794631

Influencing factors of outcome after lower-limb amputation: a five-year review in a plastic surgical department.

PubMed

Chen, Meng-Chum; Lee, Su-Shin; Hsieh, Ya-Lun; Wu, Shu-Jung; Lai, Chung-Sheng; Lin, Sin-Daw

2008-09-01

The crude major lower limb amputation procedure rate is 8.8 per 100,000 of the population per year in Taiwan. From January 2002 to October 2006, patients that received major lower limb amputation in our department were enrolled in this study. Retrospective chart reviews concerning different factors that can affect the eventual postoperative functional status were investigated. Factors that affected the length of hospital stay included duration before amputation (P < 0.001) and renal function (P = 0.045). Phantom limb pain was affected by wound healing time (P = 0.006). Factors that affected the daily prosthesis usage time were initial infection status (P = 0.021), renal function (P = 0.01), patient educational level (P = 0.016), and pretraining waiting time (P = 0.003). The duration of prosthetic training was affected by patient educational level (P = 0.004) and marital status (P = 0.024). In addition, subjective satisfaction about the usage of prosthesis was affected by pretraining waiting time (P = 0.001) and daily prosthesis usage time (P < 0.001). The daily prosthesis usage time was closely related to life quality improvement (P < 0.001) and subjective satisfaction of prosthesis usage (P < 0.001). Despite reported unchangeable factors like age, end-stage renal disease, dementia, coronary artery disease, and level of amputation, preprosthesis training waiting time significantly affected the satisfaction and daily usage time of the prosthesis. Surgeons can make some contribution to accelerate amputation wound healing and stump maturation by choosing the correct operating procedure, delicately managing the soft tissue, and ascertaining proper wound care to improve the outcome.

Individual Responses to a Barefoot Running Program: Insight Into Risk of Injury.

PubMed

Tam, Nicholas; Tucker, Ross; Astephen Wilson, Janie L

2016-03-01

Barefoot running is of popular interest because of its alleged benefits for runners, including reduced injury risk and increased economy of running. There is a dearth in understanding whether all runners can gain the proposed benefits of barefoot running and how barefoot running may affect long-term injury risk. The purpose of this study was to determine whether runners can achieve the proposed favorable kinematic changes and reduction in loading rate after a progressive training program that included barefoot running. It was hypothesized that not all individuals would experience a decrease in initial loading rate facilitated by increased ankle plantar flexion after a progressive barefoot running program; it was further hypothesized that relationships exist between changes in initial loading rate and sagittal ankle angle. Descriptive laboratory study. A total of 26 habitually shod runners completed an 8-week, progressively introduced barefoot running program. Pre- and postintervention barefoot and shod kinematics, electromyography, and ground-reaction force data of the lower limb were collected. Ankle and knee kinematics and kinetics, initial loading rates, spatiotemporal variables, muscle activity during preactivation, and ground contact were assessed in both conditions before and after the intervention. Individual responses were analyzed by separating runners into nonresponders, negative responders, and positive responders based on no change, increase, and decrease in barefoot initial loading rate, respectively. No biomechanical changes were found in the group after the intervention. However, condition differences did persist during both preactivation and ground contact. The positive-responder group had greater plantar flexion, increased biceps femoris and gluteus medius preactivation, and decreased rectus femoris muscle activity between testing periods. The negative responders landed in greater barefoot dorsiflexion after the intervention, and the nonresponders did not change. An overall change in ankle flexion angle was associated with a change in initial loading rate (r(2) = 0.345, P = .002) in the barefoot but not shod condition. Eight weeks of progressive barefoot running did not change overall group biomechanics, but subgroups of responders (25% of the entire group) were identified who had specific changes that reduced the initial loading rate. It appears that changes in initial loading rate are explained by changes in ankle flexion angle at initial ground contact. Uninstructed barefoot running training does not reduce initial loading rate in all runners transitioning from shod to barefoot conditions. Some factors have been identified that may assist sports medicine professionals in the evaluation and management of runners at risk of injury. Conscious instruction to runners may be required for them to acquire habitual barefoot running characteristics and to reduce risk of injury. © 2016 The Author(s).

The influences of sex and posture on joint energetics during drop landings.

PubMed

Norcross, M F; Shultz, S J; Weinhold, P S; Lewek, M D; Padua, D A; Blackburn, J T

2015-04-01

Previous observations suggest that females utilize a more erect initial landing posture than males with sex differences in landing posture possibly related to sex-specific energy absorption (EA) strategies. However, sex-specific EA strategies have only been observed when accompanied by sex differences in initial landing posture. This study (a) investigated the potential existence of sex-specific EA strategies; and (b) determined the influences of sex and initial landing posture on the biomechanical determinants of EA. The landing biomechanics of 80 subjects were recorded during drop landings in Preferred, Flexed, and Erect conditions. No sex differences in joint EA were identified after controlling for initial landing posture. Males and females exhibited greater ankle EA during Erect vs Flexed landings with this increase driven by 12% greater ankle velocity, but no change in ankle extensor moment. No differences in hip and knee EA were observed between conditions. However, to achieve similar knee EA, subjects used 7% greater mean knee extensor moment but 9% less knee angular velocity during Flexed landings. The results suggest that sex-specific EA strategies do not exist, and that the magnitude of knee joint EA can be maintained by modulating the relative contributions of joint moment and angular velocity to EA. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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. Copyright 2009 Elsevier Ltd. All rights reserved.

The influence of joint rigidity on impact efficiency and ball velocity in football kicking.

PubMed

Peacock, James C A; Ball, Kevin

2018-04-11

Executing any skill with efficiency is important for performance. In football kicking, conflicting and non-significant results have existed between reducing ankle plantarflexion during foot-ball contact with impact efficiency, making it unclear as to its importance as a coaching instruction. The aims of this study were to first validate a mechanical kicking machine with a non-rigid ankle, and secondly compare a rigid to a non-rigid ankle during the impact phase of football kicking. Measures of foot-ball contact for ten trials per ankle configuration were calculated from data recorded at 4000 Hz and compared. The non-rigid ankle was characterised by initial dorsiflexion followed by plantarflexion for the remainder of impact, and based on similarities to punt and instep kicking, was considered valid. Impact efficiency (foot-to-ball speed ratio) was greater for the rigid ankle (rigid = 1.16 ± 0.02; non-rigid = 1.10 ± 0.01; p < 0.001). The rigid ankle was characterised by significantly greater effective mass and significantly less energy losses. Increasing rigidity allowed a greater portion of mass from the shank to be used during the collision. As the ankle remained in plantarflexion at impact end, stored elastic energy was not converted to ball velocity and was considered lost. Increasing rigidity is beneficial for increasing impact efficiency, and therefore ball velocity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Intermanual transfer in training with an upper-limb myoelectric prosthesis simulator: a mechanistic, randomized, pretest-posttest study.

PubMed

Romkema, Sietske; Bongers, Raoul M; van der Sluis, Corry K

2013-01-01

Intermanual transfer may improve prosthetic handling and acceptance if used in training soon after an amputation. The purpose of this study was to determine whether intermanual transfer effects can be detected after training with a myoelectric upper-limb prosthesis simulator. A mechanistic, randomized, pretest-posttest design was used. A total of 48 right-handed participants (25 women, 23 men) who were able-bodied were randomly assigned to an experimental group or a control group. The experimental group performed a training program of 5 days' duration using the prosthesis simulator. To determine the improvement in skill, a test was administered before, immediately after, and 6 days after training. The control group only performed the tests. Training was performed with the unaffected arm, and tests were performed with the affected arm (the affected arm simulating an amputated limb). Half of the participants were tested with the dominant arm and half with the nondominant arm. Initiation time was defined as the time from starting signal until start of the movement, movement time was defined as the time from the beginning of the movement until completion of the task, and force control was defined as the maximal applied force on a deformable object. The movement time decreased significantly more in the experimental group (F₂,₉₂=7.42, P=.001, η²(G)=.028) when compared with the control group. This finding is indicative of faster handling of the prosthesis. No statistically significant differences were found between groups with regard to initiation time and force control. We did not find a difference in intermanual transfer between the dominant and nondominant arms. The training utilized participants who were able-bodied in a laboratory setting and focused only on transradial amputations. Intermanual transfer was present in the affected arm after training the unaffected arm with a myoelectric prosthesis simulator, and this effect did not depend on laterality. This effect may improve rehabilitation of patients with an upper-limb amputation.

Analysis of PITFL injuries in rotationally unstable ankle fractures.

PubMed

Warner, Stephen J; Garner, Matthew R; Schottel, Patrick C; Hinds, Richard M; Loftus, Michael L; Lorich, Dean G

2015-04-01

Reduction and stabilization of the syndesmosis in unstable ankle fractures is important for ankle mortise congruity and restoration of normal tibiotalar contact forces. Of the syndesmotic ligaments, the posterior inferior tibiofibular ligament (PITFL) provides the most strength for maintaining syndesmotic stability, and previous work has demonstrated the significance of restoring PITFL function when it remains attached to a posterior malleolus fracture fragment. However, little is known regarding the nature of a PITFL injury in the absence of a posterior malleolus fracture. The goal of this study was to describe the PITFL injury pattern based on magnetic resonance imaging (MRI) and intraoperative observation. A prospective database of all operatively treated ankle fractures by a single surgeon was used to identify all supination-external rotation (SER) types III and IV ankle fracture patients with complete preoperative orthogonal ankle radiographs and MRI. All patients with a posterior malleolus fracture were excluded. Using a combination of preoperative imaging and intraoperative findings, we analyzed the nature of injuries to the PITFL. In total, 185 SER III and IV operatively treated ankle fractures with complete imaging were initially identified. Analysis of the preoperative imaging and operative reports revealed 34% (63/185) had a posterior malleolus fracture and were excluded. From the remaining 122 ankle fractures, the PITFL was delaminated from the posterior malleolus in 97% (119/122) of cases. A smaller proportion (3%; 3/122) had an intrasubstance PITFL rupture. Accurate and stable syndesmotic reduction is a significant component of restoring the ankle mortise after unstable ankle fractures. In our large cohort of rotationally unstable ankle fractures without posterior malleolus fractures, we found that most PITFL injuries occur as a delamination off the posterior malleolus. This predictable PITFL injury pattern may be used to guide new methods for stabilizing the syndesmosis in these patients. Level IV, case series. © The Author(s) 2014.

Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes.

PubMed

Issa, Kimona; Naziri, Qais; Kapadia, Bhaveen H; Lamm, Bradley M; Jones, Lynne C; Mont, Michael A

2014-05-07

The purposes of this study were to describe the clinical manifestations of osteonecrosis involving the distal tibia and talus, to identify risk factors associated with the disease, and to evaluate the efficacy of percutaneous drilling for the treatment of ankles with early-stage symptomatic osteonecrosis. One hundred and one ankles in seventy-three patients with symptomatic osteonecrosis of the talus and/or distal tibia treated with percutaneous drilling were identified. There were eighty-one ankles in fifty-nine patients treated only at our institution and twenty ankles in fourteen patients with a failed prior core decompression at outside institutions. The parameters evaluated included demographics, disease characteristics, clinical outcomes including the American Orthopaedic Foot & Ankle Society score, Short-Form-36 scores, University of California Los Angeles activity scores, and visual analog scale pain scores, and radiographic outcomes at a mean follow-up duration of five years (range, two to nine years). Eighty-five ankles had isolated talus osteonecrosis, eleven ankles had involvement of the distal tibia and talus, and five ankles had isolated distal tibial disease. Twenty-nine patients (40%) had initially presented with symptomatic osteonecrosis of another joint, most commonly the knee (37%), the hip (29%), and the shoulder (25%). The most common identifiable risk factors included chronic corticosteroid use (49.3%), alcohol abuse (35.6%), tobacco use (29%), and hypertension (20.5%). Overall, 83% of ankles did not demonstrate further disease progression after the procedure. There were significant improvements (p < 0.05) in clinical and patient-reported outcomes after surgical treatment. The presence of human immunodeficiency virus and sickle cell disease was associated with a higher odds ratio of disease progression to joint collapse. Osteonecrosis of the distal tibia and talus was usually part of multifocal disease, and concurrent knee osteonecrosis was more common than hip osteonecrosis. The results of the present study suggest that early-stage ankle osteonecrosis can be treated successfully with percutaneous drilling.

Just-in-time Design and Additive Manufacture of Patient-specific Medical Implants

NASA Astrophysics Data System (ADS)

Shidid, Darpan; Leary, Martin; Choong, Peter; Brandt, Milan

Recent advances in medical imaging and manufacturing science have enabled the design and production of complex, patient-specific orthopaedic implants. Additive Manufacture (AM) generates three-dimensional structures layer by layer, and is not subject to the constraints associated with traditional manufacturing methods. AM provides significant opportunities for the design of novel geometries and complex lattice structures with enhanced functional performance. However, the design and manufacture of patient-specific AM implant structures requires unique expertise in handling various optimization platforms. Furthermore, the design process for complex structures is computationally intensive. The primary aim of this research is to enable the just-in-time customisation of AM prosthesis; whereby AM implant design and manufacture be completed within the time constraints of a single surgical procedure, while minimising prosthesis mass and optimising the lattice structure to match the stiffness of the surrounding bone tissue. In this research, a design approach using raw CT scan data is applied to the AM manufacture of femoral prosthesis. Using the proposed just-in-time concept, the mass of the prosthesis was rapidly designed and manufactured while satisfying the associated structural requirements. Compressive testing of lattice structures manufactured using proposed method shows that the load carrying capacity of the resected composite bone can be recovered by up to 85% and the compressive stiffness of the AM prosthesis is statistically indistinguishable from the stiffness of the initial bone.

Decoding of Ankle Flexion and Extension from Cortical Current Sources Estimated from Non-invasive Brain Activity Recording Methods.

PubMed

Mejia Tobar, Alejandra; Hyoudou, Rikiya; Kita, Kahori; Nakamura, Tatsuhiro; Kambara, Hiroyuki; Ogata, Yousuke; Hanakawa, Takashi; Koike, Yasuharu; Yoshimura, Natsue

2017-01-01

The classification of ankle movements from non-invasive brain recordings can be applied to a brain-computer interface (BCI) to control exoskeletons, prosthesis, and functional electrical stimulators for the benefit of patients with walking impairments. In this research, ankle flexion and extension tasks at two force levels in both legs, were classified from cortical current sources estimated by a hierarchical variational Bayesian method, using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) recordings. The hierarchical prior for the current source estimation from EEG was obtained from activated brain areas and their intensities from an fMRI group (second-level) analysis. The fMRI group analysis was performed on regions of interest defined over the primary motor cortex, the supplementary motor area, and the somatosensory area, which are well-known to contribute to movement control. A sparse logistic regression method was applied for a nine-class classification (eight active tasks and a resting control task) obtaining a mean accuracy of 65.64% for time series of current sources, estimated from the EEG and the fMRI signals using a variational Bayesian method, and a mean accuracy of 22.19% for the classification of the pre-processed of EEG sensor signals, with a chance level of 11.11%. The higher classification accuracy of current sources, when compared to EEG classification accuracy, was attributed to the high number of sources and the different signal patterns obtained in the same vertex for different motor tasks. Since the inverse filter estimation for current sources can be done offline with the present method, the present method is applicable to real-time BCIs. Finally, due to the highly enhanced spatial distribution of current sources over the brain cortex, this method has the potential to identify activation patterns to design BCIs for the control of an affected limb in patients with stroke, or BCIs from motor imagery in patients with spinal cord injury.

Cohesive taping and short-leg casting in acute low-type ankle sprains in physically active patients.

PubMed

Uslu, Mustafa; Inanmaz, Mustafa E; Ozsahin, Mustafa; Isık, Cengiz; Arıcan, Mehmet; Gecer, Yavuz

2015-07-01

Cohesive taping is commonly used for the prevention or treatment of ankle sprain injuries. Short-leg cast immobilization or splinting is another treatment option in such cases. To determine the clinical efficacy and antiedema effects of cohesive taping and short-leg cast immobilization in acute low-type ankle sprains of physically active patients, we performed a preliminary clinical study to assess objective evidence for edema and functional patient American Orthopaedic Foot and Ankle Society (AOFAS) scores with these alternative treatments. Fifty-nine physically active patients were included: 32 in the taping group and 27 in the short-leg cast group within a year. If a sprain was moderate (grade II) or mild (grade I), we used functional taping or short-leg cast immobilization for 10 days. We evaluated the edema and the functional scores of the injured ankle using the AOFAS Clinical Rating System on days 1, 10, and 100. In each group, edema significantly decreased and AOFAS scores increased indicating that both treatment methods were effective. With the numbers available, no statistically significant difference could be detected. Each treatment method was effective in decreasing the edema and increasing the functional scores of the ankle. At the beginning of treatment, not only the level of edema but also the initial functional scores of the ankle and examinations are important in making decisions regarding the optimal treatment option.

Individual responses to alignment perturbations in socket reaction moments while walking in transtibial prostheses.

PubMed

Kobayashi, Toshiki; Orendurff, Michael S; Zhang, Ming; Boone, David A

2014-05-01

The alignment of transtibial prostheses has a systematic effect on the mean socket reaction moments in amputees. However, understanding their individual differences in response to alignment perturbations is also important for prosthetists to fully utilize the socket reaction moments for dynamic alignment in each unique patient. The aim of this study was to investigate individual responses to alignment perturbations in transtibial prostheses with solid-ankle-cushion-heel feet. A custom instrumented prosthesis alignment component was used to measure the socket reaction moments while walking in 11 amputees with transtibial prostheses under 17 alignment conditions, including 3° and 6° of flexion, extension, abduction, and adduction of the socket, 5mm and 10mm of anterior, posterior, lateral, and medial translation of the socket, and an initial baseline alignment. Coronal moments at 30% of stance and maximum sagittal moments were extracted for comparisons from each amputee. In the coronal plane, varus moment at 30% of stance was generally reduced by adduction or medial translation of the socket in all the amputees. In the sagittal plane, extension moment was generally increased by posterior translation or flexion of the socket; however, this was not necessarily the case for all the amputees. Individual responses to alignment perturbations are not always consistent, and prosthetists would need to be aware of this variance when addressing individual socket reaction moments during dynamic alignment in clinical setting. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Anophthalmia and microphthalmia requires multidisciplinary care. Many of the children also have other medical problems].

PubMed

Jugård, Ylva; Odersjö, Marie; Topa, Alexandra; Lindgren, Gun; Andersson Grönlund, Marita

2015-07-13

Anophthalmia/microphthalmia (A/M) are rare congenital eye malformations. Early intervention with ocular prosthesis can stimulate orbital growth and prevent facial asymmetry. We reviewed medical records from 18 individuals with A/M (0.8-31 years) treated with ocular prosthesis at Sahlgrenska University Hospital between 2000 and 2012. A majority had other ocular findings. Seven had subnormal visual acuity in the fellow eye, one third were in contact with vision support services and half of the group wore glasses. Eleven individuals had extra-ocular findings such as cardiac defect, hearing impairment and neuropsychiatric disorders, possibly indicating syndromic conditions. We suggest that investigation of A/M children should include ultrasound of the eye, optionally visual evoked potential and magnetic resonance imaging of the CNS. The ophthalmologist should initiate treatment with prosthesis, pediatric assessment, hearing tests and genetic counseling, but should also monitor visual development of the fellow eye.

Single-leg drop landing movement strategies in participants with chronic ankle instability compared with lateral ankle sprain 'copers'.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

To compare the movement patterns and underlying energetics of individuals with chronic ankle instability (CAI) to ankle sprain 'copers' during a landing task. Twenty-eight (age 23.2 ± 4.9 years; body mass 75.5 ± 13.9 kg; height 1.7 ± 0.1 m) participants with CAI and 42 (age 22.7 ± 1.7 years; body mass 73.4 ± 11.3 kg; height 1.7 ± 0.1 m) ankle sprain 'copers' were evaluated 1 year after incurring a first-time lateral ankle sprain injury. Kinematics and kinetics of the hip, knee and ankle joints from 200 ms pre-initial contact (IC) to 200 ms post-IC, in addition to the vertical component of the landing ground reaction force, were acquired during performance of a drop land task. The CAI group adopted a position of increased hip flexion during the landing descent on their involved limb. This coincided with a reduced post-IC flexor pattern at the hip and increased overall hip joint stiffness compared to copers (-0.01 ± 0.05 vs. 0.02 ± 0.05°/Nm kg(-1), p = 0.03). Individuals with CAI display alterations in hip joint kinematics and energetics during a unipodal landing task compared to LAS 'copers'. These alterations may be responsible for the increased risk of injury experienced by individuals with CAI during landing manoeuvres. Thus, clinicians must recognise the potential for joints proximal to the affected ankle to contribute to impaired function following an acute lateral ankle sprain injury and to develop rehabilitation protocols accordingly. Level III.

Task-specific ankle robotics gait training after stroke: a randomized pilot study.

PubMed

Forrester, Larry W; Roy, Anindo; Hafer-Macko, Charlene; Krebs, Hermano I; Macko, Richard F

2016-06-02

An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments. Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher's exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics. Treadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery. NCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1.

Management of chronic lateral ankle instability in military service members.

PubMed

Orr, Justin D; Robbins, Justin; Waterman, Brian R

2014-10-01

Chronic lateral ankle instability is a condition frequently encountered by orthopedic surgeons treating highly active patient populations, particularly military service members. Providers treating military service members must have a high index of suspicion for this condition when signs and symptoms of functional or mechanical instability exist. Stress testing and ankle MRI, although not definitive in sensitivity for detecting instability or other concomitant injuries, should be considered during the treatment decision-making process. Appropriate nonoperative treatment should be attempted initially; however, when nonoperative treatment fails, surgical management is warranted to prevent untoward long-term sequelae. Proper surgical treatment and subsequent postoperative management are at the discretion of the individual surgeon but must account for the concomitant diseases frequently associated with chronic lateral ankle instability. Low recurrence of lateral instability can be achieved even in high-demand military patient populations with a focused treatment plan. Published by Elsevier Inc.

Peroneal electromechanical delay and fatigue in patients with chronic ankle instability.

PubMed

Flevas, Dimitrios A; Bernard, Manfred; Ristanis, Stavros; Moraiti, Constantina; Georgoulis, Anastasios D; Pappas, Evangelos

2017-06-01

The purpose of this study was to investigate the effect of chronic ankle instability (CAI) on electromechanical delay times (EMD) before and after fatigue. Understanding the mechanisms that contribute to CAI is essential for the development of effective rehabilitation programmes. It was hypothesized that patients with CAI will demonstrate prolonged EMD times compared to healthy subjects and that fatigue will cause greater increases in EMD times in the CAI group. Twenty-one male volunteers participated in the study providing data on 16 ankles with CAI and 26 with no history of ankle injury. EMD was measured on an isokinetic dynamometer. Measurements were taken with the ankle in neutral (0°) and at 30° of inversion. All subjects followed an isokinetic fatigue protocol until eversion torque fell below 50 % of initial torque for three consecutive repetitions. A 2 × 2 × 2 ANOVA was used to calculate the effect of ankle status (CAI vs. healthy), fatigue, angle (0° vs. 30°) and their interactions on EMD. Fatigue caused a significant increase on EMD [non-fatigued: 122(29)ms vs. fatigue 155(54)ms; p < 0.001]. EMD times were shorter at 30° of inversion compared to neutral [neutral: 145(39)ms vs. 30° of inversion: 132(40)ms, p = 0.015]. An interaction effect for ankle status and angle was found (p = 0.026) with CAI ankles demonstrating longer EMD [CAI: 156(45)ms vs. healthy: 133(40)ms] in neutral but not at 30° of inversion [CAI: 133(46)ms vs. 132(33)ms]. Patients with CAI had longer EMD times in neutral, but not when the ankle was placed in inversion. This suggests that rehabilitation programmes may be more effective when retraining occurs with the ankle in neutral position. It is likely that low EMD times prevent ankle acceleration at the beginning of the mechanism of injury, but they are less important when the ankle has already inverted at 30°. Both CAI and healthy subjects demonstrated longer EMD after fatigue, emphasizing the importance of proper conditioning in the prevention of delayed peroneal response and subsequent ankle injury. Improving resistance to fatigue of the peroneals may prove to be an effective prevention tool of ankle sprain recurrence in patients with CAI. III.

Incidental Learning and Explicit Recall in Upper Extremity Prosthesis Use: Insights Into Functional Rehabilitation Challenges.

PubMed

Hughey, Laura; Wheaton, Lewis A

2016-01-01

Loss of an upper extremity and the resulting rehabilitation often requires individuals to learn how to use a prosthetic device for activities of daily living. It remains unclear how prostheses affect motor learning outcomes. The authors' aim was to evaluate whether incidental motor learning and explicit recall is affected in intact persons either using prostheses (n = 10) or the sound limb (n = 10), and a chronic amputee on a modified serial reaction time task. Latency and accuracy of task completion were recorded over six blocks, with a distractor task between blocks 5 and 6. Participants were also asked to recall the sequence immediately following the study and at a 24-hr follow-up. Prosthesis users demonstrate patterns consistent with implicit learning, with sustained error patterns with the distal terminal device. More intact individuals were able to explicitly recall the sequence initially, however there was no significant difference 24 hr following the study. Acute incidental motor learning does not appear to diminish task related error patterns or accompany with explicit recall in prosthesis users, which could present limitations for acute training of prosthesis use in amputees. This suggests differing mechanisms of visuospatial sequential learning and motor control with prostheses.

[Psychosocial aspects in the rehabilitation of patients with anophthalmic socket: implications of the use of ocular prosthesis].

PubMed

Goulart, Douglas Rangel; Queiroz, Elizabeth; Fernandes, Aline Úrsula Rocha; Oliveira, Luciana Martins de

2011-01-01

Facial integrity is a condition which interferes in the daily life of the individual. The loss of an eyeball has psychological impact, requiring adaptation. Interventions such as prosthetic repair seem to lead to emotional and behavioral change. The objective of this study was to identify the psychosocial aspects related to unilateral anophthalmic socket and evaluate patient adaptation to prosthesis. All participants responded to a semi-structured interview. This was composed of two parts, the first regarding the general data of patient identification and socioeconomic aspects. The second part included information about eye loss and rehabilitation, with 31 questions. Twenty-eight volunteers were interviewed. Most were male (53.57%). Ages ranged between 11 and 67. Trauma was the prevalent etiological factor (60.71%). A significant statistical difference (p<0.05) was found between the scores of the feelings of loss before and after prosthesis (z Wilcoxon=-4.41; p<0.001). The data showed emotional difficulties in the initial contact with the loss of an eye and the role of the prosthesis as an element of social inclusion, stressing the importance of teamwork and access to fitting services in adapting these patients.

Kinematic predictors of star excursion balance test performance in individuals with chronic ankle instability.

PubMed

Hoch, Matthew C; Gaven, Stacey L; Weinhandl, Joshua T

2016-06-01

The Star Excursion Balance Test has identified dynamic postural control deficits in individuals with chronic ankle instability. While kinematic predictors of Star Excursion Balance Test performance have been evaluated in healthy individuals, this has not been thoroughly examined in individuals with chronic ankle instability. Fifteen individuals with chronic ankle instability completed the anterior reach direction of the Star Excursion Balance Test and weight-bearing dorsiflexion assessments. Maximum reach distances on the Star Excursion Balance Test were measured in cm and normalized to leg length. Three-dimensional trunk, hip, knee, and ankle motion of the stance limb were recorded during each anterior reach trial using a motion capture system. Sagittal, frontal, and transverse plane displacement observed from trial initiation to the point of maximum reach was calculated for each joint or segment and averaged for analysis. Pearson product-moment correlations were performed to examine the relationships between kinematic variables, maximal reach, and weight-bearing dorsiflexion. A backward multiple linear regression model was developed with maximal reach as the criterion variable and kinematic variables as predictors. Frontal plane displacement of the trunk, hip, and ankle and sagittal plane knee displacement were entered into the analysis. The final model (p=0.004) included all three frontal plane variables and explained 81% of the variance in maximal reach. Maximal reach distance and several kinematic variables were significantly related to weight-bearing dorsiflexion. Individuals with chronic ankle instability who demonstrated greater lateral trunk displacement toward the stance limb, hip adduction, and ankle eversion achieved greater maximal reach. Copyright © 2016. Published by Elsevier Ltd.

Robotics and gaming to improve ankle strength, motor control, and function in children with cerebral palsy--a case study series.

PubMed

Burdea, Grigore C; Cioi, Daniel; Kale, Angad; Janes, William E; Ross, Sandy A; Engsberg, Jack R

2013-03-01

The objective of this study was to investigate the feasibility of game-based robotic training of the ankle in children with cerebral palsy (CP). The design was a case study, 12 weeks intervention, with no follow-up. The setting was a university research laboratory. The participants were a referred sample of three children with cerebral palsy, age 7-12, all male. All completed the intervention. Participants trained on the Rutgers Ankle CP system for 36 rehabilitation sessions (12 weeks, three times/week), playing two custom virtual reality games. The games were played while participants were seated, and trained one ankle at-a-time for strength, motor control, and coordination. The primary study outcome measures were for impairment (DF/PF torques, DF initial contact angle and gait speed), function (GMFM), and quality of life (Peds QL). Secondary outcome measures relate to game performance (game scores as reflective of ankle motor control and endurance). Gait function improved substantially in ankle kinematics, speed and endurance. Overall function (GMFM) indicated improvements that were typical of other ankle strength training programs. Quality of life increased beyond what would be considered a minimal clinical important difference. Game performance improved in both games during the intervention. This feasibility study supports the assumption that game-based robotic training of the ankle benefits gait in children with CP. Game technology is appropriate for the age group and was well accepted by the participants. Additional studies are needed however, to quantify the level of benefit and compare the approach presented here to traditional methods of therapy.

Rollover footwear affects lower limb biomechanics during walking.

PubMed

Forghany, Saeed; Nester, Christopher J; Richards, Barry; Hatton, Anna Lucy; Liu, Anmin

2014-01-01

To investigate the effect of rollover footwear on walking speed, metabolic cost of gait, lower limb kinematics, kinetics, EMG muscle activity and plantar pressure. Twenty subjects (mean age-33.1 years, height-1.71 m, body mass-68.9 kg, BMI 23.6, 12 male) walked in: a flat control footwear; a flat control footwear weighted to match the mass of a rollover shoe; a rollover shoe; MBT footwear. Data relating to metabolic energy and temporal aspects of gait were collected during 6 min of continuous walking, all other data in a gait laboratory. The rollover footwear moved the contact point under the shoe anteriorly during early stance, increasing midfoot pressures. This changed internal ankle dorsiflexion moments to plantarflexion moments earlier, reducing ankle plantarflexion and tibialis anterior activity after initial contact, and increasing calf EMG activity. In mid stance the rollover footwear resulted in a more dorsiflexed ankle position but less ankle movement. During propulsion, the rollover footwear reduced peak ankle dorsiflexion, peak internal plantarflexor ankle moments and the range of ankle plantarflexion. Vertical ground reaction loading rates were increased by the rollover footwear. There were no effects on temporal or energy cost of gait and no effect of elevated shoe weight. Investigating all proposed effects of this footwear concurrently has enabled a more valid investigation of how the footwear effects are interrelated. There were concurrent changes in several aspects of lower limb function, with greatest effects at the foot and ankle, but no change in the metabolic cost of walking. Copyright © 2013 Elsevier B.V. All rights reserved.

Effects of an implantable two-channel peroneal nerve stimulator versus conventional walking device on spatiotemporal parameters and kinematics of hemiparetic gait.

PubMed

Kottink, Anke I R; Tenniglo, Martin J B; de Vries, Wiebe H K; Hermens, Hermie J; Buurke, Jaap H

2012-01-01

The aims of this study were: (i) to compare the neuro-prosthetic effect of implantable peroneal nerve stimulation to the orthotic effect of a standard of care intervention (no device, shoe or ankle foot orthosis) on walking, as assessed by spatiotemporal parameters; and (ii) to examine whether there is evidence of an enhanced lower-limb flexion reflex with peroneal nerve stimulation and compare the kinematic effect of an implantable peroneal nerve stimulation device vs standard of care intervention on initial loading response of the paretic limb, as assessed by hip, knee and ankle kinematics. Randomized controlled trial. A total of 23 chronic stroke survivors with drop foot. The intervention group received an implantable 2-channel peroneal nerve stimulator for correction of drop foot. The control group continued using a conventional walking device. Spatiotemporal parameters and hip, knee and ankle kinematics were measured while subjects walked with the device on using a 3-dimensional video camera system during baseline and after a follow-up period of 26 weeks. Peroneal nerve stimulation normalized stance and double support of the paretic limb and single support of the non-paretic limb, in comparison with using a conventional walking device. In addition, peroneal nerve stimulation is more effective to provide ankle dorsiflexion during swing and resulted in a normalized initial loading response. Although peroneal nerve stimulation and ankle foot orthosis are both prescribed to correct a drop foot in the same patient population, spatiotemporal parameters, dorsiflexion during swing and loading response are influenced in a functionally different way.

Active ankle dorsiflexion and the Mingazzini manoeuvre: two clinical bedside tests related to prognosis of postural transferring, standing and walking ability in patients with stroke.

PubMed

Smania, N; Gambarin, M; Paolucci, S; Girardi, P; Bortolami, M; Fiaschi, A; Santilli, V; Picelli, A

2011-09-01

Lower limb paresis is one of the main determinants of postural transferring, standing and walking disability in patients with stroke. Early prognosis of recovery of lower limb function and of related functional disability is an important issue in neurorehabilitation clinical practice. Aim of this study was to assess the relationship between active ankle dorsiflexion and the Mingazzini manoeuvre with the prognosis of lower limb function and of postural transferring, standing and walking ability in patients with stroke. This was a longitudinal study with prospectively collected data. University hospital. The study included 53 patients with first unilateral brain ischemic stroke. Patients were evaluated initially (mean 4.02 days) and approximately at six months (mean 178.6 days) after stroke. Initial assessment included active ankle dorsiflexion and the Mingazzini manoeuvre. The assessment after six months included three outcome measures evaluating the rate of improvement of lower limb function and of postural transferring, standing and walking ability (Postural Assessment Scale for Stroke patients, Functional Ambulation Category, Motricity Index leg subtest). The active ankle dorsiflexion showed to be related with the prognosis of lower limb function and of walking ability, while the Mingazzini manoeuvre was related with the improvement of postural transferring and standing ability. Active ankle dorsiflexion and the Mingazzini manoeuvre are related with the prognosis of lower limb function and of postural transferring, standing and walking ability in patients with stroke. These simple bedside tests give a picture of improvement potential of motor activities connected to lower limb function in patients with acute stroke.

Clinical results of Hi-tech Knee II total knee arthroplasty in patients with rheumatoid athritis: 5- to 12-year follow-up.

PubMed

Yamanaka, Hajime; Goto, Ken-ichiro; Suzuki, Munetaka

2012-02-22

Total knee arthroplasty (TKA) is a common form of treatment to relieve pain and improve function in cases of rheumatoid arthritis (RA). Good clinical outcomes have been reported with a variety of TKA prostheses. The cementless Hi-Tech Knee II cruciate-retaining (CR)-type prosthesis, which has 6 fins at the anterior of the femoral component, posterior cruciate ligament (PCL) retention, flat-on-flat surface component geometry, all-polyethylene patella, strong initial fixation by the center screw of the tibial base plate, 10 layers of titanium alloy fiber mesh, and direct compression molded ultra high molecular weight polyethylene (UHMWPE), is appropriate for TKA in the Japanese knee.The present study was performed to evaluate the clinical results of primary TKA in RA using the cementless Hi-Tech Knee II CR-type prosthesis. We performed 32 consecutive primary TKAs using cementless Hi-Tech Knee II CR-type prosthesis in 31 RA patients. The average follow-up period was 8 years 3 months. Clinical evaluations were performed according to the American Knee Society (KS) system, knee score, function score, radiographic evaluation, and complications. The mean postoperative maximum flexion angle was 115.6°, and the KS knee score and function score improved to 88 and 70 after surgery, respectively. Complications, such as infection, occurred in 1 patient and revision surgery was performed. There were no cases of loosening in this cohort, and prosthesis survival rate was 96.9% at 12 years postoperatively. These results suggest that TKA using the cementless Hi-Tech Knee II CR-type prosthesis is a very effective form of treatment in RA patients at 5 to 12 years postoperatively. Further long-term follow-up studies are required to determine the ultimate utility of this type of prosthesis.

Using an electrohydraulic ankle foot orthosis to study modifications in feedforward control during locomotor adaptation to force fields applied in stance

PubMed Central

Noel, Martin; Fortin, Karine; Bouyer, Laurent J

2009-01-01

Background Adapting to external forces during walking has been proposed as a tool to improve locomotion after central nervous system injury. However, sensorimotor integration during walking varies according to the timing in the gait cycle, suggesting that adaptation may also depend on gait phases. In this study, an ElectroHydraulic AFO (EHO) was used to apply forces specifically during mid-stance and push-off to evaluate if feedforward movement control can be adapted in these 2 gait phases. Methods Eleven healthy subjects walked on a treadmill before (3 min), during (5 min) and after (5 min) exposure to 2 force fields applied by the EHO (mid-stance/push-off; ~10 Nm, towards dorsiflexion). To evaluate modifications in feedforward control, strides with no force field ('catch strides') were unexpectedly inserted during the force field walking period. Results When initially exposed to a mid-stance force field (FF20%), subjects showed a significant increase in ankle dorsiflexion velocity. Catches applied early into the FF20% were similar to baseline (P > 0.99). Subjects gradually adapted by returning ankle velocity to baseline over ~50 strides. Catches applied thereafter showed decreased ankle velocity where the force field was normally applied, indicating the presence of feedforward adaptation. When initially exposed to a push-off force field (FF50%), plantarflexion velocity was reduced in the zone of force field application. No adaptation occurred over the 5 min exposure. Catch strides kinematics remained similar to control at all times, suggesting no feedforward adaptation. As a control, force fields assisting plantarflexion (-3.5 to -9.5 Nm) were applied and increased ankle plantarflexion during push-off, confirming that the lack of kinematic changes during FF50% catch strides were not simply due to a large ankle impedance. Conclusion Together these results show that ankle exoskeletons such as the EHO can be used to study phase-specific adaptive control of the ankle during locomotion. Our data suggest that, for short duration exposure, a feedforward modification in torque output occurs during mid-stance but not during push-off. These findings are important for the design of novel rehabilitation methods, as they suggest that the ability to use resistive force fields for training may depend on targeted gait phases. PMID:19493356

Using an electrohydraulic ankle foot orthosis to study modifications in feedforward control during locomotor adaptation to force fields applied in stance.

PubMed

Noel, Martin; Fortin, Karine; Bouyer, Laurent J

2009-06-03

Adapting to external forces during walking has been proposed as a tool to improve locomotion after central nervous system injury. However, sensorimotor integration during walking varies according to the timing in the gait cycle, suggesting that adaptation may also depend on gait phases. In this study, an ElectroHydraulic AFO (EHO) was used to apply forces specifically during mid-stance and push-off to evaluate if feedforward movement control can be adapted in these 2 gait phases. Eleven healthy subjects walked on a treadmill before (3 min), during (5 min) and after (5 min) exposure to 2 force fields applied by the EHO (mid-stance/push-off; approximately 10 Nm, towards dorsiflexion). To evaluate modifications in feedforward control, strides with no force field ('catch strides') were unexpectedly inserted during the force field walking period. When initially exposed to a mid-stance force field (FF 20%), subjects showed a significant increase in ankle dorsiflexion velocity. Catches applied early into the FF 20% were similar to baseline (P > 0.99). Subjects gradually adapted by returning ankle velocity to baseline over approximately 50 strides. Catches applied thereafter showed decreased ankle velocity where the force field was normally applied, indicating the presence of feedforward adaptation. When initially exposed to a push-off force field (FF 50%), plantarflexion velocity was reduced in the zone of force field application. No adaptation occurred over the 5 min exposure. Catch strides kinematics remained similar to control at all times, suggesting no feedforward adaptation. As a control, force fields assisting plantarflexion (-3.5 to -9.5 Nm) were applied and increased ankle plantarflexion during push-off, confirming that the lack of kinematic changes during FF 50% catch strides were not simply due to a large ankle impedance. Together these results show that ankle exoskeletons such as the EHO can be used to study phase-specific adaptive control of the ankle during locomotion. Our data suggest that, for short duration exposure, a feedforward modification in torque output occurs during mid-stance but not during push-off. These findings are important for the design of novel rehabilitation methods, as they suggest that the ability to use resistive force fields for training may depend on targeted gait phases.

Redistribution of Mechanical Work at the Knee and Ankle Joints During Fast Running in Minimalist Shoes.

PubMed

Fuller, Joel T; Buckley, Jonathan D; Tsiros, Margarita D; Brown, Nicholas A T; Thewlis, Dominic

2016-10-01

Minimalist shoes have been suggested as a way to alter running biomechanics to improve running performance and reduce injuries. However, to date, researchers have only considered the effect of minimalist shoes at slow running speeds. To determine if runners change foot-strike pattern and alter the distribution of mechanical work at the knee and ankle joints when running at a fast speed in minimalist shoes compared with conventional running shoes. Crossover study. Research laboratory. Twenty-six trained runners (age = 30.0 ± 7.9 years [age range, 18-40 years], height = 1.79 ± 0.06 m, mass = 75.3 ± 8.2 kg, weekly training distance = 27 ± 15 km) who ran with a habitual rearfoot foot-strike pattern and had no experience running in minimalist shoes. Participants completed overground running trials at 18 km/h in minimalist and conventional shoes. Sagittal-plane kinematics and joint work at the knee and ankle joints were computed using 3-dimensional kinematic and ground reaction force data. Foot-strike pattern was classified as rearfoot, midfoot, or forefoot strike based on strike index and ankle angle at initial contact. We observed no difference in foot-strike classification between shoes (χ 2 1 = 2.29, P = .13). Ankle angle at initial contact was less (2.46° versus 7.43°; t 25 = 3.34, P = .003) and strike index was greater (35.97% versus 29.04%; t 25 = 2.38, P = .03) when running in minimalist shoes compared with conventional shoes. We observed greater negative (52.87 J versus 42.46 J; t 24 = 2.29, P = .03) and positive work (68.91 J versus 59.08 J; t 24 = 2.65, P = .01) at the ankle but less negative (59.01 J versus 67.02 J; t 24 = 2.25, P = .03) and positive work (40.37 J versus 47.09 J; t 24 = 2.11, P = .046) at the knee with minimalist shoes compared with conventional shoes. Running in minimalist shoes at a fast speed caused a redistribution of work from the knee to the ankle joint. This finding suggests that runners changing from conventional to minimalist shoes for short-distance races could be at an increased risk of ankle and calf injuries but a reduced risk of knee injuries.

Reviewing Clinical Effectiveness of Active Training Strategies of Platform-Based Ankle Rehabilitation Robots.

PubMed

Zeng, Xiangfeng; Zhu, Guoli; Zhang, Mingming; Xie, Sheng Q

2018-01-01

This review aims to provide a systematical investigation of clinical effectiveness of active training strategies applied in platform-based ankle robots. English-language studies published from Jan 1980 to Aug 2017 were searched from four databases using key words of "Ankle ∗ " AND "Robot ∗ " AND "Effect ∗ OR Improv ∗ OR Increas ∗ ." Following an initial screening, three rounds of discrimination were successively conducted based on the title, the abstract, and the full paper. A total of 21 studies were selected with 311 patients involved; of them, 13 studies applied a single group while another eight studies used different groups for comparison to verify the therapeutic effect. Virtual-reality (VR) game training was applied in 19 studies, while two studies used proprioceptive neuromuscular facilitation (PNF) training. Active training techniques delivered by platform ankle rehabilitation robots have been demonstrated with great potential for clinical applications. Training strategies are mostly combined with one another by considering rehabilitation schemes and motion ability of ankle joints. VR game environment has been commonly used with active ankle training. Bioelectrical signals integrated with VR game training can implement intelligent identification of movement intention and assessment. These further provide the foundation for advanced interactive training strategies that can lead to enhanced training safety and confidence for patients and better treatment efficacy.

Habitual Minimalist Shod Running Biomechanics and the Acute Response to Running Barefoot.

PubMed

Tam, Nicholas; Darragh, Ian A J; Divekar, Nikhil V; Lamberts, Robert P

2017-09-01

The aim of the study was to determine whether habitual minimalist shoe runners present with purported favorable running biomechanithat reduce running injury risk such as initial loading rate. Eighteen minimalist and 16 traditionally cushioned shod runners were assessed when running both in their preferred training shoe and barefoot. Ankle and knee joint kinetics and kinematics, initial rate of loading, and footstrike angle were measured. Sagittal ankle and knee joint stiffness were also calculated. Results of a two-factor ANOVA presented no group difference in initial rate of loading when participants were running either shod or barefoot; however, initial loading rate increased for both groups when running barefoot (p=0.008). Differences in footstrike angle were observed between groups when running shod, but not when barefoot (minimalist:8.71±8.99 vs. traditional: 17.32±11.48 degrees, p=0.002). Lower ankle joint stiffness was found in both groups when running barefoot (p=0.025). These findings illustrate that risk factors for injury potentially differ between the two groups. Shoe construction differences do change mechanical demands, however, once habituated to the demands of a given shoe condition, certain acute favorable or unfavorable responses may be moderated. The purported benefits of minimalist running shoes in mimicking habitual barefoot running is questioned, and risk of injury may not be attenuated. © Georg Thieme Verlag KG Stuttgart · New York.

Effects of balance training on post-sprained ankle joint instability.

PubMed

Faizullin, I; Faizullina, E

2015-01-01

Ankle sprain is a medical condition when ankle ligaments are totally or partially torn. The primary cause of ankle sprain is sharp movements like turning or rolling the foot [1]. The ankle sprain needs to be treated right after the trauma, because if not treated it could lead to decreased stability of the ankle joint and lead to chronic ankle instability, which is characterized by increased risk of the ankle sprain [2] . We suppose that rehabilitation after the ankle sprain could significantly increase the performance of sportsmen. To investigate effects of balance exercise training on instable ankle due to the previous ankle sprain injury. In addition, the secondary aim of this systematic review was to find the effectiveness of different balance training exercises on instable ankle in order to find better opportunities for rehabilitation of sportsmen. The studies were selected from PubMed and Scopus using the library of the Friedrich-Alexander University of Erlangen-Nuremberg (further-UB FAU), we used full texts, and only texts in English were included in this review. The literature search was conducted at the end of December 2014. Texts included randomised controlled trials, which were published in the last 5 years (2009-2014). The literature was included in this review only if it was published in English and if the randomised controlled trial was conducted in the study and if the full text was available from UB FAU. The articles, which were found only in PubMed search, were excluded during Scopus search.PubMed search.First MeSH term was "Balance training for the ankle sprain" and 44 articles were found in PubMed. Then 29 articles were filtered by title and excluded from the study. Remaining 15 articles were assessed reading their abstracts, 6 of them were excluded and only 4 articles were left. The second MeSH term was "Balance training for ankle injury". Four additional articles were found by initial search. Two of them were filtered by the title and 2 were excluded at the stage of reading abstracts. The third MeSH term was "Balance exercises for instable ankle". One additional article was found by initial search and was excluded after reading the abstract.Scopus search.The same MeSH terms were used as in PubMed search. With the first MeSH term one article was found and filtered by the title. With the second MeSH term no results were found in the initial search and with the third term 2 articles were picked up by the initial search. One of these articles was filtered by the title. The other one was filtered after reading the abstract. Overall 8 articles were taken into consideration for conducting a systematic review. Nevertheless, three of them could not be downloaded for free even using UB FAU up to the 28th of December, 2014. Thus, five articles were taken for the systematic review. After reading all 5 articles, one article by Maraike Alice Wortmann and Carrie L. Docherty was excluded from the study because it was a systematic review per se and at the same time it was not mentioned neither in the article title, nor in the abstract that the current study was a systematic review [3]. Also the article by Borreani et al. 2014 [4] was excluded after reading the paragraph "Methods" as this was not an RCT but a descriptive study. Therefore, 3 articles were taken for conducting a systematic review. The first article by Janssen et al. 2011 [5] was a 3-way randomised controlled trial with 1 year follow-up. Participants aged from 12 to 70 years used this intervention. People with active participation in sports with a lateral ankle sprain during the last 2 months were eligible for inclusion in the study. Participants were divided into 3 groups. Group 1 undertook an 8 week neuromuscular training programme. Group 2 wore sports brace during their sport activities for the duration of 1 year, and group 3 was a control group and used the combination of neuromuscular training program and wore sports brace for 8 weeks. There were 122 participants in the neuromuscular training group, 126 in the brace group and 136 in combined group. The drawback of this intervention was that there was no control over the care provid.In the second study by Ben Moussa Zouita, A et al. 2013 [6] the objective was to investigate how the proprioceptive exercises effect the postural balance and isokinetic strength in athletes with ankle sprain. 16 participants were recruited in the study and divided into two groups. The experimental group consisted of 8 participants with unilateral ankle sprain symptoms. The control group included another 8 participants with bilateral non-injured ankles. The training programme included 24 sessions during 8 weeks, every session lasted between 20 and 30 minutes. Four prescribed exercises were used during the intervention: one exercise without any material, one exercise with a ball only, one exercise with a balance board only and one exercise with a ball and a balance board. As a result, after 8 weeks of proprioceptive rehabilitation a significant improvement in extensor and flexor strength of ankle at a speed of 60-deg/sec was registered.The third study by Emery, Meeuwisse 2010 [7] was aimed to examine the effectiveness of the neuromuscular prevention strategy in youth soccer players. The inclusion criteria were adolescents between 13 and 18 years of age. The exclusion criteria were injury within 6 weeks and the history of systemic disease in anamnesis (i.e. cerebral palsy, head injury). 82 soccer teams were invited to take part in the intervention. 12 trainers declined the invitation, other 10 teams declined participation. Overall 60 teams took part in the intervention programme. The teams were randomised by a club. 32 training group teams (n = 380 players) and 28 control group players (n = 364 players) took part in the intervention. The training programme included dynamic stretching exercises, agility, jumping and balance and eccentric strength. The control programme was a standardized warm-up including static, dynamic and aerobic components and home-based stretching programme using 16-inch diameter wobble board used for 15 minutes during exercises. The injury rate in the training group was 2.08 injuries/1000 player-hours, and in the control group 3.35 injuries/1000 player-hours. The neuromuscular training programme was protective in injuries of youth soccer players. Balance training is an effective training method for rehabilitation of instable ankle. Different approaches to balance training provide in general similar improvement for sprained ankle.Implications for future studies:More RCTs on chronic ankle instability are needed with large sample size and use of different intensities of exercises. It would be better for the UB FAU to provide access to articles so that students and researches could download articles for free from different electronic sources.

Analysis of 213 currently used rehabilitation protocols in foot and ankle fractures.

PubMed

Pfeifer, Christian G; Grechenig, Stephan; Frankewycz, Borys; Ernstberger, Antonio; Nerlich, Michael; Krutsch, Werner

2015-10-01

Fractures of the ankle, hind- and midfoot are amongst the five most common fractures. Besides initial operative or non-operative treatment, rehabilitation of the patients plays a crucial role for fracture union and long term functional outcome. Limited evidence is available with regard to what a rehabilitation regimen should include and what guidelines should be in place for the initial clinical course of these patients. This study therefore investigated the current rehabilitation concepts after fractures of the ankle, hind- and midfoot. Written rehabilitation protocols provided by orthopedic and trauma surgery institutions in terms of recommendations for weight bearing, range of motion (ROM), physiotherapy and choice of orthosis were screened and analysed. All protocols for lateral ankle fractures type AO 44A1, AO 44B1 and AO 44C1, for calcaneal fractures and fractures of the metatarsal as well as other not specific were included. Descriptive analysis was carried out and statistical analysis applied where appropriate. 209 rehabilitation protocols for ankle fractures type AO 44B1 and AO 44C1, 98 for AO 44A1, 193 for metatarsal fractures, 142 for calcaneal fractures, 107 for 5(th) metatarsal base fractures and 70 for 5(th) metatarsal Jones fractures were evaluated. The mean time recommended for orthosis treatment was 6.04 (SD 0.04) weeks. While the majority of protocols showed a trend towards increased weight bearing and increased ROM over time, the best consensus was noted for weight bearing recommendations. Our study shows that there exists a huge variability in rehabilitation of fractures of the ankle-, hind- and midfoot. This may be contributed to a lack of consensus (e.g. missing publication of guidelines), individualized patient care (e.g. in fragility fractures) or lack of specialization. This study might serve as basis for prospective randomized controlled trials in order to optimize rehabilitation for these common fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

Initial clinical experience with a novel biodegradable ring in patients with functional tricuspid insufficiency: Kalangos Biodegradable Tricuspid Ring.

PubMed

Burma, O; Ustunsoy, H; Davutoglu, V; Celkan, M A; Kazaz, H; Pektok, E

2007-08-01

Tricuspid annuloplasty procedures have been widely performed in clinics for many years. The Kalangos Biodegradable Tricuspid Ring (Kalangos Biodegradable Tricuspid Ring, Bioring SA, Lonay, Switzerland) is a novel prosthesis for the treatment of tricuspid insufficiency. The aim of this study was to evaluate the clinical and echocardiographic results of this novel prosthesis for functional tricuspid insufficiency. Between October 2005 and May 2006, 15 patients with the diagnosis of moderate or severe functional tricuspid insufficiency were treated by implantation of a Kalangos Biodegradable Tricuspid Ring. All patients were evaluated clinically and by echocardiography preoperatively, and control tests were performed at the end of the 1st and 6th month following surgery. Moderate and severe insufficiency was documented in 11 and 4 patients, respectively, in the preoperative tests. 1 and 6 months after surgery, 4 patients had trace and 1 patient had mild tricuspid insufficiency, while 10 patients had none. At the 1st and 6th month follow-up, systolic pulmonary arterial pressure, right atrial dimension and right ventricular diastolic diameter were found to be significantly lower than the preoperative values ( P < 0.0001). The right atrial diameter and tricuspid valve area had decreased significantly at the end of the 1st month; however, no significant difference was found between the 1st and 6th month tests ( P > 0.05). Three-quarters of the annuloplasty ring had degraded at 6 months. No complications related to the prosthesis or the procedure occurred within this period. Kalangos Biodegradable Ring is a promising prosthesis in patients with functional tricuspid insufficiency, with encouraging initial results.

Clinical Study of 3D Imaging and 3D Printing Technique for Patient-Specific Instrumentation in Total Knee Arthroplasty.

PubMed

Qiu, Bing; Liu, Fei; Tang, Bensen; Deng, Biyong; Liu, Fang; Zhu, Weimin; Zhen, Dong; Xue, Mingyuan; Zhang, Mingjiao

2017-10-01

Patient-specific instrumentation (PSI) was designed to improve the accuracy of preoperative planning and postoperative prosthesis positioning in total knee arthroplasty (TKA). However, better understanding needs to be achieved due to the subtle nature of the PSI systems. In this study, 3D printing technique based on the image data of computed tomography (CT) has been utilized for optimal controlling of the surgical parameters. Two groups of TKA cases have been randomly selected as PSI group and control group with no significant difference of age and sex ( p  > 0.05). The PSI group is treated with 3D printed cutting guides whereas the control group is treated with conventional instrumentation (CI). By evaluating the proximal osteotomy amount, distal osteotomy amount, valgus angle, external rotation angle, and tibial posterior slope angle of patients, it can be found that the preoperative quantitative assessment and intraoperative changes can be controlled with PSI whereas CI is relied on experience. In terms of postoperative parameters, such as hip-knee-ankle (HKA), frontal femoral component (FFC), frontal tibial component (FTC), and lateral tibial component (LTC) angles, there is a significant improvement in achieving the desired implant position ( p  < 0.05). Assigned from the morphology of patients' knees, the PSI represents the convergence of congruent designs with current personalized treatment tools. The PSI can achieve less extremity alignment and greater accuracy of prosthesis implantation compared against control method, which indicates potential for optimal HKA, FFC, and FTC angles. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Custom Orthosis and Rehabilitation Program on Outcomes Following Ankle and Subtalar Fusions.

PubMed

Sheean, Andrew J; Tennent, David J; Owens, Johnny G; Wilken, Jason M; Hsu, Joseph R; Stinner, Daniel J

2016-11-01

Fractures of the distal tibia, ankle, and foot sustained through a high-energy mechanism can be extremely debilitating, and ankle and/or subtalar fusion may be indicated if the limb is deemed salvageable. Functional outcomes among this population are often poor. The purposes of this study were to evaluate the effect of an advanced rehabilitation program combined with the use of a custom ankle-foot orthosis for patients with ankle or subtalar fusion on selected physical performance measures and patient-derived outcome measures and to determine if the response to treatment was predicated upon the type of fusion. We conducted a prospective, longitudinal, observational, cohort study composed of 23 active duty Service Members treated for lower extremity trauma. Patients were separated into 2 groups: group 1 was composed of 12 patients who underwent isolated ankle fusion or ankle fusion combined with ipsilateral subtalar fusion, group 2 was composed of 11 patients who underwent subtalar fusion only. Patient-reported outcome (PRO) measures and physical performance measures were recorded at baseline and at the conclusion of the rehabilitation program. Significant improvements in both groups were seen in each of the 4 physical performance measures. Only group 2 showed significant improvements in all domains of the Veteran's Rand 12-Item Health Survey (VR-12) and Short Musculoskeletal Function Assessment (SMFA) at all points during the course of rehabilitation. Among a subset of patients treated for severe lower extremity trauma with ankle and/or subtalar fusion, an integrated orthotic and rehabilitation initiative improved physical performance and PRO measures over an 8-week course. Level III, prospective comparative series. © The Author(s) 2016.

Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults: A Randomized Clinical Trial.

PubMed

Willett, Keith; Keene, David J; Mistry, Dipesh; Nam, Julian; Tutton, Elizabeth; Handley, Robert; Morgan, Lesley; Roberts, Emma; Briggs, Andrew; Lall, Ranjit; Chesser, Timothy J S; Pallister, Ian; Lamb, Sarah E

2016-10-11

Ankle fractures cause substantial morbidity in older persons. Surgical fixation is the contemporary intervention but is associated with infection and other healing complications. To determine whether initial fracture treatment with close contact casting, a molded below-knee cast with minimal padding, offers outcome equivalent to that with immediate surgery, with fewer complications and less health resource use. This was a pragmatic, equivalence, randomized clinical trial with blinded outcome assessors. A pilot study commenced in May 2004, followed by multicenter recruitment from July 2010 to November 2013; follow-up was completed May 2014. Recruitment was from 24 UK major trauma centers and general hospitals. Participants were 620 adults older than 60 years with acute, overtly unstable ankle fracture. Exclusions were serious limb or concomitant disease or substantial cognitive impairment. Participants were randomly assigned to surgery (n = 309) or casting (n = 311). Casts were applied in the operating room under general or spinal anesthesia by a trained surgeon. The primary 6-month, per-protocol outcome was the Olerud-Molander Ankle Score at 6 months (OMAS; range, 0-100; higher scores indicate better outcomes and fewer symptoms), equivalence prespecified as ±6 points. Secondary outcomes were quality of life, pain, ankle motion, mobility, complications, health resource use, and patient satisfaction. Among 620 adults (mean age, 71 years; 460 [74%] women) who were randomized, 593 (96%) completed the study. Nearly all participants (579/620; 93%) received allocated treatment; 52 of 275 (19%) who initially received casting later converted to surgery, which was allowable in the casting treatment pathway to manage early loss of fracture reduction. At 6 months, casting resulted in ankle function equivalent to that with surgery (OMAS score, 66.0 [95% CI, 63.6-68.5] for surgery vs 64.5 [95% CI, 61.8-67.2] for casting; mean difference, -0.6 [95% CI, -3.9 to 2.6]; P for equivalence = .001). Infection and wound breakdown were more common with surgery (29/298 [10%] vs 4/275 [1%]; odds ratio [OR], 7.3 [95% CI, 2.6-20.2]), as were additional operating room procedures (18/298 [6%] for surgery and 3/275 [1%] for casting; OR, 5.8 [95% CI, 1.8-18.7]). Radiologic malunion was more common in the casting group (38/249 [15%] vs 8/274 [3%] for surgery; OR, 6.0 [95% CI, 2.8-12.9]). Casting required less operating room time compared with surgery (mean difference [minutes/participant], -54 [95% CI, -58 to -50]). There were no significant differences in other secondary outcomes: quality of life, pain, ankle motion, mobility, and patient satisfaction. Among older adults with unstable ankle fracture, the use of close contact casting compared with surgery resulted in similar functional outcomes at 6 months. Close contact casting may be an appropriate treatment for such patients. isrctn.com Identifier: ISRCTN04180738.

Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report.

PubMed

Slaven, Emily J; Mathers, Jessie

2011-05-01

Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain.

Robot-Aided Neurorehabilitation: A Pediatric Robot for Ankle Rehabilitation

PubMed Central

Michmizos, Konstantinos P.; Rossi, Stefano; Castelli, Enrico; Cappa, Paolo; Krebs, Hermano Igo

2015-01-01

This paper presents the pediAnklebot, an impedance-controlled low-friction, backdriveable robotic device developed at the Massachusetts Institute of Technology that trains the ankle of neurologically impaired children of ages 6-10 years old. The design attempts to overcome the known limitations of the lower extremity robotics and the unknown difficulties of what constitutes an appropriate therapeutic interaction with children. The robot's pilot clinical evaluation is on-going and it incorporates our recent findings on the ankle sensorimotor control in neurologically intact subjects, namely the speed-accuracy tradeoff, the deviation from an ideally smooth ankle trajectory, and the reaction time. We used these concepts to develop the kinematic and kinetic performance metrics that guided the ankle therapy in a similar fashion that we have done for our upper extremity devices. Here we report on the use of the device in at least 9 training sessions for 3 neurologically impaired children. Results demonstrated a statistically significant improvement in the performance metrics assessing explicit and implicit motor learning. Based on these initial results, we are confident that the device will become an effective tool that harnesses plasticity to guide habilitation during childhood. PMID:25769168

An unusual cause of ankle pain: fracture of a talocalcaneal coalition as a differential diagnosis in an acute ankle sprain: a case report and literature review

PubMed Central

2013-01-01

Background The acute ankle sprain is one of the most common injuries seen in trauma departments. Ankle sprains have an incidence of about one injury per 10 000 people a day. In contrast tarsal coalition is a rare condition occurring in not more than one percent of the population. Case presentation We present the case of a 23 year old male patient with pain and local swelling after an acute ankle sprain. Initial clinical and radiological examination showed no pathologies. Due to prolonged pain, swelling and the inability of the patient to weight bear one week after trauma further diagnostics was performed. Imaging studies (MRI and CT) revealed a fracture of a talocalcaneal coalition. To the knowledge of the authors no fracture of a coalition was reported so far. Conclusion This report highlights the presentation of symptomatic coalitions following trauma and furthermore, it points out the difficulties in the diagnosis and treatment of a rare entity after a common injury. A diagnostic algorithm has been developed to ensure not to miss a severe injury. PMID:23530869

Sway‐dependent changes in standing ankle stiffness caused by muscle thixotropy

PubMed Central

Sakanaka, Tania E.; Lakie, Martin

2016-01-01

Key points The passive stiffness of the calf muscles contributes to standing balance, although the properties of muscle tissue are highly labile.We investigated the effect of sway history upon intrinsic ankle stiffness and demonstrated reductions in stiffness of up to 43% during conditions of increased baseline sway.This sway dependence was most apparent when using low amplitude stiffness‐measuring perturbations, and the short‐range stiffness component was smaller during periods of high sway.These characteristics are consistent with the thixotropic properties of the calf muscles causing the observed changes in ankle stiffness.Periods of increased sway impair the passive stabilization of standing, demanding more active neural control of balance. Abstract Quiet standing is achieved through a combination of active and passive mechanisms, consisting of neural control and intrinsic mechanical stiffness of the ankle joint, respectively. The mechanical stiffness is partly determined by the calf muscles. However, the viscoelastic properties of muscle are highly labile, exhibiting a strong dependence on movement history. By measuring the effect of sway history upon ankle stiffness, the present study determines whether this lability has consequences for the passive stabilization of human standing. Ten subjects stood quietly on a rotating platform whose axis was collinear with the ankle joint. Ankle sway was increased by slowly tilting this platform in a random fashion, or decreased by fixing the body to a board. Ankle stiffness was measured by using the same platform to simultaneously apply small, brief perturbations (<0.6 deg; 140 ms) at the same time as the resulting torque response was recorded. The results show that increasing sway reduces ankle stiffness by up to 43% compared to the body‐fixed condition. Normal quiet stance was associated with intermediate values. The effect was most apparent when using smaller perturbation amplitudes to measure stiffness (0.1 vs. 0.6 deg). Furthermore, torque responses exhibited a biphasic pattern, consisting of an initial steep rise followed by a shallower increase. This transition occurred earlier during increased levels of ankle sway. These results are consistent with a movement‐dependent change in passive ankle stiffness caused by thixotropic properties of the calf muscle. The consequence is to place increased reliance upon active neural control during times when increased sway renders ankle stiffness low. PMID:26607292

Is goniometry suitable for measuring ankle range of motion in female ballet dancers? An initial comparison with radiographic measurement.

PubMed

Russell, Jeffrey A; Shave, Ruth M; Kruse, David W; Nevill, Alan M; Koutedakis, Yiannis; Wyon, Matthew A

2011-06-01

Female ballet dancers require extreme ankle motion to attain the demi-plié (weight-bearing full dorsiflexion [DF]) and en pointe (weight-bearing full plantar flexion [PF]) positions of ballet. However, techniques for assessing this amount of motion have not yet received sufficient scientific scrutiny. Therefore, the purpose of this study was to examine possible differences between weight-bearing goniometric and radiographic ankle range of motion measurements in female ballet dancers. Ankle range of motion in 8 experienced female ballet dancers was assessed by goniometry and 2 radiographic measurement methods. The latter were performed on 3 mediolateral x-rays, in demi-plié, neutral, and en pointe positions; one of them used the same landmarks as goniometry. DF values were not significantly different among the methods, but PF values were (P < .05). Not only was PF of the talocrural joint significantly less than the other 2 measurements (P < .001), PF from the goniometric method applied to the x-rays was significantly less than PF obtained from clinical goniometry (P < .05). These data provide insight into the extreme ankle and foot motion, particularly PF, required in female ballet dancers and suggest that goniometry may not be ideal for assessing ankle range of motion in these individuals. Therefore, further research is needed to standardize how DF and PF are measured in ballet dancers. Diagnostic, Level I.

Use of digital technologies for nasal prosthesis manufacturing.

PubMed

Palousek, David; Rosicky, Jiri; Koutny, Daniel

2014-04-01

Digital technology is becoming more accessible for common use in medical applications; however, their expansion in prosthetic and orthotic laboratories is not large because of the persistent image of difficult applicability to real patients. This article aims to offer real example in the area of human facial prostheses. This article describes the utilization of optical digitization, computational modelling, rapid prototyping, mould fabrication and manufacturing of a nasal silicone prosthesis. This technical note defines the key points of the methodology and aspires to contribute to the introduction of a certified manufacturing procedure. The results show that the used technologies reduce the manufacturing time, reflect patient's requirements and allow the manufacture of high-quality prostheses for missing facial asymmetric parts. The methodology provides a good position for further development issues and is usable for clinical practice. Clinical relevance Utilization of digital technologies in facial prosthesis manufacturing process can be a good contribution for higher patient comfort and higher production efficiency but with higher initial investment and demands for experience with software tools.

An harmonic smile resulted from the use of ceramic prosthesis with zirconia structure: a case report.

PubMed

Tavarez, Rudys Rodolfo de Jesus; Goncalves, Leticia Machado; Dias, Ana Paula; Dias, Anna Claudia Pereira; Malheiros, Adriana Santos; Silva, Alice Carvalho; Bandeca, Matheus Coelho

2014-06-01

The rehabilitation of patients requiring an esthetic smile demands a multidisciplinary approach. This clinical report describes a treatment plan for recovery aesthetics' smile of anterior teeth using ceramic prosthesis with zirconia structure. Initially, a review of aesthetic parameters, diagnostic waxing, mock-up and provisional restorations was performed. A contextual assessment of aesthetic, proportion and shape of teeth was done to recreate a natural looking for teeth in consonance with the smile line. Subsequently, based on these parameters, fixed prostheses of the upper anterior teeth using ceramic restorations with zirconia infrastructures were performed. The use of ceramic restorations with zirconia structures associated with a careful treatment plan allows the professional to integrate esthetic and function for satisfactory clinical results. How to cite the article: Tavarez RR, Gonçalves LM, Dias AP, Dias AC, Malheiros AS, Silva AC, Bandeca MC. An harmonic smile resulted from the use of ceramic prosthesis with zirconia structure: A case report. J Int Oral Health 2014;6(3):90-2.

Gait asymmetry of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees.

PubMed

Kaufman, Kenton R; Frittoli, Serena; Frigo, Carlo A

2012-06-01

Amputees walk with an asymmetrical gait, which may lead to future musculoskeletal degenerative changes. The purpose of this study was to compare the gait asymmetry of active transfemoral amputees while using a passive mechanical knee joint or a microprocessor-controlled knee joint. Objective 3D gait measurements were obtained in 15 subjects (12 men and 3 women; age 42, range 26-57). Research participants were longtime users of a mechanical prosthesis (mean 20 years, range 3-36 years). Joint symmetry was calculated using a novel method that includes the entire waveform throughout the gait cycle. There was no significant difference in hip, knee and ankle kinematics symmetry when using the different knee prostheses. In contrast, the results demonstrated a significant improvement in lower extremity joint kinetics symmetry when using the microprocessor-controlled knee. Use of the microprocessor-controlled knee joint resulted in improved gait symmetry. These improvements may lead to a reduction in the degenerative musculoskeletal changes often experienced by amputees. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Outcome of operative treatment for supination-external rotation Lauge-Hansen stage IV ankle fractures].

PubMed

Kołodziej, Łukasz; Boczar, Tomasz; Bohatyrewicz, Andrzej; Zietek, Paweł

2010-01-01

Ankle fractures are among the most common musculoskeletal injures. These fractures occur with an overall age- and sex-adjusted incidence rate around 180 per 100 000 person-years. The most frequent mechanism is considered to be supination-external rotation (60 to 80% of all ankle fractures) consisting of pathologic external rotation of the foot initially placed in some degree of supination. According to Lauge-Hansen classification, ankle joint structures are damaged in a sequence where the final, stage IV injuries, represents transverse fracture of the medial malleolus or its equivalent-rupture of the deltoid ligament. The aim of this study is to compare the results of two subtypes of supination-external rotation stage IV fractures. 43 patients treated surgically in 2006 to 2007 at Authors institution because of stage IV supination-external rotation ankle fracture were submitted to retrospective analysis. There were 25 patients with bimalleolar fracture (type 1) and in 18 patients with lateral malleolar fracture with accompanying rupture of the deltoid ligament (type 2). The mean age was 46 years (from 20 to 82 years). Average follow up period was 37 months (from 24 to 46 months). For the evaluation of treatment AOFAS hind-foot score (American Orthopedic Foot and Ankle Society) was used. The mean AOFAS score scale for Type 1 fractures was 85 points and for type 2 was significantly higher and amounted to 91 points (p < 0.05). Supination-external rotation stage IV ankle fractures with medial malleolar fracture, requires the implementation of additional diagnostic and therapeutic strategies and procedures in order to improve the outcome of results.

Arthroscopy-Assisted Surgery for Acute Ankle Fractures: A Systematic Review.

PubMed

Chen, Xing-Zuo; Chen, Ying; Liu, Cheng-Gang; Yang, Huan; Xu, Xiao-Dong; Lin, Peng

2015-11-01

To summarize the clinical findings of adult patients undergoing arthroscopy-assisted open reduction-internal fixation for acute ankle fractures. A systematic electronic search of the PubMed databases was performed for all published literature on December 8, 2014. All English-language clinical studies on acute ankle fractures treated with arthroscopy-assisted open reduction-internal fixation were eligible for inclusion. Basic information related to the surgical procedure was collected. The search criteria initially identified 187 articles, and 10 studies were included in this systematic review. There were 2 prospective, randomized studies; 2 prognostic studies; and 6 case-series studies. There were a total of 861 patients included in this systematic review. Danis-Weber type B fractures (335 of 483 patients) and supination-external rotation fractures (187 of 366 patients) were the most common types of all the ankle fractures. Concomitant injuries were common: 63.3% of patients had chondral lesions, 60.9% had deltoid ligament injuries, and 77.9% had tibiofibular syndesmosis injuries. Lavage and debridement of the ankle joint were performed by almost all the surgeons. Chondral lesions were treated with shaving, excision, or microfracture. The mean American Orthopaedic Foot & Ankle Society hindfoot score was 91.7. Only mild complications were reported. Acute ankle fractures are commonly concomitant with multiple soft-tissue injuries in which arthroscopy may serve as a method for accurate diagnosis and appropriate treatment. Level IV, systematic review of Level I, II, III, and IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

An unusual case of chronic lateral foot pain following ankle inversion injury: osteoid osteoma of the tarsal cuboid bone.

PubMed

Aydogan, Umur; Dellenbaugh, Samuel G

2014-04-01

Osteoid osteomas are common benign tumors normally seen in the femur, tibia, and spine. They rarely are seen in the foot. We present an unusual case of osteoid osteoma of the cuboid in a 26-year-old man. This was initially thought to be an ankle sprain, as its first presentation was after a sporting injury. It was then treated as an infection before the true diagnosis--that of osteoid osteoma--was obtained.

Redistribution of Mechanical Work at the Knee and Ankle Joints During Fast Running in Minimalist Shoes

PubMed Central

Fuller, Joel T.; Buckley, Jonathan D.; Tsiros, Margarita D.; Brown, Nicholas A. T.; Thewlis, Dominic

2016-01-01

Context: Minimalist shoes have been suggested as a way to alter running biomechanics to improve running performance and reduce injuries. However, to date, researchers have only considered the effect of minimalist shoes at slow running speeds. Objective: To determine if runners change foot-strike pattern and alter the distribution of mechanical work at the knee and ankle joints when running at a fast speed in minimalist shoes compared with conventional running shoes. Design: Crossover study. Setting: Research laboratory. Patients or Other Participants: Twenty-six trained runners (age = 30.0 ± 7.9 years [age range, 18−40 years], height = 1.79 ± 0.06 m, mass = 75.3 ± 8.2 kg, weekly training distance = 27 ± 15 km) who ran with a habitual rearfoot foot-strike pattern and had no experience running in minimalist shoes. Intervention(s): Participants completed overground running trials at 18 km/h in minimalist and conventional shoes. Main Outcome Measure(s): Sagittal-plane kinematics and joint work at the knee and ankle joints were computed using 3-dimensional kinematic and ground reaction force data. Foot-strike pattern was classified as rearfoot, midfoot, or forefoot strike based on strike index and ankle angle at initial contact. Results: We observed no difference in foot-strike classification between shoes (χ21 = 2.29, P = .13). Ankle angle at initial contact was less (2.46° versus 7.43°; t25 = 3.34, P = .003) and strike index was greater (35.97% versus 29.04%; t25 = 2.38, P = .03) when running in minimalist shoes compared with conventional shoes. We observed greater negative (52.87 J versus 42.46 J; t24 = 2.29, P = .03) and positive work (68.91 J versus 59.08 J; t24 = 2.65, P = .01) at the ankle but less negative (59.01 J versus 67.02 J; t24 = 2.25, P = .03) and positive work (40.37 J versus 47.09 J; t24 = 2.11, P = .046) at the knee with minimalist shoes compared with conventional shoes. Conclusions: Running in minimalist shoes at a fast speed caused a redistribution of work from the knee to the ankle joint. This finding suggests that runners changing from conventional to minimalist shoes for short-distance races could be at an increased risk of ankle and calf injuries but a reduced risk of knee injuries. PMID:27834504

Boston type 1 keratoprosthesis for failed keratoplasty.

PubMed

Hager, Jonathan L; Phillips, David L; Goins, Kenneth M; Kitzmann, Anna S; Greiner, Mark A; Cohen, Alex W; Welder, Jeffrey D; Wagoner, Michael D

2016-02-01

The purpose of this study was to evaluate the outcomes of the Boston type 1 keratoprosthesis (Kpro-1) in eyes with failed keratoplasty. A retrospective review was performed of every patient treated with a Kpro-1 at a tertiary eye care center between January 1, 2008 and July 1, 2013. Eyes with a failed keratoplasty originally performed for corneal edema, trauma, or keratoconus were included in the statistical analysis. The main outcome measures were visual outcome, prosthesis retention, and postoperative complications. Twenty-four eyes met the inclusion criteria, including 13 eyes with corneal edema, 8 eyes with trauma, and 3 eyes with keratoconus. After a mean follow-up period of 28.9 months (range 7-63 months), the median best corrected visual acuity (BCVA) was 20/125. The BCVA was ≥ 20/40 in 4 (16.7 %) eyes, ≥ 20/70 in 9 (37.5 %) eyes, and ≥ 20/200 in 14 (58.3 %) eyes. Overall, the postoperative BCVA improved in 17 (70.9 %) eyes, was unchanged in 3 (12.5 %) eyes, and was worse in 4 (16.7 %) eyes. The initial Kpro-1 was retained in 22 (91.7 %) eyes, and was successfully repeated in the other 2 eyes. One or more serious prosthesis- or sight-threatening complications occurred in 8 (33.3 %) eyes. These included 1 case of wound dehiscence leading to prosthesis extrusion, 1 case of fungal keratitis leading to prosthesis extrusion, 4 cases of endophthalmitis, and 5 retinal detachments. The Boston Kpro-1 is associated with an excellent prognosis for prosthesis retention and satisfactory visual improvement in eyes with previous failed keratoplasty.

[Lower limb salvage with a free fillet fibula flap harvested from the contralateral amputated leg].

PubMed

Bouyer, M; Corcella, D; Forli, A; Mesquida, V; Semere, A; Moutet, F

2015-06-01

We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

EMG-Torque Dynamics Change With Contraction Bandwidth.

PubMed

Golkar, Mahsa A; Jalaleddini, Kian; Kearney, Robert E

2018-04-01

An accurate model for ElectroMyoGram (EMG)-torque dynamics has many uses. One of its applications which has gained high attention among researchers is its use, in estimating the muscle contraction level for the efficient control of prosthesis. In this paper, the dynamic relationship between the surface EMG and torque during isometric contractions at the human ankle was studied using system identification techniques. Subjects voluntarily modulated their ankle torque in dorsiflexion direction, by activating their tibialis anterior muscle, while tracking a pseudo-random binary sequence in a torque matching task. The effects of contraction bandwidth, described by torque spectrum, on EMG-torque dynamics were evaluated by varying the visual command switching time. Nonparametric impulse response functions (IRF) were estimated between the processed surface EMG and torque. It was demonstrated that: 1) at low contraction bandwidths, the identified IRFs had unphysiological anticipatory (i.e., non-causal) components, whose amplitude decreased as the contraction bandwidth increased. We hypothesized that this non-causal behavior arose, because the EMG input contained a component due to feedback from the output torque, i.e., it was recorded from within a closed-loop. Vision was not the feedback source since the non-causal behavior persisted when visual feedback was removed. Repeating the identification using a nonparametric closed-loop identification algorithm yielded causal IRFs at all bandwidths, supporting this hypothesis. 2) EMG-torque dynamics became faster and the bandwidth of system increased as contraction modulation rate increased. Thus, accurate prediction of torque from EMG signals must take into account the contraction bandwidth sensitivity of this system.

An assessment of the long saphenous vein for potential use as a vascular conduit after varicose vein surgery.

PubMed

Fligelstone, L; Carolan, G; Pugh, N; Shandall, A; Lane, I

1993-11-01

There is controversy in the surgical management of varicose veins between stripping of the long saphenous vein (LSV) and high ligation. Moreover, preservation of the LSV is desirable for future coronary or peripheral artery bypass. We have studied 75 limbs in 44 patients after high saphenous ligation with multiple stab phlebectomy. Subjective assessment of the outcome of surgery was made with a linear analog scale, and objective cosmetic outcome was assessed by an independent observer (LF) who had not been involved in the surgical treatment of these patients with our modification from the criteria first described by Jakobsen. Patency, length, and diameter of the LSV was measured 6 to 14 months (mean 12 months) after operation with a duplex scanner and a color-flow scanner. Valvular incompetence in the LSV and perforators was also assessed. Results show a good subjective and objective outcome in 95% and 97% of limbs, respectively. The LSVs were patent from ankle to groin in 68% and from ankle to knee in 82%, with a mean diameter of 4.0 +/- 0.1 mm (mean +/- SEM). There was no statistically significant difference in symptomatic outcome and presence of reflux in the LSV (X2 = 0.465; p = 0.4954; NS) or objective cosmetic outcome and the presence of reflux in the LSV (chi 2 = 2.916; p = 0.0877; NS). It is concluded that high saphenofemoral ligation combined with multiple "stab avulsions" preserves an LSV with characteristics suggesting suitability for future use as a vascular prosthesis with good early symptomatic and cosmetic results.

The biomechanics of one-footed vertical jump performance in unilateral trans-tibial amputees.

PubMed

Strike, S C; Diss, C

2005-04-01

This study investigated vertical jumps from single support for two trans-tibial amputees from a standing position. The mechanisms used to achieve flight and the compensatory mechanisms used in the production of force in the absence of plantarflexors are detailed. Two participants completed countermovement maximum vertical jumps from the prosthetic and the sound limbs. The jumps were recorded by a 7-camera 512 VICON motion analysis system integrated with a Kistler forceplate. Flight height was 5 cm jumping from the prosthetic side and 18-19 cm from the sound side. The countermovement was shallower and its duration was less on the prosthetic side compared to the sound side. The reduced and passive range of motion at the prosthesis resulted in an asymmetrical countermovement for both participants with the knee and ankle joints most affected. The duration of the push-off phase was not consistently affected. At take-off the joints on the sound side reached close to full extension while on the prosthetic side they remained more flexed. Joint extension velocity in the push-off phase was similar for both participants on the sound side, though the timing for participant 2 illustrated earlier peaks. The pattern of joint extension velocity was not a smooth proximal to distal sequence on the prosthetic side. The magnitude and timing of the inter-segment extensor moments were asymmetrical for both subjects. The power pattern was asymmetrical in both the countermovement and push-off phases; the lack of power generation at the ankle affected that produced at the remaining joints.

Transcatheter heart valves for the treatment of aortic stenosis: state-of-the-art.

PubMed

Del Valle-Fernández, R; Ruiz, C E

2008-10-01

Degenerative aortic stenosis is the most frequent heart valve disease. As an alternative to surgical aortic valve replacement, several companies are working on the development of new prosthesis designed to be deployed by transcatheter approaches. Both transfemoral and transapical techniques are feasible, and initial trials in high-risk patients show good procedural outcomes and mid-term (up to 2 years) functionality. Two first-generation prosthesis (Edwards-SAPIEN and CoreValve Revalving System) are commercially available in Europe, and a number of other second-generation valves (with the capabilities of repositioning and retrievability) are under evaluation. Among them, the Sadra-Lotus Valve, The Direct Flow Medical valve and the Paniagua Heart Valve have published first-in-man results; the JenaValve and AorTx devices have also been temporarily implanted in humans. The development of repositionable and retrievable prosthesis with improved profile is mandatory, and it is the main focus of current projects. Not only technical improvements but also operators specialization and an optimal patient selection are essential to improve these initial Some procedural challenges need to be overcome prior to the expansion of these techniques to lower risk groups, and time is needed for detailed long-term outcomes and risk estimations. Only with a close collaboration among different specialists, basic researchers and the industry will the future development of transcatheter aortic implantation techniques be ensured.

Pattern of External Breast Prosthesis Use by Post Mastectomy Breast Cancer Patients in India: Descriptive Study from Tertiary Care Centre.

PubMed

Ramu, D; Ramesh, Rakesh S; Manjunath, Suraj; Shivakumar; Goel, Vipin; Hemnath, G N; Alexander, Annie

2015-12-01

In India, Breast cancer is now the most common cancer in urban and 2nd most common in rural areas [1]. The incidence is rising, more younger women are getting affected and due to increase in survival rates there is an increase in the total number of women suffering from breast Cancer. So far there are no studies evaluating the pattern of breast prosthesis use in Indian scenario. The aim of this study is to address the patterns of external breast prosthesis used in India and view of Indian women on such prosthesis after mastectomy for breast cancer. This was a descriptive longitudinal study. In this study we interviewed (telephonic) 63 people, after three years of completing treatment under The Department of Surgical Oncology, St. Johns medical college, Bangalore. Among the study group, 27 members (40 %) were using various prosthesis, rest 36 women were not using any type of prosthesis. Among the users of prosthesis, silicon prosthesis was used by 6 women, padded cups by 8 women, cloth or cotton by 12 women and 1 woman used other type of prosthesis. Most women use simple items like cloth and cotton (44 %). Next most commonly used prosthesis are padded cups(). Only 22 % of women were found using silicon prosthesis in this study. Most of the well educated patients used external prosthesis either in the form of silicon prosthesis or padded cups. Most of women below age of 50 used external breast prosthesis. Use of prosthesis was more in urban compared to rural population (48 % vs 25 %). Prosthesis users worried more about the body image than women not using prosthesis. 25 % of women using prosthesis had body image issues where as only 5 % of non prosthesis users had such problems. Prosthesis users need improvement in terms of comfort, size, shape and affordability. Most common reasons for not using prosthesis are age, lack of motivation and awareness. Less than half of the women included in this study used external prosthesis after mastectomy for breast cancer. Most of the women are used home made prosthesis like cloth and cotton (44.4 %). Education, age and urban status are the strong factors which influences use of prosthesis. Prosthesis users are those who are more concerned about their body image. There is a palpable need to develop better prosthesis at affordable price.

SALMONELLA SEPTIC BURSITIS OF THE ANKLE IN A HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENT: A CASE REPORT AND LITERATURE REVIEW.

PubMed

Hiransuthikul, Akarin; Hiransuthikul, Narin

2016-11-01

Salmonella is an unusual cause of septic bursitis of the ankle. A 48-yearold male fish-merchant with a history of HIV infection with a CD4 cell count of 79 cells/ml presented with pain of the left ankle for 2 weeks and fever for 1 day. The bursal fluid was aspirated and culture of the fluid revealed Salmonella group D. He was treated initially with intravenous ceftriaxone 2g once daily for 5 days, followed by oral ciprofloxacin 500mg twice daily for 4 weeks to give a treatment course of 5 weeks. Follow-up visit revealed complete recovery without any residual defects. Salmonella should be considered in the differential of the etiology of immunosuppressed patient with septic bursitis.

Clinical results of Hi-tech Knee II total knee arthroplasty in patients with rheumatoid athritis: 5- to 12-year follow-up

PubMed Central

2012-01-01

Background Total knee arthroplasty (TKA) is a common form of treatment to relieve pain and improve function in cases of rheumatoid arthritis (RA). Good clinical outcomes have been reported with a variety of TKA prostheses. The cementless Hi-Tech Knee II cruciate-retaining (CR)-type prosthesis, which has 6 fins at the anterior of the femoral component, posterior cruciate ligament (PCL) retention, flat-on-flat surface component geometry, all-polyethylene patella, strong initial fixation by the center screw of the tibial base plate, 10 layers of titanium alloy fiber mesh, and direct compression molded ultra high molecular weight polyethylene (UHMWPE), is appropriate for TKA in the Japanese knee. The present study was performed to evaluate the clinical results of primary TKA in RA using the cementless Hi-Tech Knee II CR-type prosthesis. Materials and methods We performed 32 consecutive primary TKAs using cementless Hi-Tech Knee II CR-type prosthesis in 31 RA patients. The average follow-up period was 8 years 3 months. Clinical evaluations were performed according to the American Knee Society (KS) system, knee score, function score, radiographic evaluation, and complications. Results The mean postoperative maximum flexion angle was 115.6°, and the KS knee score and function score improved to 88 and 70 after surgery, respectively. Complications, such as infection, occurred in 1 patient and revision surgery was performed. There were no cases of loosening in this cohort, and prosthesis survival rate was 96.9% at 12 years postoperatively. Conclusion These results suggest that TKA using the cementless Hi-Tech Knee II CR-type prosthesis is a very effective form of treatment in RA patients at 5 to 12 years postoperatively. Further long-term follow-up studies are required to determine the ultimate utility of this type of prosthesis. PMID:22356935

Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle

PubMed Central

Dhillon, Mandeep Singh; Agashe, Vikas; Patil, Sampat Dumbre

2017-01-01

Background: Tuberculosis of the foot and ankle still remains to be a significant problem, especially in the developing countries, and with an increase in incidence in immunosuppressed patients. Treatment is mainly medical using multidrug chemotherapy; surgical interventions range from biopsy, synovectomy and debridement, to joint preserving procedures like distraction in early cases, and arthrodesis of hindfoot joints and the ankle in advanced disease with joint destruction. Surgical Options: All procedures should be done after initiating appropriate medical management. The ankle is the commonest joint needing intervention, followed by the subtalar and talo-navicular joint. Forefoot TB limited to the bone rarely needs surgical intervention except when the infective focus is threatening to invade a joint. Articular disease can spread rapidly, so early diagnosis and treatment can influence the outcome. Surgical interventions may need to be modified in the presence of sinuses and active disease; fusions need compression, and implants have to be chosen wisely. External fixators are the commonest devices used for compression in active disease, but intramedullary nails better stabilize pantalar arthrodesis. Arthroscopy has become a valuable tool for visualizing the ankle and hindfoot joints, and is an excellent adjunct for arthrodesis by minimally invasive methods. Conclusion: Although Osteoarticular Tb involving the foot and ankle is largely managed with chemotherapy, specific indications for surgical intervention exist. Timely done procedures could limit joint destruction, or prevent spread to adjacent joints. Fusions are the commonest procedure for sequelae of disease or for correcting residual deformity. PMID:29081861

Altered visual focus on sensorimotor control in people with chronic ankle instability.

PubMed

Terada, Masafumi; Ball, Lindsay M; Pietrosimone, Brian G; Gribble, Phillip A

2016-01-01

The purpose of this investigation was to examine the effects of the combination of chronic ankle instability (CAI) and altered visual focus on strategies for dynamic stability during a drop-jump task. Nineteen participants with self-reported CAI and 19 healthy participants performed a drop-jump task in looking-up and looking-down conditions. For the looking-up condition, participants looked up and read a random number that flashed on a computer monitor. For the looking-down condition, participants focused their vision on the force plate. Sagittal- and frontal-plane kinematics in the hip, knee and ankle were calculated at the time points of 100 ms pre-initial foot contact to ground and at IC. The resultant vector time to stabilisation was calculated with ground reaction force data. The CAI group demonstrated less hip flexion at the point of 100 ms pre-initial contact (P < 0.01), and less hip flexion (P = 0.03) and knee flexion at initial contact (P = 0.047) compared to controls. No differences in kinematics or dynamic stability were observed in either looking-up or looking-down conditions (P > 0.05). Altered visual focus did not influence movement patterns during the drop-jump task, but the presence of CAI did. The current data suggests that centrally mediated changes associated with CAI may lead to global alterations in the sensorimotor control.

Penile Prosthesis Surgery: Current Recommendations From the International Consultation on Sexual Medicine.

PubMed

Levine, Laurence A; Becher, Edgardo; Bella, Anthony; Brant, William; Kohler, Tobias; Martinez-Salamanca, Juan Ignacio; Trost, Landon; Morey, Allen

2016-04-01

Penile prosthesis implantation has emerged as a definitive treatment to restore sexual function to the motivated man with erectile dysfunction. Substantial improvements in the design of inflatable devices have been made since they first became available more than four decades ago. To review the history of the penile prosthesis, the indications, preoperative evaluation, and patient and partner satisfaction. The current approaches to addressing intra- and postoperative complications, provide an understanding of prosthesis infection, and placement of these devices will be reviewed. A committee of worldwide experts in this field was assembled during the 2015 International Consultation on Sexual Medicine (ICSM) and performed a systematic review of the peer-reviewed published medical literature pertaining to penile prosthesis. Particular attention was given to higher level trials when available. Recommendations are based upon the Oxford Criteria. Unfortunately there is limited level 1 and 2 evidence, and where expert opinion was utilized, the decision was unanimous within the committee with a goal of presenting a clinically relevant guideline pertaining to penile prostheses. Penile prosthesis has undergone an evolution over the past 40 years resulting in a more effective and reliable treatment for advanced erectile dysfunction not responding to less invasive methods including oral treatment with PDE5 inhibitors, vacuum erection device, and intracorporal injection therapy. It should be considered an appropriate treatment option for the man who wishes to restore erectile function and who understands the potential risk of mechanical failure and infection, both of which are less common now as a result of improvements made in device design as well as surgical protocols adhered to in the operating room. Patients must be clearly informed of the risks associated with penile prosthesis including mechanical failure, infection, shortening of the penis, change in sensation and configuration of the penis, as well as injury to local structures. Intraoperative complications are unusual but do occur and can usually be addressed intraoperatively to allow placement of the device at the time of initial surgery. Postoperative complications may also be addressed when they occur but may require more advanced reconstructive surgical techniques. Men with Peyronie's disease, corporal fibrosis due to infection, trauma, prior prosthesis explantation, priapism, and men who have undergone construction of a neophallus may require additional advanced maneuvers to obtain optimum results with a penile prosthesis. Penile prosthesis remains as an important, viable, and effective treatment for male erectile dysfunction that does not respond to other less invasive approaches or when these approaches are contraindicated or not acceptable to the patient. These devices provide the patient with the ability to engage in penetrative sexual activity without interfering with urination, ejaculation, sensation, or orgasm. Although mechanical failure can occur, the current devices are more reliable as a result of design modifications. Infection remains the most dreaded complication but since the introduction of antibiotic and hydrophilic coatings, infection is less common. Overall, patient and partner satisfaction appear to be reasonably high when a penile prosthesis is used to restore erectile function. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

The effect of ankle bracing on knee kinetics and kinematics during volleyball-specific tasks.

PubMed

West, T; Ng, L; Campbell, A

2014-12-01

The purpose of this study was to examine the effects of ankle bracing on knee kinetics and kinematics during volleyball tasks. Fifteen healthy, elite, female volleyball players performed a series of straight-line and lateral volleyball tasks with no brace and when wearing an ankle brace. A 14-camera Vicon motion analysis system and AMTI force plate were used to capture the kinetic and kinematic data. Knee range of motion, peak knee anterior-posterior and medial-lateral shear forces, and peak ground reaction forces that occurred between initial contact with the force plate and toe off were compared using paired sample t-tests between the braced and non-braced conditions (P < 0.05). The results revealed no significant effect of bracing on knee kinematics or ground reaction forces during any task or on knee kinetics during the straight-line movement volleyball tasks. However, ankle bracing was demonstrated to reduce knee lateral shear forces during all of the lateral movement volleyball tasks. Wearing the Active Ankle T2 brace will not impact knee joint range of motion and may in fact reduce shear loading to the knee joint in volleyball players. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Inconsistency between simultaneous blood pressure measurements in the arm, forearm, and leg in anesthetized children.

PubMed

Keidan, Ilan; Sidi, Avner; Ben-Menachem, Erez; Tene, Yael; Berkenstadt, Haim

2014-02-01

To determine the accuracy and precision of simultaneous noninvasive blood pressure (NIBP) measurement in the arm, forearm, and ankle in anesthetized children. Prospective, randomized study. University medical center. 101 ASA physical status 1 and 2 children (aged 1-8 yrs) scheduled for elective surgery with general anesthesia. Simultaneous NIBP measurements were recorded at the arm, forearm, and ankle at 5-minute intervals. The systolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 63% and 29% of measurements, and within the ± 20% range in 85% and 67% of measurements, respectively. The diastolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 42% and 44% and within the ± 20% range in 67% and 74% of measurements, respectively. In patients in whom the initial three NIBP measurements were within the ± 20% range between the forearm and arm, 86% of the subsequent measurements were also within that limit. Forearm and ankle NIBP measurements are unreliable and inconsistent with NIBP measured in the arm of anesthetized children. These alternative BP measurement sites are not reliable in accuracy (comparison with reference "gold" standard) and precision (reproducibility). Copyright © 2014 Elsevier Inc. All rights reserved.

What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?

PubMed

van den Bekerom, Michel P J; Struijs, Peter A A; Blankevoort, Leendert; Welling, Lieke; van Dijk, C Niek; Kerkhoffs, Gino M M J

2012-01-01

Ankle sprains are common problems in acute medical care. The variation in treatment observed for the acutely injured lateral ankle ligament complex in the first week after the injury suggests a lack of evidence-based management strategies for this problem. To analyze the effectiveness of applying rest, ice, compression, and elevation (RICE) therapy begun within 72 hours after trauma for patients in the initial period after ankle sprain. Eligible studies were published original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 subtreatments of RICE therapy in the treatment of acute ankle sprains in adults. MEDLINE, Cochrane Clinical Trial Register, CINAHL, and EMBASE. The lists of references of retrieved publications also were checked manually. We extracted relevant data on treatment outcome (pain, swelling, ankle mobility or range of motion, return to sports, return to work, complications, and patient satisfaction) and assessed the quality of included studies. If feasible, the results of comparable studies were pooled using fixed- or random-effects models. After deduction of the overlaps among the different databases, evaluation of the abstracts, and contact with some authors, 24 potentially eligible trials remained. The full texts of these articles were retrieved and thoroughly assessed as described. This resulted in the inclusion of 11 trials involving 868 patients. The main reason for exclusion was that the authors did not describe a well-defined control group without the intervention of interest. Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines.

Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes.

PubMed

Kudaş, Savaş; Dönmez, Gürhan; Işık, Çetin; Çelebi, Mesut; Çay, Nurdan; Bozkurt, Murat

2016-12-01

To describe a clinical treatment algorithm for posterior ankle impingement (PAI) syndrome in professional football players. A case series of 26 elite professional football players diagnosed and treated for posterior ankle impingement syndrome were included for the study. All of the athletes received conservative treatment with physical therapy modalities initially. If the first line medical treatment and rehabilitation was ineffective to alleviate the symptoms, ultrasound-guided corticosteroid injection was proposed and thereafter the patients underwent posterior ankle arthroscopy if the complaints are still unresolved. The pain scores (AOFAS, VAS), and time to return to play were the main outcome measures. The complaints of 18 (69.2%) players were subsided with non-surgical treatment whereas three of acute cases and five of the chronic cases did not respond to medical treatment and arthroscopic surgery was performed for eight athletes. Eighteen players returned to training for a mean time of 36.3 days (24-42 days) after conservative treatment. The patients who underwent arthroscopic surgery returned to training for a mean time of 49.8 days (42-56 days) after the surgery. All athletes returned to their previous level of competition after treatment without any complications or recurrence in a mean follow-up 36.5 months (19-77 months). Non-surgical treatment modalities were effective in 2/3 of posterior ankle impingement syndrome in elite football players. On the other hand, posterior ankle arthroscopy is safe and effective treatment option for posterior ankle impingement syndrome if the conservative treatment fails. Level IV, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

The "All-Inside" Arthroscopic Broström Procedure With Additional Suture Anchor Augmentation: A Prospective Study of 45 Consecutive Patients.

PubMed

Cottom, James M; Baker, Joseph S; Richardson, Phillip E

Lateral ankle sprains are a common injury that typically respond well to nonoperative therapy. When nonoperative therapy fails and patients develop chronic lateral ankle instability, they become candidates for surgical repair. The present study examined 45 consecutive patients (45 ankles) with chronic lateral ankle instability who underwent arthroscopic Broström repair using a double-row suture anchor construct. The 45 patients (27 females and 18 males) were followed up for a mean of 14 (range 12 to 20) months. The mean time to weightbearing with crutches was 3.3 (range 2 to 4) days, and full weightbearing was initiated at a mean of 14.4 (range 12 to 16) days. All patients participated in structured physical therapy, which was started at 21.6 (range 18 to 23) days. Patients were transitioned to regular shoe gear with a stirrup-style ankle brace at 28.7 (range 26 to 31) days. The American Orthopaedic Foot and Ankle Society scale scores improved from an average preoperative score of 48.7 (range 45 to 55) to 95.4 (range 90 to 100) postoperatively. The average visual analog scale decreased from 8 (range 6 to 10) preoperatively to 0.6 (range 0 to 5) postoperatively at the last follow-up visit. The Karlsson-Peterson score postoperatively was 87 of 100. We have shown that patients with this new arthroscopic Broström technique modified with a proximal suture anchor can begin weightbearing earlier than previously reported, without adverse effects in terms of pain, functional outcomes scores, and clinical outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Hemi-Castaing ligamentoplasty for the treatment of chronic lateral ankle instability: a retrospective assessment of outcome.

PubMed

Schepers, Tim; Vogels, Lucas M M; Van Lieshout, Esther M M

2011-12-01

In the treatment of chronic ankle instability, most non-anatomical reconstructions use the peroneus brevis tendon. This, however, sacrifices the natural ankle stabilising properties of the peroneus brevis muscle. The aim of this study was to evaluate the functional outcome of patients treated with a hemi-Castaing procedure, which uses only half the peroneus brevis tendon. We performed a retrospective cohort study of patients who underwent hemi-Castaing ligamentoplasty for chronic lateral ankle instability between 1993 and 2010, with a minimum of one year follow-up. Patients were sent a postal questionnaire comprising five validated outcome measures: Olerud-Molander Ankle Score (OMAS), Karlsson Ankle Functional Score (KAFS), Tegner Activity Level Score (pre-injury, prior to surgery, at follow-up), visual analog scale on pain (VAS) and the Short Form 36 (SF-36). Twenty patients completed the questionnaire on functional outcome. The OMAS showed good to excellent outcome in 80% and the KAFS in 65%, the Tegner Score improved from surgery but did not reach pre-injury levels, the VAS on pain was 1 of 10 and the SF-36 returned to normal compared with the average population. Even though most patients were satisfied with the results, outcome at long-term follow-up was less favourable compared with the literature on anatomical reconstructions. In accordance with the literature, we therefore conclude that the initial surgical treatment of chronic lateral ankle instability should be an anatomical repair with augmentation (i.e. the Broström-Gould technique) and the non-anatomical repair should be reserved for unsuccessful cases after anatomical repair or in cases where no adequate ligament remnants are available for reconstruction.

A new ankle laxity tester and its use in the measurement of the effectiveness of taping.

PubMed

Kirk, T; Saha, S; Bowman, L S

2000-12-01

Damage to the lateral ligaments of the ankle, namely the anterior talofibular (ATFL) and the calcaneofibular (CFL) ligaments, is a frequently reported sports injury. The anterior drawer test is generally used to evaluate whether the ATFL has been torn, while the talar tilt test is used to determine if the CFL has been injured. Although these two manual tests are often utilized for quick diagnosis, they have been criticized because of their subjective nature and their inability to produce quantitative and reproducible results. A prototype ankle tester was manufactured that could measure the input force and torque, as well as the linear and angular deprivations for the anterior drawer test and the talar tilt test, respectively. This device was used to take readings on 10 human volunteers of a mean age of 21.6 years. This device was X-ray compatible, adjustable for varying patient sizes, relatively small, portable, and easy to operate. Testing was performed to determine how the stiffness of the ankle would respond to taping, and the effect of walking on the taped ankle. The overall mean anterior drawer was 5.93 mm and the mean talar tilt was 51.6 degrees for bare ankles using a force of 111 N (25 lbs) for the drawer and a torque of 16 N m for the tilt. Taping provided an average increase in stiffness of 11.3%, demonstrating that it did provide increased stability. However, statistically significant (P<0.05) decreases in the stiffness subsequent to taping were observed between the initially taped ankles and after 20 min of walking, when it was shown that talar tilt had increased. The prototype ankle tester produced repeatable measurements, and results show that the increase in stiffness due to taping did decrease after a short period of time.

[Congenital club foot: treatment in childhood, outcome and problems in adulthood].

PubMed

Besse, J L; Leemrijse, T; Thémar-Noël, C; Tourné, Y

2006-04-01

PURPOSE OF THE SYMPOSIUM: Treatment of idiopathic talipes varus, or congenital clubfoot, is designed to re-align the foot to alleviate pain and allow plantigrade weight bearing with adequate joint motion despite the subnormal radiographic presentation. This symposium was held to review current management practices for congenital clubfoot in children and to analyze outcome in adults in order to propose the most appropriate therapeutic solutions. Idiopathic talipes varus can be suspected from the fetal ultrasound. Parents should be given precise information concerning proposed treatment after birth. Deviations must be assessed in the newborn then revised regularly using objective scales during and after the end of treatment. This enables a better apprehension of the evolution in comparison with the severity of the initial deformation. Conservative treatment is proposed by many teams: a functional approach (rehabilitation and minimal use of orthetic material) or the Ponseti method (progressive correction using casts associated with percutaneous tenotomy of the calcaneal tendon) are currently preferred. If such methods are insufficient or unsuccessful, surgery may be performed as needed at about 8 to 11 months to achieve posteromedial release. Good results are obtained in 80% of patients who generally present minimal residual deformations (adduction of the forefoot, minimal calcaneal varus, residual medial rotation, limitation of dorsal flexion), which must be followed regularly through growth. The difficulty is to distinguish acceptable from non-acceptable deformation. At the end of the growth phase, severe articular sequelae are rare (stiff joint, recurrence of initial deformation, overcorrection) but difficult to correct surgically: osteotomy, tendon transfer, double arthrodesis, Ilizarov fixator. Gait analysis is essential to quantify function and obtain an objective assessment of the impact on higher joints, providing valuable guidance for surgical correction. There have been very few studies evaluating the long-term functional outcome after treatment during childhood. According to two studies presented at this symposium (Brussels, Lausanne), results have been generally good but with subnormal radiographs irrespective of the type of treatment or how early treatment started in childhood. Hypoplasia of the talar dome is a constant finding and is correlated with limitation of dorsal flexion of the ankle joint. A small degree under-correction is often observed but well tolerated while overcorrection is generally less well tolerated. Functional outcome depends highly on preservation of subtalar joint motion. There have been no reports on the results of treatment of sequelae in adults. Most problems (pain, stiffness, osteoarthritis) are observed in the mid or rear foot. Indications for conservative surgery (osteotomy) of the mid or rear foot are rare compared with indications for combined arthrodesis. Talocrural decompensation is a turning point observed in the adult. Management at this point is difficult: fusion of the ankle worsens the situation by increasing the stress on the forefoot and aggravating the disability; implantation of an ankle prosthesis is technically difficult and remains to be fully developed. Treatment of the dorsal bunion of the great toe may require tendon transfer and/or fusion. A child born with clubfoot will never have a normal foot in adulthood. Sequelae present at the end of growth will intensify during adult life; under-correction is easier to treat in adulthood than overcorrection. The most difficult problems in adulthood are: neglected clubfoot, over correction, and degradation of the talocrural joint.

Influence of functionally graded pores on bone ingrowth in cementless hip prosthesis: a finite element study using mechano-regulatory algorithm.

PubMed

Tarlochan, Faris; Mehboob, Hassan; Mehboob, Ali; Chang, Seung-Hwan

2018-06-01

Cementless hip prostheses with porous outer coating are commonly used to repair the proximally damaged femurs. It has been demonstrated that stability of prosthesis is also highly dependent on the bone ingrowth into the porous texture. Bone ingrowth is influenced by the mechanical environment produced in the callus. In this study, bone ingrowth into the porous structure was predicted by using a mechano-regulatory model. Homogenously distributed pores (200 and 800 [Formula: see text]m in diameter) and functionally graded pores along the length of the prosthesis were introduced as a porous coating. Bone ingrowth was simulated using 25 and 12 [Formula: see text]m micromovements. Load control simulations were carried out instead of traditionally used displacement control. Spatial and temporal distributions of tissues were predicted in all cases. Functionally graded pore decreasing models gave the most homogenous bone distribution, the highest bone ingrowth (98%) with highest average Young's modulus of all tissue phenotypes approximately 4.1 GPa. Besides this, the volume of the initial callus increased to 8.33% in functionally graded pores as compared to the 200 [Formula: see text]m pore size models which increased the bone volume. These findings indicate that functionally graded porous surface promote bone ingrowth efficiently which can be considered to design of surface texture of hip prosthesis.

Using "Rebar" to Stabilize Rigid Chest Wall Reconstruction.

PubMed

Robinson, Lary A; Grubbs, Deanna M

2016-04-01

After major chest wall resection, reconstruction of the bony defect with a rigid prosthesis is mandatory to protect the underlying thoracic organs, and to prevent flail chest physiology. Although many methods have been described for chest wall reconstruction, a commonly used technique employs a composite Marlex (polypropylene) mesh with methyl-methacrylate cement sandwiched between two layers of mesh (MMS), which is tailored to the defect size and shape. In building construction, steel "rebar" is used to strengthen and reinforce masonry structures. To avoid the initial residual motion of the rigid prosthesis used to reconstruct very large defects, particularly the sternum, we devised a simple technique of adding one or more Steinmann steel pins as "rebar" to strengthen and immediately stabilize the prosthesis to the surrounding ribs and sternum. For the very large defects, particularly over the heart and great vessels, titanium mesh may also be readily added into the sandwich construction for increased strength and to prevent late prosthetic fractures. Short- and long-term results of this inexpensive modification of the MMS reconstruction technique are excellent. This modified MMS tailor-made prosthesis is only one-third the cost of the recently popular prosthetic titanium systems, takes much less operative time to create and implant, and avoids the well-described complications of late titanium bar fracture and erosion/infection as well as loosening of screws and/or titanium bars. Georg Thieme Verlag KG Stuttgart · New York.

Nasofacial defect following fibrosarcoma excision and radiotherapy.

PubMed

Burget, G L; Panje, W R; Krause, C J

1988-01-01

For initial reconstruction, Dr. Burget suggests that he would have advanced the cheek flap medially toward the nasal septum and, subsequently, reconstructed the missing right half of the nose with a forehead flap and cartilage grafts. Dr. Panje suggested early prosthetic rehabilitation, while Dr. Krause's concepts were similar to Dr. Burget's, with forehead flap nasal reconstruction, after cheek reconstruction to the nasofacial and nasolabial lines with a medially advanced cheek flap. Dr. Panje recommended an immediate maxillary denture prosthesis, as did Dr. Krause (who supplemented this with foam rubber). Dr. Burget placed the prosthesis 3 weeks after tumor ablation. For skin grafts, Drs. Panje and Burget suggested split thickness grafts to all new surfaces to decrease wound contracture, while Dr. Krause used dermis grafts for the same purpose. Other reconstructive methods mentioned were the (1) cervical tubed flap, (2) free scapular flap, (3) Washio flap, (4) tissue expansion, and (5) nasolabial flap. Suggestions for isolated defects included: Lower eyelid--increase internal support by building up the prosthesis; release lower lid from deltopectoral flap and V-Y advancement; support graft or irradiated cartilage (1-2 mm sheet) under orbicularis oculi. Nasal ala--bring present ala down and insert cartilage graft; turn internal skin down and fill the resulting defect with a composite graft. Upper lip--multiple Z-plasty. Retrodisplacement of cheek due to maxillectomy--release buccal scar; skin graft the raw internal surface and build up prosthesis.

Incidence of wrong-site surgery among foot and ankle surgeons.

PubMed

Schweitzer, Karl M; Brimmo, Olubusola; May, Ryan; Parekh, Selene G

2011-02-01

In 1998, the American Academy of Orthopaedic Surgeons initiated the "sign your site" campaign to address the issue of wrong-site surgery (WSS). Using a confidential online survey sent to 1094 active members of the American Academy of Foot and Ankle Surgeons, the authors assessed participation in the "sign your site" campaign and the occurrence of WSS encountered during their careers. A total of 319 responses were received (response rate = 29.2%). In all, 41 of 310 respondents (13%) reported performing WSS at least once, with 4 surgeons (1%) reporting the occurrence twice in their careers; 70 of 310 (23%) surgeons reported that they had prepped the wrong surgical site, but the error was recognized prior to making an incision. In all, 302 of 309 respondents (97.7%) reported that they were aware of the "sign your site" initiative. Since the introduction of the campaign, significantly more (89.2% vs 49.2%) foot and ankle surgeons routinely mark the surgical site (P < .001). The Joint Commission revised the universal protocol for surgical site verification requiring an individual directly involved in a surgical procedure to mark the site as of January 1, 2009. The authors believe this revision will lower the incidence of WSS further.

Foot and Ankle Kinematics During Descent From Varying Step Heights.

PubMed

Gerstle, Emily E; O'Connor, Kristian; Keenan, Kevin G; Cobb, Stephen C

2017-12-01

In the general population, one-third of incidences during step negotiation occur during the transition to level walking. Furthermore, falls during curb negotiation are a common cause of injury in older adults. Distal foot kinematics may be an important factor in determining injury risk associated with transition step negotiation. The purpose of this study was to identify foot and ankle kinematics of uninjured individuals during descent from varying step heights. A 7-segment foot model was used to quantify kinematics as participants walked on a level walkway, stepped down a single step (heights: 5 cm, 15 cm, 25 cm), and continued walking. As step height increased, landing strategy transitioned from the rearfoot to the forefoot, and the rearfoot, lateral and medial midfoot, and medial forefoot became more plantar flexed. During weight acceptance, sagittal plane range of motion of the rearfoot, lateral midfoot, and medial and lateral forefoot increased as step height increased. The changes in landing strategy and distal foot function suggest a less stable ankle position at initial contact and increased demand on the distal foot at initial contact and through the weight acceptance phase of transition step negotiation as step height increases.

Reflexes in cat ankle muscles after landing from falls.

PubMed Central

Prochazka, A; Schofield, P; Westerman, R A; Ziccone, S P

1977-01-01

1. Electrical activity and length of ankle muscles were recorded by telemetry during free fall and landing in cats. 2. After foot contact, there was a delay in onset of stretch of ankle extensors of between 8 and 11 ms. High-speed cinematography showed the delay to be associated with rapid initial dorsiflexion of the toes. 3. Electromyograms (e.m.g.) from lateral gastrocnemius increased in amplitude prior to landing. An early depression of lateral gastrocnemius e.m.g. commenced at 8 ms after foot contact, and was followed by a large peak of activity commencing some 8 ms after the first increase in lateral gastrocnemius length. 4. Local anaesthesia of the plantar cushion did not alter this pattern of response. 5. The early inhibition of lateral gastrocnemius was attributed to the action on lateral gastrocnemius motoneurones of non-cutaneous afferents responding to the initial toe dorsiflexion. Additional autogenetic inhibition may also have contributed. 6. The subsequent peak of e.m.g. was at a latenty consistent with a rapid stretch reflex, and occurred soon enough for the resulting active tension to contribute significantly to the extensor force during body deceleration. PMID:592210

Experience using the «Shetty test» for initial foot and ankle fracture screening in the Emergency Department.

PubMed

Ojeda-Jiménez, J; Méndez-Ojeda, M M; Martín-Vélez, P; Tejero-García, S; Pais-Brito, J L; Herrera-Pérez, M

2018-03-20

The indiscriminate practice of radiographs for foot and ankle injuries is not justified and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty Test in our area. A cross-sectional observational study by applying the Shetty test to patients seen in the Emergency Department. We enrolled 100 patients with an average age of 39.25 (16-86). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: 4 were false positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). The Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Progress Toward Development of a Multichannel Vestibular Prosthesis for Treatment of Bilateral Vestibular Deficiency

PubMed Central

FRIDMAN, GENE Y.; DELLA SANTINA, CHARLES C.

2014-01-01

This article reviews vestibular pathology and the requirements and progress made in the design and construction of a vestibular prosthesis. Bilateral loss of vestibular sensation is disabling. When vestibular hair cells are injured by ototoxic medications or other insults to the labyrinth, the resulting loss of sensory input disrupts vestibulo-ocular reflexes (VORs) and vestibulo-spinal reflexes that normally stabilize the eyes and body. Affected individuals suffer poor vision during head movement, postural instability, chronic disequilibrium, and cognitive distraction. Although most individuals with residual sensation compensate for their loss over time, others fail to do so and have no adequate treatment options. A vestibular prosthesis analogous to cochlear implants but designed to modulate vestibular nerve activity during head movement should improve quality of life for these chronically dizzy individuals. We describe the impact of bilateral loss of vestibular sensation, animal studies supporting feasibility of prosthetic vestibular stimulation, the current status of multichannel vestibular sensory replacement prosthesis development, and challenges to successfully realizing this approach in clinical practice. In bilaterally vestibular-deficient rodents and rhesus monkeys, the Johns Hopkins multichannel vestibular prosthesis (MVP) partially restores the three-dimensional (3D) VOR for head rotations about any axis. Attempts at prosthetic vestibular stimulation of humans have not yet included the 3D eye movement assays necessary to accurately evaluate VOR alignment, but these initial forays have revealed responses that are otherwise comparable to observations in animals. Current efforts now focus on refining electrode design and surgical technique to enhance stimulus selectivity and preserve cochlear function, optimizing stimulus protocols to improve dynamic range and reduce excitation–inhibition asymmetry, and adapting laboratory MVP prototypes into devices appropriate for use in clinical trials. PMID:23044664

[The endo-exo prosthesis treatment concept : Improvement in quality of life after limb amputation].

PubMed

Hoffmeister, T; Schwarze, F; Aschoff, H H

2017-05-01

Osseointegrated, percutaneous implants as the force bearer for exoprosthetics after limb amputation have been used in individual cases for clinical rehabilitation of amputees during the past years. Most experience in this field in Germany has been accumulated at the Sana Klinik in Lübeck with the so-called endo-exo prosthesis (EEP) system. The two-step implantation procedure can now be considered as reliable. Following a well-documented learning curve initial soft tissue problems concerning the cutaneous stoma can now be regarded as exceptions. The retrospective examination of the results concerning by now more than 100 patients provided with an endo-exo femoral prosthesis (EEFP) showed a very satisfying outcome concerning objective as well as subjective values, such as duration of daily use and wearing comfort of the exoprosthesis. Regaining the ability of osseoperception due to the intraosseous fixation is described by the patients as a great advantage. The step from a socket prosthesis to an EEP is felt to be a big increase in quality of life by nearly all patients included into the follow-up. Nearly all of the patients questioned would choose an endo-exo prosthesis again. Meanwhile, the success of the EEP resulted in the broadening of indications from above-knee amputations to transtibial as well as transhumeral amputations. The results are likewise encouraging. The use of EEP for the upper limbs leads to substantial improvement in the range of motion of the shoulder joint with the intramedullary anchored percutaneous implant. Furthermore, new pathbreaking possibilities in the fixation of myoelectrically controlled arm prostheses may arise from the EEP technique.

Association between dental prosthesis need, nutritional status and quality of life of elderly subjects.

PubMed

Pillai, Rajath Sasidharan; Mathur, Vijay Prakash; Jain, Veena; Shah, Naseem; Kalra, Sandeep; Kumar, Pravesh; Dey, A B

2015-12-01

To determine the effect of prosthesis need on nutritional status and oral health-related quality of life (OHrQoL) in elderly and to check the disparity between prosthesis need and prosthesis want in the Indian elderly. A total of 946 geriatric participants reporting to a geriatric medicine clinic were recruited in the study. Mini-nutritional assessment (MNA), geriatric oral health assessment (GOHAI) indices, prosthesis need according to WHO criteria, and prosthesis want was recorded along with age, gender, socioeconomic status and posterior occluding pair. Significant associations exist between prosthesis need and age (p = 0.005), MNA (p = 0.006) and GOHAI (p = 0.000). Prosthesis demand too was influenced by age (p = 0.004), posterior occluding pairs (p = 0.000), MNA (p = 0.012) and GOHAI (p = 0.000). GOHAI was negatively correlated with upper (r = -0.445) and lower prosthesis need (r = -0.460). Participants with some prosthesis need had significantly lower MNA and GOHAI scores as compared to those with no prosthesis need. Though prosthesis need was high (79.7 %), demand was low (39.3 %). Prosthesis need affects nutritional status and OHrQoL in elderly, and a wide gap exists between need and want of prosthesis.

[Ankle injuries without fracture in children. Prospective study with magnetic resonance in 116 patients].

PubMed

Launay, F; Barrau, K; Petit, P; Jouve, J-L; Auquier, P; Bollini, G

2008-09-01

Appropriate assessment of ankle injuries in children and adolescents is a common emergency room problem. Many imaging techniques have been proposed, but with no consensus on the reality of anatomic lesions in ankles free of fractures, complicating the therapeutic decision. We analyzed the lesions observed with magnetic resonance imaging (MRI) in a large number of acute ankles in children. This prospective study was conducted in a pediatric emergency room. The study population included all children aged eight to 15 years who presented an isolated injury of the ankle without fracture on the plain x-ray. History taking and physical examination were standardized. MRI was performed within three days of the initial physical examination. All the radiographic documents were examined by an experienced radiologist blinded to the results of the physical examination. During the study period, 116 patients were included. One hundred two MRI series were examined. Minor ligament injury was noted in 20 patients and ligament tear in five, including three with a closed distal tibial growth plate. Minor bone injury was noted in 42 patients and fracture in seven. None of these fractures were visible on the plain x-ray, even after knowledge of the MRI. Injuries were more frequent in boys. Injuries were more frequent when the pain was localized on the lateral aspect of the ankle and when there was an edema. Despite an abundant literature on ankle sprains, prospective studies are scarce in the pediatric population. We have found that MRI is particularly well-adapted for children because it allows a complete examination of anatomic lesions involving the bone or ligaments without the inconveniences of injections, pain, or radiation. Our clinical and imaging findings show that ankle sprains are real in children. We were however unable to identify any clinical factors predictive of ligament and/or bone injury. Other studies should be conducted to better understand the nosological context of ankle sprain in children and adolescents. Further study will enable a better evidence-based approach to individually adapted therapy.

EFFICACY OF THE STRETCH BAND ANKLE TRACTION TECHNIQUE IN THE TREATMENT OF PEDIATRIC PATIENTS WITH ACUTE ANKLE SPRAINS: A RANDOMIZED CONTROL TRIAL

PubMed Central

Iammarino, Kathryn; Marrie, James; Lowes, Linda P.

2018-01-01

Background Ankle injuries account for up to 40% of all sport related injuries. These injuries can result in weeks to months of missed sport or work. The PRICE (Protection, Rest, Ice, Compression, Elevation) treatment is standard care for most acute ankle sprains. Recently, early mobilization in adults has been shown to decrease time off from sport or work, and the likelihood of developing chronic instability. To date, no research has been performed assessing the effectiveness of early mobilization in pediatric patients (<18 years). Purpose: There were two objectives of this study: (1) to determine if early ankle joint mobilization using elastic band traction is effective and (2) assess the occurrence of adverse events with this technique in the pediatric population. Methods Patients with an acute ankle sprain of <7 days referred to physical therapy were randomly assigned to receive early mobilization or PRICE. Early mobilization was performed using a stretch band ankle traction technique. Both groups received a standardized rehabilitation program. Pain, edema, ankle strength using hand-held dynamometry, and Foot and Ankle Disability Index (FADI) were measured at both initial evaluation and at discharge. The number of days before return to sport and the number of treatment sessions were also variables of interest. Results Forty-one pediatric patients were recruited for participation (mean age 14.6 + 1.9 years). Both treatment groups had clinically significant improvements in pain, edema, strength, and FADI scores. No significant differences in outcomes were noted between treatment groups. Mean number of days for return to sport for the PRICE group was 26.33 + 7.14 and the early mobilization group was 26.63 + 14.82, the difference between groups was not significant (p = 0.607). The number of total visits for the PRICE group of 8.07 + 2.63 and the early mobilization groups of 8.5 + 1.57, was also not statistically significantly different (p = 0.762). There were no reported adverse events with early mobilization. Conclusion Early mobilization appears to be a safe intervention in pediatric patients with an acute ankle sprain. Early mobilization resulted in similar outcomes when compared to traditional PRICE treatment. A high drop-out rate in both treatment groups was a limitation of this randomized trial. Level of evidence 1b PMID:29484236

EFFICACY OF THE STRETCH BAND ANKLE TRACTION TECHNIQUE IN THE TREATMENT OF PEDIATRIC PATIENTS WITH ACUTE ANKLE SPRAINS: A RANDOMIZED CONTROL TRIAL.

PubMed

Iammarino, Kathryn; Marrie, James; Selhorst, Mitchell; Lowes, Linda P

2018-02-01

Ankle injuries account for up to 40% of all sport related injuries. These injuries can result in weeks to months of missed sport or work. The PRICE (Protection, Rest, Ice, Compression, Elevation) treatment is standard care for most acute ankle sprains. Recently, early mobilization in adults has been shown to decrease time off from sport or work, and the likelihood of developing chronic instability. To date, no research has been performed assessing the effectiveness of early mobilization in pediatric patients (<18 years). Purpose: There were two objectives of this study: (1) to determine if early ankle joint mobilization using elastic band traction is effective and (2) assess the occurrence of adverse events with this technique in the pediatric population. Patients with an acute ankle sprain of <7 days referred to physical therapy were randomly assigned to receive early mobilization or PRICE. Early mobilization was performed using a stretch band ankle traction technique. Both groups received a standardized rehabilitation program. Pain, edema, ankle strength using hand-held dynamometry, and Foot and Ankle Disability Index (FADI) were measured at both initial evaluation and at discharge. The number of days before return to sport and the number of treatment sessions were also variables of interest. Forty-one pediatric patients were recruited for participation (mean age 14.6 + 1.9 years). Both treatment groups had clinically significant improvements in pain, edema, strength, and FADI scores. No significant differences in outcomes were noted between treatment groups. Mean number of days for return to sport for the PRICE group was 26.33 + 7.14 and the early mobilization group was 26.63 + 14.82, the difference between groups was not significant ( p = 0.607). The number of total visits for the PRICE group of 8.07 + 2.63 and the early mobilization groups of 8.5 + 1.57, was also not statistically significantly different ( p = 0.762). There were no reported adverse events with early mobilization. Early mobilization appears to be a safe intervention in pediatric patients with an acute ankle sprain. Early mobilization resulted in similar outcomes when compared to traditional PRICE treatment. A high drop-out rate in both treatment groups was a limitation of this randomized trial. 1b.

Changes in lower extremity movement and power absorption during forefoot striking and barefoot running.

PubMed

Williams, D S Blaise; Green, Douglas H; Wurzinger, Brian

2012-10-01

Both forefoot strike shod (FFS) and barefoot (BF) running styles result in different mechanics when compared to rearfoot strike (RFS) shod running. Additionally, running mechanics of FFS and BF running are similar to one another. Comparing the mechanical changes occurring in each of these patterns is necessary to understand potential benefits and risks of these running styles. The authors hypothesized that FFS and BF conditions would result in increased sagittal plane joint angles at initial contact and that FFS and BF conditions would demonstrate a shift in sagittal plane joint power from the knee to the ankle when compared to the RFS condition. Finally, total lower extremity power absorption will be least in BF and greatest in the RFS shod condition. The study included 10 male and 10 female RFS runners who completed 3-dimensional running analysis in 3 conditions: shod with RFS, shod with FFS, and BF. Variables were the angles of plantarflexion, knee flexion, and hip flexion at initial contact and peak sagittal plane joint power at the hip, knee, and ankle during stance phase. Running with a FFS pattern and BF resulted in significantly greater plantarflexion and significantly less negative knee power (absorption) when compared to shod RFS condition. FFS condition runners landed in the most plantarflexion and demonstrated the most peak ankle power absorption and lowest knee power absorption between the 3 conditions. BF and FFS conditions demonstrated decreased total lower extremity power absorption compared to the shod RFS condition but did not differ from one another. BF and FFS running result in reduced total lower extremity power, hip power and knee power and a shift of power absorption from the knee to the ankle. Alterations associated with BF running patterns are present in a FFS pattern when wearing shoes. Additionally, both patterns result in increased demand at the foot and ankle as compared to the knee.

CHANGES IN LOWER EXTREMITY MOVEMENT AND POWER ABSORPTION DURING FOREFOOT STRIKING AND BAREFOOT RUNNING

PubMed Central

Green, Douglas H.; Wurzinger, Brian

2012-01-01

Purpose/Background: Both forefoot strike shod (FFS) and barefoot (BF) running styles result in different mechanics when compared to rearfoot strike (RFS) shod running. Additionally, running mechanics of FFS and BF running are similar to one another. Comparing the mechanical changes occurring in each of these patterns is necessary to understand potential benefits and risks of these running styles. The authors hypothesized that FFS and BF conditions would result in increased sagittal plane joint angles at initial contact and that FFS and BF conditions would demonstrate a shift in sagittal plane joint power from the knee to the ankle when compared to the RFS condition. Finally, total lower extremity power absorption will be least in BF and greatest in the RFS shod condition. Methods: The study included 10 male and 10 female RFS runners who completed 3‐dimensional running analysis in 3 conditions: shod with RFS, shod with FFS, and BF. Variables were the angles of plantarflexion, knee flexion, and hip flexion at initial contact and peak sagittal plane joint power at the hip, knee, and ankle during stance phase. Results: Running with a FFS pattern and BF resulted in significantly greater plantarflexion and significantly less negative knee power (absorption) when compared to shod RFS condition. FFS condition runners landed in the most plantarflexion and demonstrated the most peak ankle power absorption and lowest knee power absorption between the 3 conditions. BF and FFS conditions demonstrated decreased total lower extremity power absorption compared to the shod RFS condition but did not differ from one another. Conclusions: BF and FFS running result in reduced total lower extremity power, hip power and knee power and a shift of power absorption from the knee to the ankle. Clinical Relevance: Alterations associated with BF running patterns are present in a FFS pattern when wearing shoes. Additionally, both patterns result in increased demand at the foot and ankle as compared to the knee. PMID:23091785

Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis.

PubMed

Yeung, Ling-Fung; Ockenfeld, Corinna; Pang, Man-Kit; Wai, Hon-Wah; Soo, Oi-Yan; Li, Sheung-Wai; Tong, Kai-Yu

2018-06-19

Robot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is capable of detecting walking intentions using sensor feedback of wearer's gait pattern. This study aims to investigate the therapeutic effects of robot-assisted gait training with ankle dorsiflexion assistance. This was a double-blinded randomized controlled trial. Nineteen chronic stroke patients with motor impairment at ankle participated in 20-session robot-assisted gait training for about five weeks, with 30-min over-ground walking and stair ambulation practices. Robot-assisted AFO either provided active powered ankle assistance during swing phase in Robotic Group (n = 9), or torque impedance at ankle joint as passive AFO in Sham Group (n = 10). Functional assessments were performed before and after the 20-session gait training with 3-month Follow-up. Primary outcome measure was gait independency assessed by Functional Ambulatory Category (FAC). Secondary outcome measures were clinical scores including Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Timed 10-Meter Walk Test (10MWT), Six-minute Walk Test (SMWT), supplemented by gait analysis. All outcome measures were performed in unassisted gait after patients had taken off the robot-assisted AFO. Repeated-measures analysis of covariance was conducted to test the group differences referenced to clinical scores before training. After 20-session robot-assisted gait training with ankle dorsiflexion assistance, the active ankle assistance in Robotic Group induced changes in gait pattern with improved gait independency (all patients FAC ≥ 5 post-training and 3-month follow-up), motor recovery, walking speed, and greater confidence in affected side loading response (vertical ground reaction force + 1.49 N/kg, peak braking force + 0.24 N/kg) with heel strike instead of flat foot touch-down at initial contact (foot tilting + 1.91°). Sham Group reported reduction in affected leg range of motion (ankle dorsiflexion - 2.36° and knee flexion - 8.48°) during swing. Robot-assisted gait training with ankle dorsiflexion assistance could improve gait independency and help stroke patients developing confidence in weight acceptance, but future development of robot-assisted AFO should consider more lightweight and custom-fit design. ClinicalTrials.gov NCT02471248 . Registered 15 June 2015 retrospectively registered.

Reducing the metabolic cost of walking with an ankle exoskeleton: interaction between actuation timing and power.

PubMed

Galle, Samuel; Malcolm, Philippe; Collins, Steven Hartley; De Clercq, Dirk

2017-04-27

Powered ankle-foot exoskeletons can reduce the metabolic cost of human walking to below normal levels, but optimal assistance properties remain unclear. The purpose of this study was to test the effects of different assistance timing and power characteristics in an experiment with a tethered ankle-foot exoskeleton. Ten healthy female subjects walked on a treadmill with bilateral ankle-foot exoskeletons in 10 different assistance conditions. Artificial pneumatic muscles assisted plantarflexion during ankle push-off using one of four actuation onset timings (36, 42, 48 and 54% of the stride) and three power levels (average positive exoskeleton power over a stride, summed for both legs, of 0.2, 0.4 and 0.5 W∙kg -1 ). We compared metabolic rate, kinematics and electromyography (EMG) between conditions. Optimal assistance was achieved with an onset of 42% stride and average power of 0.4 W∙kg -1 , leading to 21% reduction in metabolic cost compared to walking with the exoskeleton deactivated and 12% reduction compared to normal walking without the exoskeleton. With suboptimal timing or power, the exoskeleton still reduced metabolic cost, but substantially less so. The relationship between timing, power and metabolic rate was well-characterized by a two-dimensional quadratic function. The assistive mechanisms leading to these improvements included reducing muscular activity in the ankle plantarflexors and assisting leg swing initiation. These results emphasize the importance of optimizing exoskeleton actuation properties when assisting or augmenting human locomotion. Our optimal assistance onset timing and average power levels could be used for other exoskeletons to improve assistance and resulting benefits.

A randomized controlled trial on providing ankle-foot orthoses in patients with (sub-)acute stroke: Short-term kinematic and spatiotemporal effects and effects of timing.

PubMed

Nikamp, Corien D M; Hobbelink, Marte S H; van der Palen, Job; Hermens, Hermie J; Rietman, Johan S; Buurke, Jaap H

2017-06-01

Initial walking function is often limited after stroke, and regaining walking ability is an important goal in rehabilitation. Various compensatory movement strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses (AFOs) are often prescribed to improve foot-clearance and may influence these strategies. However, research studying effects of actual AFO-provision early after stroke is limited. We conducted an explorative randomized controlled trial and aimed to study the short-term effects of AFO-provision on kinematic and spatiotemporal parameters in patients early after stroke. In addition, we studied whether timing of AFO-provision influenced these effects. Unilateral hemiparetic patients maximal six weeks post-stroke were randomly assigned to AFO-provision: early (at inclusion) or delayed (eight weeks later). Three-dimensional gait-analysis with and without AFO in randomized order was performed within two weeks after AFO-provision. Twenty subjects (8 early, 12 delayed) were analyzed. We found significant positive effects of AFO-provision for ankle dorsiflexion at initial contact, foot-off and during swing (-3.6° (7.3) vs 3.0° (3.9); 0.0° (7.4) vs 5.2° (3.7); and -6.1° (7.8) vs 2.6° (3.5), respectively), all p<0.001. No changes in knee, hip and pelvis angles were found after AFO-provision, except for knee (+2.3°) and hip flexion (+1.6°) at initial contact, p≤0.001. Significant effects of AFO-provision were found for cadence (+2.1 steps/min, p=0.026), stride duration (-0.08s, p=0.015) and single support duration (+1.0%, p=0.002). Early or delayed AFO-provision after stroke did not affect results. In conclusion, positive short-term effects of AFO-provision were found on ankle kinematics early after stroke. Timing of AFO-provision did not influence the results. NTR1930. Copyright © 2017 Elsevier B.V. All rights reserved.

Calcaneocuboid joint instability: a novel operative technique for anatomic reconstruction.

PubMed

Lohrer, Heinz; Arentz, Sabine

2004-05-01

A case history of a 13-year-old female national top-level gymnast, suffering from calcaneocuboid joint instability, is presented. The procedure was done as an anatomic repair by capsular reefing, which was augmented using a local periosteal flap. Initially, the athlete twisted her ankle. Clinical investigation revealed no sign of a lateral ankle ligament injury, but following this initial examination, recurrent giving-way of the foot occurred. She additionally felt significant but diffuse pain on the lateral side of the foot during loading in training and competition. For 2 months she was unable to run and conservative treatment failed. Diagnosis of a calcaneocuboid instability was established 4 months after the initial lesion by clinical and x-ray stress examination of the calcaneocuboid joint. Open surgery was successfully performed. Early functional posttreatment was done and the patient returned to full high-level gymnastics ability 16 weeks after surgery. Two years later, a similar injury occurred to the opposite calcaneocuboid joint and the same operative procedure again led to full sports ability.

Custom-made ocular prosthesis.

PubMed

Gunaseelaraj, Rajkumar; Karthikeyan, Suma; Kumar, Mohan N; Balamurugan, T; Jagadeeshwaran, A R

2012-08-01

An ocular defect may affect a patient psychologically. An ocular prosthesis is given to uplift the patient psychologically and improve the confidence. Ocular prosthesis can be custom made or a stock shell. To improve the comfort and matching of the prosthesis with that of the adjacent natural eye an custom made ocular prosthesis is preferred. Different techniques are available to fabricate a custom ocular prosthesis, here we have used paper iris disk technique.

Experiences in the provision, fitting and supply of external breast prostheses: findings from a national survey.

PubMed

Gallagher, P; Buckmaster, A; O'Carroll, S; Kiernan, G; Geraghty, J

2009-11-01

A good-quality external breast prosthesis and prosthesis-fitting service is integral to recovery post-mastectomy. However, this area of care has minimal information or research available. The aim of this study was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. Three national surveys were undertaken with women (n = 527), breast care nurses (BCNs) (n = 32) and retail prosthesis fitters (n = 12). The findings identified the importance of the prosthesis for shape, appearance to self, appearance to others, sense of well-being, self-confidence and femininity. Dissatisfaction with weight, comfort and movement of the prosthesis was identified. Cost and travel distance were found to influence the replacement of the prosthesis. Dissatisfaction emerged with the display and choice of products, and brochure availability at the prosthesis fitting. Women preferred to be fitted for the first silicone prosthesis by a BCN in a hospital setting whereas for the replacement prosthesis they preferred a trained fitter at a specialized prosthesis supplier. BCNs and retail fitters identified the need for service guidelines and increased availability of professional development opportunities in prosthesis-fitting. These findings contributed to the development of standards of care for breast prosthesis-fitting services to benefit women and to provide guidelines for those providing the service.

Reviewing Clinical Effectiveness of Active Training Strategies of Platform-Based Ankle Rehabilitation Robots

PubMed Central

2018-01-01

Objective This review aims to provide a systematical investigation of clinical effectiveness of active training strategies applied in platform-based ankle robots. Method English-language studies published from Jan 1980 to Aug 2017 were searched from four databases using key words of “Ankle∗” AND “Robot∗” AND “Effect∗ OR Improv∗ OR Increas∗.” Following an initial screening, three rounds of discrimination were successively conducted based on the title, the abstract, and the full paper. Result A total of 21 studies were selected with 311 patients involved; of them, 13 studies applied a single group while another eight studies used different groups for comparison to verify the therapeutic effect. Virtual-reality (VR) game training was applied in 19 studies, while two studies used proprioceptive neuromuscular facilitation (PNF) training. Conclusion Active training techniques delivered by platform ankle rehabilitation robots have been demonstrated with great potential for clinical applications. Training strategies are mostly combined with one another by considering rehabilitation schemes and motion ability of ankle joints. VR game environment has been commonly used with active ankle training. Bioelectrical signals integrated with VR game training can implement intelligent identification of movement intention and assessment. These further provide the foundation for advanced interactive training strategies that can lead to enhanced training safety and confidence for patients and better treatment efficacy. PMID:29675142

Does it pay to have a damper in a powered ankle prosthesis? A power-energy perspective.

PubMed

Eslamy, Mahdy; Grimmer, Martin; Rinderknecht, Stephan; Seyfarth, Andre

2013-06-01

In this paper we investigated on peak power (PP) and energy (ER) requirements for different active ankle actuation concepts that can have both elasticity and damping characteristics. A lower PP or ER requirement is an important issue because it will lead to a smaller motor or battery. In addition to spring, these actuation concepts are assumed to have (passive) damper in series (series elastic-damper actuator SEDA) or parallel (parallel elastic-damper actuator PEDA) to the motor. For SEA (series elastic actuator), SEDA and PEDA, we calculated the required minimum motor PP and ER in different human gaits: normal level walking, ascending and descending the stairs. We found that for level walking and ascending the stairs, the SEA concept, and for descending, the SEDA, were the favorable concepts to reduce required minimum PP and ER in comparison to a DD (direct drive) concept. In SEDA concept, the minimum PP could be reduced to half of what SEA would require. Nevertheless, it was found that spring was always required, however damper showed 'task specific' advantages. As a result, if a simple design perspective is in mind, from PP-ER viewpoint, SEA could be the best compromise to be used for different above-mentioned gaits. For SEDA or PEDA concepts, a controllable damper should be used. In addition, our results show that it is beneficial to select spring stiffness in SEA, based on level walking gait. The PP and ER requirements would increase very slightly for stairs ascending, and to some extent (10.5%) for descending as a consequence of this selection. In contrast, stiffness selection based on stair ascending or descending, increases the PP requirements of level walking more noticeably (17-24%).

Alignment of the lower extremity mechanical axis by computer-aided design and application in total knee arthroplasty.

PubMed

Zhang, Yuan Z; Lu, Sheng; Zhang, Hui Q; Jin, Zhong M; Zhao, Jian M; Huang, Jian; Zhang, Zhi F

2016-10-01

The success of total knee arthroplasty (TKA) depends on many factors. The position of a prosthesis is vitally important. The purpose of the present study was to evaluate the value of a computer-aided establishing lower extremity mechanical axis in TKA using digital technology. A total of 36 cases of patients with TKA were randomly divided into the computer-aided design of navigation template group (NT) and conventional intramedullary positioning group (CIP). Three-dimensional (3D) CT scanning images of the hip, knee, and ankle were obtained in NT group. X-ray images and CT scans were transferred into the 3D reconstruction software. A 3D bone model of the hip, knee, ankle, as well as the modified loading, was reconstructed and saved in a stereolithographic format. In the 3D reconstruction model, the mechanical axis of the lower limb was determined, and the navigational templates produced an accurate model using a rapid prototyping technique. The THA in CIP group was performed according to a routine operation. CT scans were performed postoperatively to evaluate the accuracy of the two TKA methods. The averaged operative time of the NT group procedures was [Formula: see text] min shorter than those of the conventional procedures ([Formula: see text]  min). The coronal femoral angle, coronal tibial angle, posterior tibial slope were [Formula: see text], [Formula: see text], [Formula: see text] in NT group and [Formula: see text], [Formula: see text], [Formula: see text] in CIP group, respectively. Statistically significant group differences were found. The navigation template produced through mechanical axis of lower extremity may provide a relative accurate and simple method for TKA.

The effects of prosthetic foot stiffness on transtibial amputee walking mechanics and balance control during turning.

PubMed

Shell, Courtney E; Segal, Ava D; Klute, Glenn K; Neptune, Richard R

2017-11-01

Little evidence exists regarding how prosthesis design characteristics affect performance in tasks that challenge mediolateral balance such as turning. This study assesses the influence of prosthetic foot stiffness on amputee walking mechanics and balance control during a continuous turning task. Three-dimensional kinematic and kinetic data were collected from eight unilateral transtibial amputees as they walked overground at self-selected speed clockwise and counterclockwise around a 1-meter circle and along a straight line. Subjects performed the walking tasks wearing three different ankle-foot prostheses that spanned a range of sagittal- and coronal-plane stiffness levels. A decrease in stiffness increased residual ankle dorsiflexion (10-13°), caused smaller adaptations (<5°) in proximal joint angles, decreased residual and increased intact limb body support, increased residual limb propulsion and increased intact limb braking for all tasks. While changes in sagittal-plane joint work due to decreased stiffness were generally consistent across tasks, effects on coronal-plane hip work were task-dependent. When the residual limb was on the inside of the turn and during straight-line walking, coronal-plane hip work increased and coronal-plane peak-to-peak range of whole-body angular momentum decreased with decreased stiffness. Changes in sagittal-plane kinematics and kinetics were similar to those previously observed in straight-line walking. Mediolateral balance improved with decreased stiffness, but adaptations in coronal-plane angles, work and ground reaction force impulses were less systematic than those in sagittal-plane measures. Effects of stiffness varied with the residual limb inside versus outside the turn, which suggests that actively adjusting stiffness to turn direction may be beneficial. Copyright © 2017 Elsevier Ltd. All rights reserved.

Foot fractures frequently misdiagnosed as ankle sprains.

PubMed

Judd, Daniel B; Kim, David H

2002-09-01

Most ankle injuries are straightforward ligamentous injuries. However, the clinical presentation of subtle fractures can be similar to that of ankle sprains, and these fractures are frequently missed on initial examination. Fractures of the talar dome may be medial or lateral, and they are usually the result of inversion injuries, although medial injuries may be atraumatic. Lateral talar process fractures are characterized by point tenderness over the lateral process. Posterior talar process fractures are often associated with tenderness to deep palpation anterior to the Achilles tendon over the posterolateral talus, and plantar flexion may exacerbate the pain. These fractures can often be managed nonsurgically with nonweight-bearing status and a short leg cast worn for approximately four weeks. Delays in treatment can result in long-term disability and surgery. Computed tomographic scans or magnetic resonance imaging may be required because these fractures are difficult to detect on plain films.

Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.

PubMed

Guery, Jacques; Favard, Luc; Sirveaux, François; Oudet, Didier; Mole, Daniel; Walch, Gilles

2006-08-01

Reverse total shoulder arthroplasty is currently being used to treat selected patients with disabling shoulder arthropathy. The purposes of this study were to investigate the medium-term results of reverse total shoulder arthroplasty and to analyze the influence of etiology on the result. We carried out a multicenter study with a minimum follow-up of five years and determined the survival rate of the prosthesis according to the initial etiology of the shoulder arthropathy. Eighty prostheses were implanted in seventy-seven patients between 1992 and 1998. Sixty-six shoulders had an arthropathy with a massive rotator cuff tear, and fourteen shoulders had a disorder with another etiology (rheumatoid arthritis, trauma, or revision arthropathy). At the time of review, eighteen patients had died and two were lost to follow-up. The remaining fifty-seven patients (sixty shoulders) were examined or interviewed by telephone at a mean follow-up of 69.6 months. Cumulative survival curves were generated with replacement of the prosthesis, glenoid loosening, and a functional Constant score of <30 as the end points. The survival rate with replacement of the prosthesis and glenoid loosening as the end points were 91% and 84%, respectively, at 120 months, with shoulders that had arthropathy with a massive rotator cuff tear demonstrating a significantly better result than those that had a disorder with another etiology (p < 0.05). On the other hand, the survival rate with an absolute Constant score of <30 as an end point was 58% at 120 months, with no significant difference with respect to etiology. Two breaks were observed in the survival curves. The first concerned survival until replacement of the prosthesis and occurred at around three years, reflecting early loosening of the prosthesis. The curve then became stable. A second break started at around six years and reflected progressive deterioration of the functional result. Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthropathy with a massive rotator cuff rupture, and it should be used exclusively in patients over seventy years old with low functional demands.

Sockets Manufactured by CAD/CAM Method Have Positive Effects on the Quality of Life of Patients With Transtibial Amputation.

PubMed

Karakoç, Mehmet; Batmaz, İbrahim; Sariyildiz, Mustafa Akif; Yazmalar, Levent; Aydin, Abdülkadir; Em, Serda

2017-08-01

Patients with amputation need prosthesis to comfortably move around. One of the most important parts of a good prosthesis is the socket. Currently, the most commonly used method is the traditional socket manufacturing method, which involves manual work; however, computer-aided design/computer-aided manufacturing (CAD/CAM) is also being used in the recent years. The present study aimed to investigate the effects of sockets manufactured by traditional and CAD/CAM method on clinical characteristics and quality of life of patients with transtibial amputation. The study included 72 patients with transtibial amputation using prosthesis, 36 of whom had CAD/CAM prosthetic sockets (group 1) and 36 had traditional prosthetic sockets (group 2). Amputation reason, prosthesis lifetime, walking time and distance with prosthesis, pain-free walking time with prosthesis, production time of the prosthesis, and adaptation time to the prosthesis were questioned. Quality of life was assessed using the 36-item Short Form Health Survey questionnaire and the Trinity Amputation and Prosthesis Experience Scales. Walking time and distance and pain-free walking time with prosthesis were significantly better in group 1 than those in group 2. Furthermore, the prosthesis was applied in a significantly shorter time, and socket adaptation time was significantly shorter in group 1. Except emotional role limitation, all 36-item Short Form Healthy Survey questionnaire parameters were significantly better in group 1 than in group 2. Trinity Amputation and Prosthesis Experience Scales activity limitation scores of group 1 were lower, and Trinity Amputation and Prosthesis Experience Scales satisfaction with the prosthesis scores were higher than those in group 2. Our study demonstrated that the sockets manufactured by CAD/CAM methods yield better outcomes in quality of life of patients with transtibial amputation than the sockets manufactured by the traditional method.

Women's Satisfaction with Their Breast Prosthesis: What Determines a Quality Prosthesis?

ERIC Educational Resources Information Center

Livingston, Patricia M.; White, Victoria M.; Roberts, Susan B.; Pritchard, Emma; Hayman, Jane; Gibbs, Anne; Hill, David J.

2005-01-01

The aim of this study is to determine what factors constitute a quality prosthesis and ascertain which factors affect prosthesis satisfaction. Sixty-four women who received full funding for their prosthesis and 38 women who received their hospital's usual funding were recruited. Women rated the information provided about breast prostheses very…

Penile prosthesis implant: scientific advances and technological innovations over the last four decades.

PubMed

Chung, Eric

2017-02-01

Despite introduction of oral phosphodiesterase type 5 inhibitors and intracavernosal vasoactive agents, penile prosthesis implant remains a relevant and desired option with sales of penile prostheses continue to stay high, as many men became refractory to medical therapy and/or seeking a more effective and permanent therapy. There are two types of penile prosthesis implants: inflatable and non-inflatable types, and the inflatable penile implants can be subdivided into single-, two- and three-piece devices. Non-inflatable penile prosthesis (non-IPP) may be referred to as semi-rigid rod or malleable prosthesis. IPP is considered a superior option to malleable prosthesis as it produces penile rigidity and flaccidity that closely replicates a normal penile erectile function. Since the introduction of IPP by Scott in 1973, surgical landscape for penile prosthesis implantation has changed dramatically. Advances in prosthesis design, device technologies and surgical techniques have made penile prosthesis implant a more natural, durable and reliable device. The following article reviews the scientific advances and technological innovation in modern penile prosthesis implants over the last four decades.

Penile prosthesis implant: scientific advances and technological innovations over the last four decades

PubMed Central

2017-01-01

Despite introduction of oral phosphodiesterase type 5 inhibitors and intracavernosal vasoactive agents, penile prosthesis implant remains a relevant and desired option with sales of penile prostheses continue to stay high, as many men became refractory to medical therapy and/or seeking a more effective and permanent therapy. There are two types of penile prosthesis implants: inflatable and non-inflatable types, and the inflatable penile implants can be subdivided into single-, two- and three-piece devices. Non-inflatable penile prosthesis (non-IPP) may be referred to as semi-rigid rod or malleable prosthesis. IPP is considered a superior option to malleable prosthesis as it produces penile rigidity and flaccidity that closely replicates a normal penile erectile function. Since the introduction of IPP by Scott in 1973, surgical landscape for penile prosthesis implantation has changed dramatically. Advances in prosthesis design, device technologies and surgical techniques have made penile prosthesis implant a more natural, durable and reliable device. The following article reviews the scientific advances and technological innovation in modern penile prosthesis implants over the last four decades. PMID:28217449

Use of Powered Prosthesis for Children with Upper Limb Deficiency at Hyogo Rehabilitation Center.

PubMed

Toda, Mitsunori; Chin, Takaaki; Shibata, Yaeko; Mizobe, Futoshi

2015-01-01

There has been no research investigating the use of powered prosthetic for children in Japan. To gain better insight into the state of powered prosthesis usage and identify a ratio of rejection among children. Subjects were 37 unilateral below elbow amputees between the ages of 0 and 16 at the time of their first experienced fitting with a powered prosthesis at our Center. The information was collected from medical records and through face-to-face interviews, and we examined rejection rate and the factors affecting the use of powered prosthesis. The rate of discontinuation was 21.6% as 8 of the 37 children stopped using powered prosthesis. All of them were fitted their prosthesis after 2 years of age, and they rejected prosthesis between 5 to 19 years. We found that the level of amputation had no influence on the use of a powered prosthesis. Children fitted before 2 years of age tend to accept their powered prosthesis than those fitted after 2 years. Multidisciprinary team approach, adequate rehabilitation, detailed follow-up and involvement of parents are quite important for introducing powered prosthesis for children.

Diagnosis Of Persistent Infection In Prosthetic Two-Stage Exchange: PCR analysis of Sonication fluid From Bone Cement Spacers.

PubMed

Mariaux, Sandrine; Tafin, Ulrika Furustrand; Borens, Olivier

2017-01-01

Introduction: When treating periprosthetic joint infections with a two-stage procedure, antibiotic-impregnated spacers are used in the interval between removal of prosthesis and reimplantation. According to our experience, cultures of sonicated spacers are most often negative. The objective of our study was to investigate whether PCR analysis would improve the detection of bacteria in the spacer sonication fluid. Methods: A prospective monocentric study was performed from September 2014 to January 2016. Inclusion criteria were two-stage procedure for prosthetic infection and agreement of the patient to participate in the study. Beside tissues samples and sonication, broad range bacterial PCRs, specific S. aureus PCRs and Unyvero-multiplex PCRs were performed on the sonicated spacer fluid. Results: 30 patients were identified (15 hip, 14 knee and 1 ankle replacements). At reimplantation, cultures of tissue samples and spacer sonication fluid were all negative. Broad range PCRs were all negative. Specific S. aureus PCRs were positive in 5 cases. We had two persistent infections and four cases of infection recurrence were observed, with bacteria different than for the initial infection in three cases. Conclusion: The three different types of PCRs did not detect any bacteria in spacer sonication fluid that was culture-negative. In our study, PCR did not improve the bacterial detection and did not help to predict whether the patient will present a persistent or recurrent infection. Prosthetic 2-stage exchange with short interval and antibiotic-impregnated spacer is an efficient treatment to eradicate infection as both culture- and molecular-based methods were unable to detect bacteria in spacer sonication fluid after reimplantation.

Relationship between viscosity of the ankle joint complex and functional ankle instability for inversion ankle sprain patients.

PubMed

Lin, Che-Yu; Kang, Jiunn-Horng; Wang, Chung-Li; Shau, Yio-Wha

2015-03-01

Measurement of viscosity of the ankle joint complex is a novel method to assess mechanical ankle instability. In order to further investigate the clinical significance of the method, this study intended to investigate the relationship between ankle viscosity and severity of functional ankle instability. Cross-sectional study. 15 participants with unilateral inversion ankle sprain and 15 controls were recruited. Their ankles were further classified into stable and unstable ankles. Ankle viscosity was measured by an instrumental anterior drawer test. Severity of functional ankle instability was measured by the Cumberland Ankle Instability Tool. Unstable ankles were compared with stable ankles. Injured ankles were compared with uninjured ankles of both groups. The spearman's rank correlation coefficient was applied to determine the relationship between ankle viscosity and severity of functional ankle instability in unstable ankles. There was a moderate relationship between ankle viscosity and severity of functional ankle instability (r=-0.64, p<0.0001). Unstable ankles exhibited significantly lower viscosity (p<0.005) and more severe functional ankle instability (p<0.0001) than stable ankles. Injured ankles exhibited significantly lower viscosity and more severe functional ankle instability than uninjured ankles (p<0.0001). There was a moderate relationship between ankle viscosity and severity of functional ankle instability. This finding suggested that, severity of functional ankle instability may be partially attributed to mechanical insufficiencies such as the degenerative changes in ankle viscosity following the inversion ankle sprain. In clinical application, measurement of ankle viscosity could be a useful tool to evaluate severity of chronic ankle instability. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Prosthetic management of mid-facial defect with magnet-retained silicone prosthesis.

PubMed

Buzayan, Muaiyed M

2014-02-01

Mid-facial defect is one of the most disfiguring and impairing defects. A design of prosthesis that is aesthetic and stable can be precious to a patient who has lost part of his face due to surgical excision. Prosthesis can restore the patients' self-esteem and confidence, which affects the patients and their life style. The aim of this case report is to describe a technique of mid-facial silicone prosthesis fabrication. To provide an aesthetic and stable facial prosthesis, the extra-oral prosthesis was fabricated using silicone material, while the intra-oral defect was restored with obturator prosthesis, and then both prostheses were connected and attached to each other using magnets. This clinical report describes the rehabilitation of a large mid-facial defect with a two-piece prosthesis. The silicone facial prosthesis was made hollow and lighter by using an acrylic framework. Two acrylic channels were included within the facial prosthesis to provide the patient with clean and patent airways. A sectional mid-facial prosthesis was made and retained in place by using magnets, which resulted in a significant improvement in the aesthetical and functional outcome without the need for plastic surgery. Silicone prostheses are reliable alternatives to surgery and should be considered in selected cases.

Effect of a plaster containing DHEP and heparin in acute ankle sprains with oedema: a randomized, double-blind, placebo-controlled, clinical study.

PubMed

Coudreuse, J-M; de Vathaire, F

2010-09-01

Ankle sprains are the most frequent injuries in sport and daily life, and are usually treated with anti-inflammatory drugs or compounds that have an effect on microcirculation. The efficacy and tolerability of a novel plaster containing both diclofenac epolamine (DHEP) and heparin in the treatment of acute painful ankle sprains with oedema was investigated in a randomized, double-blind, placebo-controlled study. This study, carried out in 32 French medical centres, enrolled 233 patients (148 male and 86 female, aged 18-65 years) with an ankle sprain that had occurred within the previous 48 hours. Patients were treated once daily with DHEP heparin or placebo plaster for 7 days. Reduction in ankle joint swelling measured by submalleolar circumference was the primary efficacy endpoint; secondary endpoints were pain (at rest, in active mobilization, by passive stretch and by pressure), functional disability and global judgement of efficacy and tolerability. DHEP heparin-treated patients experienced a significantly greater reduction in joint swelling compared with placebo (p = 0.005). The reduction in pain was also in favour of DHEP heparin patients, with significantly lower pain in DHEP heparin-treated than placebo-treated patients within 3 hours of the first application (p < 0.05). Only two patients in the DHEP heparin plaster group and six in the placebo group experienced minor adverse events, all of which resolved spontaneously. By design, the study was limited to a placebo-controlled comparison, and there was no test for possible selection bias (subsequently ruled out by choice of efficacy parameters and measures) that may have resulted in a baseline imbalance between patient groups. Results confirm the efficacy of DHEP heparin plaster compared with placebo for the treatment of painful ankle sprain with oedema. Prompt control of pain and oedema may shorten the time to initiation of a rehabilitation programme, thus reducing the risk of ankle disability recurrence and the development of chronic injury.

What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?

PubMed Central

van den Bekerom, Michel P.J; Struijs, Peter A.A; Blankevoort, Leendert; Welling, Lieke; van Dijk, C. Niek; Kerkhoffs, Gino M.M.J

2012-01-01

Context: Ankle sprains are common problems in acute medical care. The variation in treatment observed for the acutely injured lateral ankle ligament complex in the first week after the injury suggests a lack of evidence-based management strategies for this problem. Objective: To analyze the effectiveness of applying rest, ice, compression, and elevation (RICE) therapy begun within 72 hours after trauma for patients in the initial period after ankle sprain. Study Selection: Eligible studies were published original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 subtreatments of RICE therapy in the treatment of acute ankle sprains in adults. Data Sources: MEDLINE, Cochrane Clinical Trial Register, CINAHL, and EMBASE. The lists of references of retrieved publications also were checked manually. Data Extraction: We extracted relevant data on treatment outcome (pain, swelling, ankle mobility or range of motion, return to sports, return to work, complications, and patient satisfaction) and assessed the quality of included studies. If feasible, the results of comparable studies were pooled using fixed- or random-effects models. Data Synthesis: After deduction of the overlaps among the different databases, evaluation of the abstracts, and contact with some authors, 24 potentially eligible trials remained. The full texts of these articles were retrieved and thoroughly assessed as described. This resulted in the inclusion of 11 trials involving 868 patients. The main reason for exclusion was that the authors did not describe a well-defined control group without the intervention of interest. Conclusions: Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines. PMID:22889660

Assessment of Relationships Between Joint Motion Quality and Postural Control in Patients With Chronic Ankle Joint Instability.

PubMed

Bączkowicz, Dawid; Falkowski, Krzysztof; Majorczyk, Edyta

2017-08-01

Study Design Controlled laboratory study, cross-sectional. Background Lateral ankle sprains are among the most common injuries encountered during athletic participation. Following the initial injury, there is an alarmingly high risk of reinjury and development of chronic ankle instability (CAI), which is dependent on a combination of factors, including sensorimotor deficits and changes in the biomechanical environment of the ankle joint. Objective To evaluate CAI-related disturbances in arthrokinematic motion quality and postural control and the relationships between them. Methods Sixty-three male subjects (31 with CAI and 32 healthy controls) were enrolled in the study. For arthrokinematic motion quality analysis, the vibroarthrographic signals were collected during ankle flexion/extension motion using an acceleration sensor and described by variability (variance of mean squares [VMS]), amplitude (mean of 4 maximal and 4 minimal values [R4]), and frequency (vibroarthrographic signal bands of 50 to 250 Hz [P1] and 250 to 450 Hz [P2]) parameters. Using the Biodex Balance System, single-leg dynamic balance was measured by overall, anteroposterior, and mediolateral stability indices. Results Values of vibroarthrographic parameters (VMS, R4, P1 and P2) were significantly higher in the CAI group than those in the control group (P<.01). Similar results were obtained for all postural control parameters (overall, anteroposterior, and mediolateral stability indices; P<.05). Moreover, correlations between the overall stability index and VMS, and P1 and P2, as well as between the anteroposterior stability index and P1 and P2, were observed in the CAI patient group, but not in controls. Conclusion In patients with CAI, deficits in both quality of ankle arthrokinematic motion and postural control were present. Therefore, physical therapy interventions focused on improving ankle neuromuscular control and arthrokinematic function are necessary in CAI patient care. J Orthop Sports Phys Ther 2017;47(8):570-577. Epub 4 Nov 2016. doi:10.2519/jospt.2017.6836.

Comparing the Effects of Peroneal Muscle Fatigue and Cyclic Loading on Ankle Neuromuscular Control During Lateral-Hop Landing.

PubMed

Malmir, Kazem; Olyaei, Gholam Reza; Talebian, Saeed; Jamshidi, Ali Ashraf

2015-08-01

Cyclic movements and muscle fatigue may result in musculoskeletal injuries by inducing changes in neuromuscular control. Ankle frontal-plane neuromuscular control has rarely been studied in spite of its importance. To compare the effects of peroneal muscle fatigue and a cyclic passive-inversion (CPI) protocol on ankle neuromuscular control during a lateral hop. Quasi-experimental, repeated measures. University laboratory. 22 recreationally active, healthy men with no history of ankle sprain or giving way. Participants performed a lateral hop before and after 2 interventions on a Biodex dynamometer. They were randomly assigned to intervention order and interventions were 1 wk apart. A passive intervention included 40 CPIs at 5°/s through 80% of maximum range of motion, and a fatigue intervention involved an isometric eversion at 40% of the maximal voluntary isometric contraction until the torque decreased to 50% of its initial value. Median frequency of the peroneus longus during the fatigue protocol, energy absorption by the viscoelastic tissues during the CPI protocol, and feedforward onset and reaction time of the peroneus longus during landing. A significant fall in median frequency (P < .05) and a significant decrease in energy absorption (P < .05) confirmed fatigue and a change in viscoelastic behavior, respectively. There was a significant main effect of condition on feedforward onset and reaction time (P < .05). No significant main effect of intervention or intervention × condition interaction was noted (P > .05). There was a significant difference between pre- and postintervention measures (P < .0125), but no significant difference was found between postintervention measures (P > .0125). Both fatigue and the CPI may similarly impair ankle neuromuscular control. Thus, in prolonged sports competitions and exercises, the ankle may be injured due to either fatigue or changes in the biomechanical properties of the viscoelastic tissues.

A Novel Thermal-activated Shape Memory Penile Prosthesis: Comparative Mechanical Testing.

PubMed

Le, Brian; McVary, Kevin; McKenna, Kevin; Colombo, Alberto

2017-01-01

To compare a novel nickel-titanium (Ni-Ti) shape memory alloy (SMA) penile prosthesis of our own design with commercially available prostheses using a format similar to mechanical testing done at major penile prosthesis manufacturers. We evaluated the mechanical parameters of commercially available penile prostheses and used this information to guide the development of the Ni-Ti-based physiological penile prosthesis that expands and becomes erect with a small amount of heat applied. A penile prosthesis consisting of an exoskeleton of temperature-tuned Nitinol was designed and prototyped. Mechanical testing was performed in a model of penile buckling, penile lateral deviation, and original penile shape recovery commonly used by penile prosthesis manufacturers for testing. Our SMA penile prosthesis demonstrated useful mechanical characteristics, including rigidity to buckling when activated similar to an inflatable penile prosthesis (2.62 kgf SMA vs 1.42 kgf inflatable penile prosthesis vs 6.45 kgf for a malleable prosthesis). The Ni-Ti also became more pliable when deactivated within acceptable mechanical ranges of existing devices. It could be repeatedly cycled and generate a restorative force to become erect. An SMA-based penile prosthesis represents a promising new technology in the treatment of erectile dysfunction. We demonstrated that an Ni-Ti-based prosthesis can produce the mechanical forces necessary for producing a simulated erection without the need for a pump or reservoir, comparable with existing prostheses. Copyright © 2016 Elsevier Inc. All rights reserved.

Penile Prosthesis Implantation in Patients with a History of Total Phallic Construction.

PubMed

Zuckerman, Jack M; Smentkowski, Katherine; Gilbert, David; Storme, Oscar; Jordan, Gerald; Virasoro, Ramon; Tonkin, Jeremy; McCammon, Kurt

2015-12-01

Outcomes following penile prosthesis implantation in patients with a history of total phallic construction are not well described. The aim of this study was to evaluate outcomes following neophallus penile prosthesis placement. Retrospective review penile prosthesis placement in patients with prior total phallic construction. GORE-TEX® (Gore Medical, Flagstaff, AZ) sleeve neotunica construction was utilized in all patients. Success defined as patient sexual activity with a functioning prosthesis. Thirty-one patients underwent neophallic prosthesis implantation at a mean 35.6 years of age. Prosthesis placement occurred at an average 56.3 months following phallic construction and follow-up was a mean of 59.7 months. Malleable prostheses were placed in 21 patients and inflatable in 10; implants were bilateral in 94%. Six percent experienced operative complications including a bladder injury (1) and phallic flap arterial injury (1). Postoperative complications occurred in 23% at a median 5.5 months following placement. Five prostheses were explanted secondary to infection or erosion and two additional required revisions. Of the explanted prosthesis two were later replaced without further complication. Eighty-one percent of patients were sexually active following prosthesis placement. Penile prosthesis placement is possible in patients with prior penile reconstruction/phallic construction. Although complications rates appear to be elevated in this population compared with historic controls of normal anatomic men, the majority of patients in this series were sexually active following prosthesis placement. This demonstrates the utility of prosthesis implantation in these difficult patients. © 2015 International Society for Sexual Medicine.

Multivariate prediction of upper limb prosthesis acceptance or rejection.

PubMed

Biddiss, Elaine A; Chau, Tom T

2008-07-01

To develop a model for prediction of upper limb prosthesis use or rejection. A questionnaire exploring factors in prosthesis acceptance was distributed internationally to individuals with upper limb absence through community-based support groups and rehabilitation hospitals. A total of 191 participants (59 prosthesis rejecters and 132 prosthesis wearers) were included in this study. A logistic regression model, a C5.0 decision tree, and a radial basis function neural network were developed and compared in terms of sensitivity (prediction of prosthesis rejecters), specificity (prediction of prosthesis wearers), and overall cross-validation accuracy. The logistic regression and neural network provided comparable overall accuracies of approximately 84 +/- 3%, specificity of 93%, and sensitivity of 61%. Fitting time-frame emerged as the predominant predictor. Individuals fitted within two years of birth (congenital) or six months of amputation (acquired) were 16 times more likely to continue prosthesis use. To increase rates of prosthesis acceptance, clinical directives should focus on timely, client-centred fitting strategies and the development of improved prostheses and healthcare for individuals with high-level or bilateral limb absence. Multivariate analyses are useful in determining the relative importance of the many factors involved in prosthesis acceptance and rejection.

Use of Powered Prosthesis for Children with Upper Limb Deficiency at Hyogo Rehabilitation Center

PubMed Central

Shibata, Yaeko; Mizobe, Futoshi

2015-01-01

Background There has been no research investigating the use of powered prosthetic for children in Japan. Objective To gain better insight into the state of powered prosthesis usage and identify a ratio of rejection among children. Methods Subjects were 37 unilateral below elbow amputees between the ages of 0 and 16 at the time of their first experienced fitting with a powered prosthesis at our Center. The information was collected from medical records and through face-to-face interviews, and we examined rejection rate and the factors affecting the use of powered prosthesis. Results The rate of discontinuation was 21.6% as 8 of the 37 children stopped using powered prosthesis. All of them were fitted their prosthesis after 2 years of age, and they rejected prosthesis between 5 to 19 years. We found that the level of amputation had no influence on the use of a powered prosthesis. Conclusions Children fitted before 2 years of age tend to accept their powered prosthesis than those fitted after 2 years. Multidisciprinary team approach, adequate rehabilitation, detailed follow-up and involvement of parents are quite important for introducing powered prosthesis for children. PMID:26125974

Clinical application of a modular ankle robot for stroke rehabilitation.

PubMed

Forrester, Larry W; Roy, Anindo; Goodman, Ronald N; Rietschel, Jeremy; Barton, Joseph E; Krebs, Hermano Igo; Macko, Richard F

2013-01-01

Advances in our understanding of neuroplasticity and motor learning post-stroke are now being leveraged with the use of robotics technology to enhance physical rehabilitation strategies. Major advances have been made with upper extremity robotics, which have been tested for efficacy in multi-site trials across the subacute and chronic phases of stroke. In contrast, use of lower extremity robotics to promote locomotor re-learning has been more recent and presents unique challenges by virtue of the complex multi-segmental mechanics of gait. Here we review a programmatic effort to develop and apply the concept of joint-specific modular robotics to the paretic ankle as a means to improve underlying impairments in distal motor control that may have a significant impact on gait biomechanics and balance. An impedance controlled ankle robot module (anklebot) is described as a platform to test the idea that a modular approach can be used to modify training and measure the time profile of treatment response. Pilot studies using seated visuomotor anklebot training with chronic patients are reviewed, along with results from initial efforts to evaluate the anklebot's utility as a clinical tool for assessing intrinsic ankle stiffness. The review includes a brief discussion of future directions for using the seated anklebot training in the earliest phases of sub-acute therapy, and to incorporate neurophysiological measures of cerebro-cortical activity as a means to reveal underlying mechanistic processes of motor learning and brain plasticity associated with robotic training. Finally we conclude with an initial control systems strategy for utilizing the anklebot as a gait training tool that includes integrating an Internal Model-based adaptive controller to both accommodate individual deficit severities and adapt to changes in patient performance.

Clinical application of a modular ankle robot for stroke rehabilitation

PubMed Central

Forrester, Larry W.; Roy, Anindo; Goodman, Ronald N.; Rietschel, Jeremy; Barton, Joseph E.; Krebs, Hermano Igo; Macko, Richard F.

2015-01-01

Background Advances in our understanding of neuroplasticity and motor learning post-stroke are now being leveraged with the use of robotics technology to enhance physical rehabilitation strategies. Major advances have been made with upper extremity robotics, which have been tested for efficacy in multi-site trials across the subacute and chronic phases of stroke. In contrast, use of lower extremity robotics to promote locomotor re-learning has been more recent and presents unique challenges by virtue of the complex multi-segmental mechanics of gait. Objectives Here we review a programmatic effort to develop and apply the concept of joint-specific modular robotics to the paretic ankle as a means to improve underlying impairments in distal motor control that may have a significant impact on gait biomechanics and balance. Methods An impedance controlled ankle robot module (anklebot) is described as a platform to test the idea that a modular approach can be used to modify training and measure the time profile of treatment response. Results Pilot studies using seated visuomotor anklebot training with chronic patients are reviewed, along with results from initial efforts to evaluate the anklebot's utility as a clinical tool for assessing intrinsic ankle stiffness. The review includes a brief discussion of future directions for using the seated anklebot training in the earliest phases of sub-acute therapy, and to incorporate neurophysiological measures of cerebro-cortical activity as a means to reveal underlying mechanistic processes of motor learning and brain plasticity associated with robotic training. Conclusions Finally we conclude with an initial control systems strategy for utilizing the anklebot as a gait training tool that includes integrating an Internal Model-based adaptive controller to both accommodate individual deficit severities and adapt to changes in patient performance. PMID:23949045

The association between lower extremity energy absorption and biomechanical factors related to anterior cruciate ligament injury.

PubMed

Norcross, Marc F; Blackburn, J Troy; Goerger, Benjamin M; Padua, Darin A

2010-12-01

Greater total energy absorption by the lower extremity musculature during landing may reduce stresses placed on capsuloligamentous tissues with differences in joint contributions to energy absorption potentially affecting anterior cruciate ligament injury risk. However, the relationships between energy absorption and prospectively identified biomechanical factors associated with non-contact anterior cruciate ligament injury have yet to be demonstrated. Sagittal plane total, hip, knee and ankle energy absorption, and peak vertical ground reaction force, anterior tibial shear force, knee flexion and knee valgus angles, and internal hip extension and knee varus moments were measured in 27 individuals (14 females, 13 males) performing double leg jump landings. Correlation coefficients assessed the relationships between energy absorption during three time intervals (initial impact phase, terminal phase, and total landing) and biomechanical factors related to anterior cruciate ligament injury. More favorable values of biomechanical factors related to non-contact anterior cruciate ligament injury were associated with: 1) Lesser total (R(2)=0.178-0.558), hip (R(2)=0.229-0.651) and ankle (R(2)=0.280), but greater knee (R(2)=0.147) energy absorption during the initial impact phase; 2) Greater total (R(2)=0.170-0.845), hip (R(2)=0.599), knee (R(2)=0.236-0.834), and ankle (R(2)=0.276) energy absorption during the terminal phase of landing; and 3) Greater knee (R(2)=0.158-0.709), but lesser hip (R(2)=0.309) and ankle (R(2)=0.210-0.319) energy absorption during the total landing period. These results suggest that biomechanical factors related to anterior cruciate ligament injury are influenced by both the magnitude and timing of lower extremity energy absorption during landing. Copyright © 2010 Elsevier Ltd. All rights reserved.

Laser-assisted fixation of a nitinol stapes prosthesis.

PubMed

Schrötzlmair, Florian; Suchan, Fabian; Pongratz, Thomas; Krause, Eike; Müller, Joachim; Sroka, Ronald

2018-02-01

Otosclerosis is an inner ear bone disease characterized by fixation of the stapes and consequently progressive hearing loss. One treatment option is the surgical replacement of the stapes by a prosthesis. When so called "smart materials" like nitinol are used, prosthesis fixation can be performed using a laser without manual crimping on the incus. However, specific laser-prosthesis interactions have not been described yet. The aim of the present study was to elucidate the thermo-mechanical properties of the NiTiBOND® prosthesis as a basis for handling instructions for laser-assisted prosthesis fixation. Closure of the NiTiBOND® prosthesis was induced ex vivo by either a diode laser emitting at λ = 940 nm or a CO 2 laser (λ = 10,600 nm). Total energy for closure was determined. Suitable laser parameters (pulse duration, power per pulse, distance between tip of the laser fiber and prosthesis) were assessed. Specific laser-prosthesis interactions were recorded. Especially the diode laser was found to be an appropriate energy source. A total energy deposit of 60 mJ by pulses in near contact application was found to be sufficient for prosthesis closure ex vivo. Energy should be transmitted through a laser fiber equipollent to the prosthesis band diameter. Specific deformation characteristics due to the zonal prosthesis composition have to be taken into account. NiTiBOND® stapes prosthesis can be closed by very little energy when appropriate energy sources like diode lasers are used, suggesting a relatively safe application in vivo. Lasers Surg. Med. 50:153-157, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Simultaneous, proportional, multi-axis prosthesis control using multichannel surface EMG.

PubMed

Yatsenko, Dimitri; McDonnall, Daniel; Guillory, K Shane

2007-01-01

Most upper limb prosthesis controllers only allow the individual selection and control of single joints of the limb. The main limiting factor for simultaneous multi-joint control is usually the availability of reliable independent control signals that can intuitively be used. In this paper, a novel method is presented for extraction of individual muscle source signals from surface EMG array recordings, based on EMG energy orthonormalization along principle movement vectors. In cases where independently-controllable muscles are present in residual limbs, this method can be used to provide simultaneous, multi-axis, proportional control of prosthetic systems. Initial results are presented for simultaneous control of wrist rotation, wrist flexion/extension, and grip open/close for two intact subjects under both isometric and non-isometric conditions and for one subject with transradial amputation.

Multidisciplinary team approach to residual limb lengthening using the Ilizarov technique: A case study.

PubMed

Savage, Zoliakha; Munjal, Ramesh

2015-10-01

A 47-year-old male suffered a traumatic transtibial amputation; initial limb use was unsuccessful and the short tibial length was thought to be the cause of failure. The patient underwent gradual tibia lengthening using the Ilizarov technique and utilised a weight-bearing prosthesis to expedite bone growth and repair. The patient is now able to use his prosthesis successfully without aids. This case study demonstrates that combining a scientifically based surgical technique with a tailored rehabilitation approach had an improved outcome for the patient. This study reports one case where tibial lengthening using the Ilizarov technique combined with a collaborative team approach has enabled a patient to return to successful prosthetic limb use. © The International Society for Prosthetics and Orthotics 2014.

A 29-year-old Harken disk mitral valve: long-term follow-up by echocardiographic and cineradiographic imaging.

PubMed

Hsi, David H; Ryan, Gerald F; Taft, Janice; Arnone, Thomas J

2003-01-01

An 81-year-old woman was evaluated for prosthetic mitral valve function. She had received a Harken disk mitral valve 29 years earlier due to severe mitral valve disease. This particular valve prosthesis is known for premature disk edge wear and erosion. The patients 2-dimensional Doppler echocardiogram showed the distinctive appearance of a disk mitral valve prosthesis. Color Doppler in diastole showed a unique crown appearance, with initial flow acceleration around the disk followed by convergence to laminar flow in the left ventricle. Cineradiographic imaging revealed normal valve function and minimal disk erosion. We believe this to be the longest reported follow-up of a surviving patient with a rare Harken disk valve. We present images with unique echocardiographic and cineangiographic features.

A 29-Year-Old Harken Disk Mitral Valve

PubMed Central

Hsi, David H.; Ryan, Gerald F.; Taft, Janice; Arnone, Thomas J.

2003-01-01

An 81-year-old woman was evaluated for prosthetic mitral valve function. She had received a Harken disk mitral valve 29 years earlier due to severe mitral valve disease. This particular valve prosthesis is known for premature disk edge wear and erosion. The patient's 2-dimensional Doppler echocardiogram showed the distinctive appearance of a disk mitral valve prosthesis. Color Doppler in diastole showed a unique crown appearance, with initial flow acceleration around the disk followed by convergence to laminar flow in the left ventricle. Cineradiographic imaging revealed normal valve function and minimal disk erosion. We believe this to be the longest reported follow-up of a surviving patient with a rare Harken disk valve. We present images with unique echocardiographic and cineangiographic features. (Tex Heart Inst J 2003;30:319–21) PMID:14677746

An EMG-Controlled SMA Device for the Rehabilitation of the Ankle Joint in Post-Acute Stroke

NASA Astrophysics Data System (ADS)

Pittaccio, S.; Viscuso, S.

2011-07-01

The capacity of flexing one's ankle is an indispensible segment of gait re-learning, as imbalance, wrong compensatory use of other joints and risk of falling may depend on the so-called drop-foot. The rehabilitation of ankle dorsiflexion may be achieved through active exercising of the relevant musculature (especially tibialis anterior, TA). This can be troublesome for patients affected by weakness and flaccid paresis. Thus, as needs evolve during patient's improvements, a therapeutic device should be able to guide and sustain gradual recovery by providing commensurate aid. This includes exploiting even initial attempts at voluntary motion and turns those into effective workout. An active orthosis powered by two rotary actuators containing NiTi wire was designed to obtain ankle dorsiflexion. A computer routine that analyzes the electromyographic (sEMG) signal from TA muscle is used to control the orthosis and trigger its activation. The software also provides instructions and feed-back for the patient. Tests on the orthosis proved that it can produce strokes up to 36° against resisting torques exceeding 180 Ncm. Three healthy subjects were able to control the orthosis by modulating their TA sEMG activity. The movement produced in the preliminary tests is interesting for lower limb rehabilitation, and will be further improved by optimizing body-orthosis interface. It is hoped that this device will enhance early rehabilitation and recovery of ankle mobility in stroke patients.

Single-leg drop landing movement strategies 6 months following first-time acute lateral ankle sprain injury.

PubMed

Doherty, C; Bleakley, C; Hertel, J; Caulfield, B; Ryan, J; Delahunt, E

2015-12-01

No research exists predicating a link between acute ankle sprain injury-affiliated movement patterns and those of chronic ankle instability (CAI) populations. The aim of the current study was to perform a biomechanical analysis of participants, 6 months after they sustained a first-time acute lateral ankle sprain (LAS) injury to establish this link. Fifty-seven participants with a 6-month history of first-time LAS and 20 noninjured participants completed a single-leg drop landing task on both limbs. Three-dimensional kinematic (angular displacement) and sagittal plane kinetic (moment of force) data were acquired for the joints of the lower extremity, from 200 ms pre-initial contact (IC) to 200 ms post-IC. Individual joint stiffnesses and the peak magnitude of the vertical component of the ground reaction force (GRF) were also computed. LAS participants displayed increases in hip flexion and ankle inversion on their injured limb (P < 0.05); this coincided with a reduction in the net flexion-extension moment at the hip joint, with an increase in its stiffness (P < 0.05). There was no difference in the magnitude of the peak vertical GRF for either limb compared with controls. These results demonstrate that altered movement strategies persist in participants, 6 months following acute LAS, which may precipitate the onset of CAI. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Predictors of Receiving a Prosthesis for Adults With Above-Knee Amputations in a Well-Defined Population.

PubMed

Mundell, Benjamin F; Kremers, Hilal Maradit; Visscher, Sue; Hoppe, Kurtis M; Kaufman, Kenton R

2016-08-01

Prior studies have identified age as a factor in determining an individual's likelihood of receiving a prosthesis following a lower limb amputation. These studies are limited to specific subsets of the general population and are unable to account for preamputation characteristics within their study populations. Our study seeks to determine the effect of preamputation characteristics on the probability of receiving a prosthesis for the general population in the United States. To identify preamputation characteristics that predict of the likelihood of receiving a prosthesis following an above-knee amputation. A retrospective, population-based cohort study. Olmsted County, Minnesota (2010 population: 144,248). Individuals (n = 93) over the age of 18 years who underwent an above-knee amputation, that is, knee disarticulation or transfemoral amputation, while residing in Olmsted County, MN, between 1987 and 2013. Characteristics affecting the receipt of a prosthesis were analyzed using a logistic regression and a random forest algorithm for classification trees. Preamputation characteristics included age, gender, amputation etiology, year of amputation, mobility, cognitive ability, comorbidities, and time between surgery and the prosthesis decision. The association of preamputation characteristics with the receipt of a prosthesis following an above-knee amputation. Twenty-four of the participants received a prosthesis. The odds of receiving a prosthesis were almost 30 times higher in those able to walk independently prior to an amputation relative to those who could not walk independently. A 10-year increase in age was associated with a 53.8% decrease in the likelihood of being fit for a prosthesis (odds ratio = 0.462, P =.030). Time elapsed between surgery and the prosthesis decision was associated with a rise in probability of receiving a prosthesis for the first 3 months in the random forest algorithm. No other observed characteristics were associated with receipt of a prosthesis. The association of preamputation mobility and age with the likelihood of being fit for a prosthesis is well understood. The effect of age, after controlling for confounders, still persists and is associated with the likelihood of being fit for a prosthesis. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Preparation for the Implantation of an Intracortical Visual Prosthesis in a Human

DTIC Science & Technology

2014-10-01

Intracortical Visual Prosthesis in a Human PRINCIPAL INVESTIGATOR: Philip R Troyk, PhD... Prosthesis in a Human 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-12-1-0394 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Philip R Troyk...visual prosthesis (ICVP) for testing in a human. No human trial testing of the prosthesis will occur under the funded work. Preparatory tasks include

Biomechanics of Step Initiation After Balance Recovery With Implications for Humanoid Robot Locomotion.

PubMed

Miller Buffinton, Christine; Buffinton, Elise M; Bieryla, Kathleen A; Pratt, Jerry E

2016-03-01

Balance-recovery stepping is often necessary for both a human and humanoid robot to avoid a fall by taking a single step or multiple steps after an external perturbation. The determination of where to step to come to a complete stop has been studied, but little is known about the strategy for initiation of forward motion from the static position following such a step. The goal of this study was to examine the human strategy for stepping by moving the back foot forward from a static, double-support position, comparing parameters from normal step length (SL) to those from increasing SLs to the point of step failure, to provide inspiration for a humanoid control strategy. Healthy young adults instrumented with joint reflective markers executed a prescribed-length step from rest while marker positions and ground reaction forces (GRFs) were measured. The participants were scaled to the Gait2354 model in opensim software to calculate body kinematic and joint kinetic parameters, with further post-processing in matlab. With increasing SL, participants reduced both static and push-off back-foot GRF. Body center of mass (CoM) lowered and moved forward, with additional lowering at the longer steps, and followed a path centered within the initial base of support (BoS). Step execution was successful if participants gained enough forward momentum at toe-off to move the instantaneous capture point (ICP) to within the BoS defined by the final position of both feet on the front force plate. All lower extremity joint torques increased with SL except ankle joint. Front knee work increased dramatically with SL, accompanied by decrease in back-ankle work. As SL increased, the human strategy changed, with participants shifting their CoM forward and downward before toe-off, thus gaining forward momentum, while using less propulsive work from the back ankle and engaging the front knee to straighten the body. The results have significance for human motion, suggesting the upper limit of the SL that can be completed with back-ankle push-off before additional knee flexion and torque is needed. For biped control, the results support stability based on capture-point dynamics and suggest strategy for center-of-mass trajectory and distribution of ground force reactions that can be compared with robot controllers for initiation of gait after recovery steps.

Titanium clip ball joint: a partial ossicular reconstruction prosthesis.

PubMed

Beutner, Dirk; Luers, Jan Christoffer; Bornitz, Matthias; Zahnert, Thomas; Huttenbrink, Karl-Bernd

2011-06-01

To describe a new titanium clip prosthesis for partial ossicular reconstruction with a micro ball joint in the headplate for compensation of tympanic membrane displacements. Laboratory experiments followed by 18 consecutive patients. A micro ball joint was implemented into a headplate of titanium middle ear prosthesis. First, the new prosthesis was tested in the laboratory in temporal bone experiments. Second, the new prosthesis was clinically installed in 18 patients. Results of laser Doppler vibrometry and force measurements in the laboratory experiments, analysis of a questionnaire, and preoperative and postoperative pure tone audiometry. The frictional resistance in the joint was measured to be 12 mN that should allow for adequate mobility under physiologic conditions. The effective sound transmission of the prosthesis was demonstrated by laser Doppler vibrometry. Intraoperatively, the installation of the prosthesis was always straightforward with headplate prosthesis shaft angles between 60 and 90 degrees. Postoperatively, pure tone audiometry revealed satisfying hearing results with a remaining average air-bone gap of 18.2 dB over the frequencies 500, 1,000, 2,000, and 3,000 Hz. No signs of prosthesis dislocation were discovered within the follow-up period of approximately 6 months. The experimental data show that the new modified prosthesis headplate fulfills the requirements necessary for sound transmission. The joint allows the plate to follow movements of the tympanic membrane. This characteristic in conjunction with the proven clip design ensure for optimal prosthesis placement and effectiveness.

Plantar pressure during running in subjects with chronic ankle instability.

PubMed

Morrison, Katherine E; Hudson, David J; Davis, Irene S; Richards, James G; Royer, Todd D; Dierks, Tracy A; Kaminski, Thomas W

2010-11-01

It has been suggested that dynamic foot and ankle mechanics predispose individuals with CAI to repetitive episodes of the ankle ``giving way.'' Plantar pressure variations during a walking gait have been detected in those with CAI, but more dynamic conditions for analysis are needed. The purpose of this study was to evaluate plantar pressure distributions during a running gait in individuals with CAI, individuals who suffered a lateral ankle sprain, but did not develop CAI (AS), and subjects with no history of a lateral ankle sprain (CON). Forty-five subjects [15 in each group, healthy males (18) and females (27), age 18 to 45] were recruited from University communities to participate in this study. Plantar pressure distributions were analyzed on a Tekscan© plantar pressure mat at 66 frames per second during a running gait at a controlled speed. The following variables were obtained: rearfoot medial/lateral (M/L) pressure ratio at foot strike (FS) and center-of-pressure (COP) trajectory during the initial loading response (heel strike to initial peak GRF). Separate one-way ANOVA with Tukey's post-hoc were used to test for group differences. The significance level was defined as p < 0.05. The CAI group had a significantly more lateral ratio (0.97 ± 0.12) at FS when compared to the CON (1.01 ± 0.13) and AS (1.11 ± 0.13) groups. The CAI subjects had a lateral COP trajectory during the loading phase (7.97 degrees ± 11.02), while both the AS (-3.68 degrees ± 10.24) and CON groups (-6.27 degrees ± 9.86) had medial trajectories. The difference was significant between the CAI group and both the AS and CON groups (all significant {\\it p} values were less than 0.05). Our results confirm that CAI subjects have a more lateral foot positioning and loading pattern during a barefoot running gait when compared to both the CON and LAS groups. Clinicians treating patients with CAI should consider providing interventions to decrease the amount of rearfoot inversion at FS and during loading in order to create a more medial COP trajectory upon impact.

Long-term role of external breast prostheses after total mastectomy.

PubMed

Glaus, Simone W; Carlson, Grant W

2009-01-01

After total mastectomy, many women choose to wear external breast prosthesis rather than undergo breast reconstruction. The purpose of this study was to evaluate long-term satisfaction among external breast prosthesis wearers and the impact of satisfaction on prosthesis use. A questionnaire was designed to assess demographic information, prosthesis information provision, prosthesis use, and satisfaction with prosthesis. Fifty-nine women who had undergone total mastectomy without breast reconstruction completed the questionnaire. The majority of women (68%) were at least 5 years out from mastectomy. Approximately half (49%) of the women had received information about breast prostheses prior to mastectomy; 29% received information from the surgeon performing the operation. Frequent and prolonged prosthesis use was prevalent with 64% of participants reporting prosthesis use all the time, 6-7 days/week. Participants showed high rates (83%) of overall satisfaction. However, women who wore their prosthesis out in public only were less satisfied than more frequent wearers (50% versus 89%, chi(2) = 8.83, d.f. = 1, alpha = 0.05). Satisfaction increased over time, as women who were greater than 5 years out from mastectomy were more satisfied than women less that 5 years post-mastectomy (90% versus 67%, chi(2) = 4.43, d.f. = 1, alpha = 0.05). The vast majority of women are satisfied with their external breast prosthesis several years after mastectomy. Most women used their prosthesis all the time and overall satisfaction contributed to higher levels of prosthesis use. Given the long-term importance of external breast prostheses for women who have undergone mastectomy, a greater effort to inform patients about external breast prostheses prior to surgery is needed.

Do CTA measurements of annular diameter, perimeter and area result in different TAVI prosthesis sizes?

PubMed

Horehledova, Barbora; Mihl, Casper; Hendriks, Babs M F; Eijsvoogel, Nienke G; Vainer, Jindrich; Veenstra, Leo F; Wildberger, Joachim E; Das, Marco

2018-06-16

Incorrect prosthesis size has direct impact on patient outcome after transcatheter aortic valve implantation (TAVI) procedure. Currently, annular diameter, area or perimeter may be used for prosthesis size selection. The aim was to evaluate whether the use different annular dimensions would result in the selection of different prosthesis sizes, when assessed in the same TAVI-candidate during the same phase of a cardiac cycle. Fifty consecutive TAVI-candidates underwent retrospectively ECG-gated computed tomography angiography (CTA). Aortic root dimensions were assessed in the 20% phase of the R-R interval. Annular short diameter, perimeter and area were used to select the prosthesis size, based on the industry recommendations for a self-expandable (Medtronic CoreValve; MCV) and balloon-expandable (Edwards Sapien XT Valve; ESV) valve. Complete agreement on selected prosthesis size amongst all three annular dimensions was observed in 62% (31/50; ESV) and 30% (15/50; MCV). Short aortic annulus measurement resulted in a smaller prosthesis size in 20% (10/50; ESV) and in 60% of cases (30/50; MCV) compared to the size suggested by both annular perimeter and area. In 18% (9/50; ESV) and 10% of cases (5/50; MCV) a larger prosthesis would have been selected based on annular perimeter compared to annular diameter and area. Prosthesis size derived from area was always in agreement with at least one other parameter in all cases. Aortic annulus area appears to be the most robust parameter for TAVI-prosthesis size selection, regardless of the specific prosthesis size. Short aortic annulus diameter may underestimate the prosthesis size, while use of annular perimeter may lead to size overestimation in some cases.

Permanent Quadriplegia Following Replacement of Voice Prosthesis.

PubMed

Ozturk, Kayhan; Erdur, Omer; Kibar, Ertugrul

2016-11-01

The authors presented a patient with quadriplegia caused by cervical spine abscess following voice prosthesis replacement. The authors present the first reported permanent quadriplegia patient caused by voice prosthesis replacement. The authors wanted to emphasize that life-threatening complications may be faced during the replacement of voice prosthesis. Care should be taken during the replacement of voice prosthesis and if some problems have been faced during the procedure patients must be followed closely.

Preparation for the Implantation of an Intracortical Visual Prosthesis in a Human

DTIC Science & Technology

2013-10-01

Intracortical Visual Prosthesis in a Human PRINCIPAL INVESTIGATOR: Philip R Troyk, PhD... Prosthesis in a Human 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-12-1-0394 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Philip R Troyk, PhD...to prepare an intracortical visual prosthesis (ICVP) for testing in a human. No human trial testing of the prosthesis will occur under the funded

Effects of knee and ankle muscle fatigue on postural control in the unipedal stance.

PubMed

Bizid, Riadh; Margnes, Eric; François, Yrieix; Jully, Jean Louis; Gonzalez, Gerard; Dupui, Philippe; Paillard, Thierry

2009-06-01

The aim of this study was to compare the effects of acute muscle fatigue of the ankle and knee musculature on postural control by immediate measures after performing fatiguing tasks (POST condition). One group of subjects (n = 8) performed a fatiguing task by voluntary contractions of the triceps surae (group TRI) and the other (n = 9) performed a fatiguing task by voluntary contractions of the quadriceps femoris (group QUA). Each muscle group was exercised until the loss of maximal voluntary contraction torque reached 50% (isokinetic dynamometer). Posture was assessed by measuring the centre of foot pressure (COP) with a force platform during a test of unipedal quiet standing posture with eyes closed. Initially (in PRE condition), the mean COP velocity was not significantly different between group TRI and group QUA. In POST condition, the mean COP velocity increased more in group QUA than in group TRI. The postural control was more impaired by knee muscle fatigue than by ankle muscle fatigue.

[Chronic ankle joint instability: in unrecognized distal rupture of the syndosmosis and malunion of the distal fibula].

PubMed

Michelitsch, C; Acklin, Y P; Stoffel, K; Bereiter, H

2014-04-01

It is often difficult in the acute phase to diagnose a lesion of the distal tibiofibular syndesmosis. If this lesion is overlooked, the patient will develop an incongruity of the upper ankle joint with a pathological external rotation of the talus. The risk of a possible premature arthritis is clearly increased. In this case study a distal rupture of the syndesmosis in a young patient was overlooked in the initial diagnostic work-up. A search of the relevant literature and a case report. In the case described the shortened fibula and chronic instability of the tibiofibular syndesmosis were repaired with a lengthening and derotational osteotomy and reconstruction using the gracilis muscle tendon. Through this method an exact reconstruction of the normal anatomy could be achieved. Posttraumatic misalignment in the ankle joint is associated with a high risk of secondary degenerative lesions. In cases with suspicion of a syndesmosis lesion, confirmation of the diagnosis is imperative so as to perform an anatomic repositioning and reconstruction of stability.

Lower extremity muscle functions during full squats.

PubMed

Robertson, D G E; Wilson, Jean-Marie J; St Pierre, Taunya A

2008-11-01

The purpose of this research was to determine the functions of the gluteus maximus, biceps femoris, semitendinosus, rectus femoris, vastus lateralis, soleus, gastrocnemius, and tibialis anterior muscles about their associated joints during full (deep-knee) squats. Muscle function was determined from joint kinematics, inverse dynamics, electromyography, and muscle length changes. The subjects were six experienced, male weight lifters. Analyses revealed that the prime movers during ascent were the monoarticular gluteus maximus and vasti muscles (as exemplified by vastus lateralis) and to a lesser extent the soleus muscles. The biarticular muscles functioned mainly as stabilizers of the ankle, knee, and hip joints by working eccentrically to control descent or transferring energy among the segments during scent. During the ascent phase, the hip extensor moments of force produced the largest powers followed by the ankle plantar flexors and then the knee extensors. The hip and knee extensors provided the initial bursts of power during ascent with the ankle extensors and especially a second burst from the hip extensors adding power during the latter half of the ascent.

Magnetic resonance imaging of injuries to the ankle joint: can it predict clinical outcome?

PubMed

Zanetti, M; De Simoni, C; Wetz, H H; Zollinger, H; Hodler, J

1997-02-01

To predict clinical outcome after ankle sprains on the basis of magnetic resonance (MR) findings. Twenty-nine consecutive patients (mean age 32.9 years, range 13-60 years) were examined clinically and with MR imaging both after trauma and following standardized conservative therapy. Various MR abnormalities were related to a clinical outcome score. There was a tendency for a better clinical outcome in partial, rather than complete, tears of the anterior talofibular ligament and when there was no fluid within the peroneal tendon sheath at the initial MR examination (P = 0.092 for either abnormality). A number of other MR features did not significantly influence clinical outcome, including the presence of a calcaneofibular ligament lesion and a bone bruise of the talar dome. Clinical outcome after ankle sprain cannot consistently be predicted by MR imaging, although MR imaging may be more accurate when the anterior talofibular ligament is only partially torn and there are no signs of injury to the peroneal tendon sheath.

Intermittent, noncyclic dysfunction of a mechanical aortic prosthesis by pannus formation.

PubMed

Giroux, Sylvie K; Labinaz, Marino X; Grisoli, Dominique; Klug, Andrew P; Veinot, John P; Burwash, Ian G

2010-01-01

Mechanical aortic prosthesis dysfunction can result from thrombosis or pannus formation. Pannus formation usually restricts systolic excursion of the occluding disk, resulting in progressive stenosis of the aortic prosthesis. Intermittent dysfunction of a mechanical aortic prosthesis is usually ascribed to thrombus formation. We describe an unusual case of intermittent, noncyclic dysfunction of a mechanical aortic prosthesis due to pannus formation in the absence of systolic restriction of disk excursion that presented with intermittent massive aortic regurgitation, severe ischemia, and shock. Pannus formation should be considered as a potential cause of acute intermittent severe aortic regurgitation in a patient with a mechanical aortic prosthesis.

Management of long span partially edentulous maxilla with fixed removable denture prosthesis

PubMed Central

Jeyavalan, Mahilan I.; Narasimman, M.; Venkatakrishnan, C. J.; Philip, Jacob M.

2012-01-01

Restoration of a long span partially edentulous maxilla with tooth supported prosthesis is challenging because of inherent anatomic limitations and unfavourable biomechanics present after the loss of teeth. A tooth supported fixed-removable prosthesis is a treatment option for restoration of such long span partially edentulous maxillary arches. This prosthesis meets the requirements for esthetics, phonetics, comfort, and hygiene, as well as favourable biomechanical stress distribution to the remaining natural tooth abutments. This article presents a procedure for fabrication of a fixed-removable prosthesis that has cement-retained custom cast bar metal substructure and a ball attachment retained removable superstructure prosthesis. PMID:23293488

Management of long span partially edentulous maxilla with fixed removable denture prosthesis.

PubMed

Jeyavalan, Mahilan I; Narasimman, M; Venkatakrishnan, C J; Philip, Jacob M

2012-07-01

Restoration of a long span partially edentulous maxilla with tooth supported prosthesis is challenging because of inherent anatomic limitations and unfavourable biomechanics present after the loss of teeth. A tooth supported fixed-removable prosthesis is a treatment option for restoration of such long span partially edentulous maxillary arches. This prosthesis meets the requirements for esthetics, phonetics, comfort, and hygiene, as well as favourable biomechanical stress distribution to the remaining natural tooth abutments. This article presents a procedure for fabrication of a fixed-removable prosthesis that has cement-retained custom cast bar metal substructure and a ball attachment retained removable superstructure prosthesis.

BIORESORBABLE POLYMERIC MENISCAL PROSTHESIS: STUDY IN RABBITS

PubMed Central

Cardoso, Tulio Pereira; de Rezende Duek, Eliana Aparecida; Amatuzzi, Marco Martins; Caetano, Edie Benedito

2015-01-01

Objective: To induce growth of a neomeniscus into the pores of a prosthesis in order to protect the knee joint cartilage. Methods: 70 knees of 35 New Zealand rabbits were operated. The rabbits were five to seven months old, weighed 2 to 3.8 kilograms, and 22 were male and 13 were female. Each animal underwent medial meniscectomy in both knees during a single operation. A bioabsorbable polymeric meniscal prosthesis composed of 70% polydioxanone and 30% L-lactic acid polymer was implanted in one side. The animals were sacrificed after different postoperative time intervals. The femoral condyles and neomeniscus were subjected to histological analysis. Histograms were used to measure the degradation and absorption of the prosthesis, the growth of meniscal tissue in the prosthesis and the degree of degradation of the femoral condyle joint cartilage. Results: The data obtained showed that tissue growth histologically resembling a normal meniscus occurred, with gradual absorption of the prosthesis, and the percentages of chondrocytes on the control side and prosthesis side. Conclusion: Tissue growth into the prosthesis pores that histologically resembled the normal rabbit meniscus was observed. The joint cartilage of the femoral condyles on the prosthesis side presented greater numbers of chondrocytes in all its layers. PMID:27022549

Duocentric® reversed shoulder prosthesis and Personal Fit® templates: innovative strategies to optimize prosthesis positioning and prevent scapular notching.

PubMed

Trouilloud, P; Gonzalvez, M; Martz, P; Charles, H; Handelberg, F; Nyffeler, R W; Baulot, E

2014-05-01

We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices.

PubMed

Schwab, Patrik R; Benneker, Lorin M; Eggli, Stefan; Zimmermann, Heinz; Exadaktylos, Aristomenis K

2008-12-23

In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17). After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER): Follow-up and final examination in the hospital's emergency unit. Group B (GP): Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. Female and male patients were equally represented in both groups. The age of the patients ranged from 16 - 64 years, with a mean age of 34 years (ER) and 35 years (GP). 98% (n = 98) of all patients were satisfied with their treatment, and 93% (n = 93) were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively). 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc.) on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669). Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a general practitioner for follow-up treatment without affecting patient satisfaction regarding treatment and treatment outcome.

Short-term changes in running mechanics and foot strike pattern after introduction to minimalistic footwear.

PubMed

Willson, John D; Bjorhus, Jordan S; Williams, D S Blaise; Butler, Robert J; Porcari, John P; Kernozek, Thomas W

2014-01-01

Minimalistic footwear has garnered widespread interest in the running community, based largely on the premise that the footwear may reduce certain running-related injury risk factors through adaptations in running mechanics and foot strike pattern. To examine short-term adaptations in running mechanics among runners who typically run in conventional cushioned heel running shoes as they transition to minimalistic footwear. A 2-week, prospective, observational study. A movement science laboratory. Nineteen female runners with a rear foot strike (RFS) pattern who usually train in conventional running shoes. The participants trained for 20 minutes, 3 times per week for 2 weeks by using minimalistic footwear. Three-dimensional lower extremity running mechanics were analyzed before and after this 2-week period. Hip, knee, and ankle joint kinematics at initial contact; step length; stance time; peak ankle joint moment and joint work; impact peak; vertical ground reaction force loading rate; and foot strike pattern preference were evaluated before and after the intervention. The knee flexion angle at initial contact increased 3.8° (P < .01), but the ankle and hip flexion angles at initial contact did not change after training. No changes in ankle joint kinetics or running temporospatial parameters were observed. The majority of participants (71%), before the intervention, demonstrated an RFS pattern while running in minimalistic footwear. The proportion of runners with an RFS pattern did not decrease after 2 weeks (P = .25). Those runners who chose an RFS pattern in minimalistic shoes experienced a vertical loading rate that was 3 times greater than those who chose to run with a non-RFS pattern. Few systematic changes in running mechanics were observed among participants after 2 weeks of training in minimalistic footwear. The majority of the participants continued to use an RFS pattern after training in minimalistic footwear, and these participants experienced higher vertical loading rates. Continued exposure to these greater loading rates may have detrimental effects over time. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device intended...

21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device intended...

21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device intended...

21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device intended...

21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device intended...

21 CFR 872.3940 - Total temporomandibular joint prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Total temporomandibular joint prosthesis. 872.3940... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3940 Total temporomandibular joint prosthesis. (a) Identification. A total temporomandibular joint prosthesis is a device that is intended to be...

21 CFR 872.3940 - Total temporomandibular joint prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Total temporomandibular joint prosthesis. 872.3940... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3940 Total temporomandibular joint prosthesis. (a) Identification. A total temporomandibular joint prosthesis is a device that is intended to be...

Design, characterisation and evaluation of a soft robotic sock device on healthy subjects for assisted ankle rehabilitation.

PubMed

Low, Fan-Zhe; Lim, Jeong Hoon; Yeow, Chen-Hua

2018-01-01

Motor impairment is one of the common neurological conditions suffered by stroke patients, where this chronic immobility together with the absence of early limb mobilisation can lead to conditions such as joint contracture with spastic limbs. In this study, a soft robotic sock device was developed, which can provide compliant actuation to the ankle joint in the early stage of stroke recovery. The device is fitted with soft extension actuators and when the actuators are inflated, they extend and guide the foot into plantarflexion; upon deflation, the actuators will resume their initial conformations. Each actuator is linked to a pneumatic pump-valve control system that injects pressurised air into or release air from the system. In this study, the design and characterisation of the soft actuators will be presented, where the theoretical and experimental forces generated by the actuators were compared. The performance of the device was also evaluated on healthy subjects and the results had shown that the device was able to move the subjects' ankles into cycles of dorsiflexion-plantarflexion, in the absence of voluntary muscle effort. The findings suggested that the soft wearable robotic device was capable of assisting the subjects in performing repeated cycles of ankle flexion.

MPR-CT Imaging for Stapes Prosthesis: Accuracy and Clinical Significance.

PubMed

Fang, Yanqing; Wang, Bing; Galvin, John J; Tao, Duoduo; Deng, Rui; Ou, Xiong; Liu, Yangwenyi; Dai, Peidong; Sha, Yan; Zhang, Tianyu; Chen, Bing

2016-04-01

The aims of this article are: 1) to re-evaluate the accuracy of multiple planar reconstruction computed tomography (MPR-CT) imaging on stapes-prosthesis parameters, and 2) to clarify possible relationships between prosthesis intravestibular depth and postoperative hearing outcomes. Seventy patients (46 women and 24 men; 32 right and 38 left sides) with the mean age of 40 years (range, 19-62 yr) with clinical otosclerosis. All patients underwent stapedotomy and were implanted with the same type of titanium piston prosthesis by the same surgeon. Postoperative MPR-CTs were obtained at patients' follow-up visits. The length and intravestibular depth of the stapes prosthesis (including absolute and relative depth) were calculated from the MPR-CT imaging. Relationships between the intravestibular depth of the prosthesis and hearing outcomes (pre- and postoperative audiograms) were analyzed using Spearman correlation analyses. The length of the prosthesis was overestimated by 1.8% (0.1 mm) by the MPR-CT imaging. Axial and coronal measurements were significantly correlated (p < 0.05). There was great intersubject variability in hearing outcomes differed insignificantly, regardless of intravestibular depth within the security range. No relationships were found between the intravestibular depth of the stapes prosthesis, as measured with MPR-CT, and postoperative hearing results. MPR-CT can provide an accurate estimation of stapes prosthesis parameters. However, the prosthesis intravestibular depth did not seem to affect postoperative hearing outcomes.

An innovative method of ocular prosthesis fabrication by bio-CAD and rapid 3-D printing technology: A pilot study.

PubMed

Alam, Md Shahid; Sugavaneswaran, M; Arumaikkannu, G; Mukherjee, Bipasha

2017-08-01

Ocular prosthesis is either a readymade stock shell or custom made prosthesis (CMP). Presently, there is no other technology available, which is either superior or even comparable to the conventional CMP. The present study was designed to fabricate ocular prosthesis using computer aided design (CAD) and rapid manufacturing (RM) technology and to compare it with custom made prosthesis (CMP). The ocular prosthesis prepared by CAD was compared with conventional CMP in terms of time taken for fabrication, weight, cosmesis, comfort, and motility. Two eyes of two patients were included. Computerized tomography scan of wax model of socket was converted into three dimensional format using Materialize Interactive Medical Image Control System (MIMICS)software and further refined. This was given as an input to rapid manufacturing machine (Polyjet 3-D printer). The final painting on prototype was done by an ocularist. The average effective time required for fabrication of CAD prosthesis was 2.5 hours; and weight 2.9 grams. The same for CMP were 10 hours; and 4.4 grams. CAD prosthesis was more comfortable for both the patients. The study demonstrates the first ever attempt of fabricating a complete ocular prosthesis using CAD and rapid manufacturing and comparing it with conventional CMP. This prosthesis takes lesser time for fabrication, and is more comfortable. Studies with larger sample size will be required to further validate this technique.

Initial Evaluation of the Dermoskeleton Concept: Application of Biomechatronics and Artificial Intelligence to Address the Soldiers Overload Challenge

DTIC Science & Technology

2011-05-01

leg prosthesis for above-the-knee amputees currently commercialized by Ossur hf and developed by Victhom Human Bionics Inc., a medical device...did not feel they worked as hard when wearing the K-SRDTM version POC during the loaded conditions. However, based on our heart rate measured, there

Artificial limb representation in amputees

PubMed Central

van den Heiligenberg, Fiona M Z; Orlov, Tanya; Macdonald, Scott N; Duff, Eugene P; Henderson Slater, David; Beckmann, Christian F; Johansen-Berg, Heidi; Culham, Jody C; Makin, Tamar R

2018-01-01

Abstract The human brain contains multiple hand-selective areas, in both the sensorimotor and visual systems. Could our brain repurpose neural resources, originally developed for supporting hand function, to represent and control artificial limbs? We studied individuals with congenital or acquired hand-loss (hereafter one-handers) using functional MRI. We show that the more one-handers use an artificial limb (prosthesis) in their everyday life, the stronger visual hand-selective areas in the lateral occipitotemporal cortex respond to prosthesis images. This was found even when one-handers were presented with images of active prostheses that share the functionality of the hand but not necessarily its visual features (e.g. a ‘hook’ prosthesis). Further, we show that daily prosthesis usage determines large-scale inter-network communication across hand-selective areas. This was demonstrated by increased resting state functional connectivity between visual and sensorimotor hand-selective areas, proportional to the intensiveness of everyday prosthesis usage. Further analysis revealed a 3-fold coupling between prosthesis activity, visuomotor connectivity and usage, suggesting a possible role for the motor system in shaping use-dependent representation in visual hand-selective areas, and/or vice versa. Moreover, able-bodied control participants who routinely observe prosthesis usage (albeit less intensively than the prosthesis users) showed significantly weaker associations between degree of prosthesis observation and visual cortex activity or connectivity. Together, our findings suggest that altered daily motor behaviour facilitates prosthesis-related visual processing and shapes communication across hand-selective areas. This neurophysiological substrate for prosthesis embodiment may inspire rehabilitation approaches to improve usage of existing substitutionary devices and aid implementation of future assistive and augmentative technologies. PMID:29534154

Artificial limb representation in amputees.

PubMed

van den Heiligenberg, Fiona M Z; Orlov, Tanya; Macdonald, Scott N; Duff, Eugene P; Henderson Slater, David; Beckmann, Christian F; Johansen-Berg, Heidi; Culham, Jody C; Makin, Tamar R

2018-05-01

The human brain contains multiple hand-selective areas, in both the sensorimotor and visual systems. Could our brain repurpose neural resources, originally developed for supporting hand function, to represent and control artificial limbs? We studied individuals with congenital or acquired hand-loss (hereafter one-handers) using functional MRI. We show that the more one-handers use an artificial limb (prosthesis) in their everyday life, the stronger visual hand-selective areas in the lateral occipitotemporal cortex respond to prosthesis images. This was found even when one-handers were presented with images of active prostheses that share the functionality of the hand but not necessarily its visual features (e.g. a 'hook' prosthesis). Further, we show that daily prosthesis usage determines large-scale inter-network communication across hand-selective areas. This was demonstrated by increased resting state functional connectivity between visual and sensorimotor hand-selective areas, proportional to the intensiveness of everyday prosthesis usage. Further analysis revealed a 3-fold coupling between prosthesis activity, visuomotor connectivity and usage, suggesting a possible role for the motor system in shaping use-dependent representation in visual hand-selective areas, and/or vice versa. Moreover, able-bodied control participants who routinely observe prosthesis usage (albeit less intensively than the prosthesis users) showed significantly weaker associations between degree of prosthesis observation and visual cortex activity or connectivity. Together, our findings suggest that altered daily motor behaviour facilitates prosthesis-related visual processing and shapes communication across hand-selective areas. This neurophysiological substrate for prosthesis embodiment may inspire rehabilitation approaches to improve usage of existing substitutionary devices and aid implementation of future assistive and augmentative technologies.

21 CFR 888.3790 - Wrist joint metal constrained cemented prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint metal constrained cemented prosthesis... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3790 Wrist joint metal constrained cemented prosthesis. (a) Identification. A wrist joint metal constrained cemented prosthesis is a...

21 CFR 888.3790 - Wrist joint metal constrained cemented prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint metal constrained cemented prosthesis... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3790 Wrist joint metal constrained cemented prosthesis. (a) Identification. A wrist joint metal constrained cemented prosthesis is a...

21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of silicone...

21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made of...

21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of silicone...

21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made of...

21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made of...

21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made of...

21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of silicone...

21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of silicone...

21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made of...

21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of silicone...

21 CFR 872.3960 - Mandibular condyle prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw to... requirement for premarket approval for any mandibular condyle prosthesis intended to be implanted in the human...

21 CFR 888.3025 - Passive tendon prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Passive tendon prosthesis. 888.3025 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a) Identification. A passive tendon prosthesis is a device intended to be implanted made of silicon elastomer or a...

21 CFR 888.3025 - Passive tendon prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Passive tendon prosthesis. 888.3025 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a) Identification. A passive tendon prosthesis is a device intended to be implanted made of silicon elastomer or a...

Reverse Shoulder Arthroplasty Prosthesis Design Classification System.

PubMed

Routman, Howard D; Flurin, Pierre-Henri; Wright, Thomas W; Zuckerman, Joseph D; Hamilton, Matthew A; Roche, Christopher P

2015-12-01

Multiple different reverse total shoulder arthroplasty (rTSA) prosthesis designs are available in the global marketplace for surgeons to perform this growing procedure. Subtle differences in rTSA prosthesis design parameters have been shown to have significant biomechanical impact and clinical consequences. We propose an rTSA prosthesis design classification system to objectively identify and categorize different designs based upon their specific glenoid and humeral prosthetic characteristics for the purpose of standardizing nomenclature that will help the orthopaedic surgeon determine which combination of design configurations best suit a given clinical scenario. The impact of each prosthesis classification type on shoulder muscle length and deltoid wrapping are also described to illustrate how each prosthesis classification type impacts these biomechanical parameters.

Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults.

PubMed

El-Sayed, Mohamed; Atef, Ashraf

2012-10-01

Although intramedullary fixation of closed simple (type A or B) diaphyseal tibial fractures in adults is well tolerated by patients, providing lower morbidity rates and better mobility, it is associated with some complications. This study evaluated the results of managing these fractures using percutaneous minimal internal fixation using one or more lag screws, and Ilizarov external fixation. This method was tested to evaluate its efficacy in immediate weight bearing, fracture healing and prevention of any post-immobilisation stiffness of the ankle and knee joints. This randomised blinded study was performed at a referral, academically supervised, level III trauma centre. Three hundred and twenty-four of the initial 351 patients completed this study and were followed up for a minimum of 12 (12-88) months. Patient ages ranged from 20 to 51 years, with a mean of 39 years. Ankle and knee movements and full weight bearing were encouraged immediately postoperatively. Solid union was assessed clinically and radiographically. Active and passive ankle and knee ranges of motion were measured and compared with the normal side using the Wilcoxon signed rank test for matched pairs. Subjective Olerud and Molander Ankle Score was used to detect any ankle joint symptoms at the final follow-up. No patient showed delayed or nonunion. All fractures healed within 95-129 days. Based on final clinical and radiographic outcomes, this technique proves to be adequate for managing simple diaphyseal tibial fractures. On the other hand, it is relatively expensive, technically demanding, necessitates exposure to radiation and patients are expected to be frame friendly.

Joint stability characteristics of the ankle complex in female athletes with histories of lateral ankle sprain, part II: clinical experience using arthrometric measurement.

PubMed

Kovaleski, John E; Heitman, Robert J; Gurchiek, Larry R; Hollis, J M; Liu, Wei; Pearsall, Albert W

2014-01-01

This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Cross-sectional study. University research laboratory. Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P < .01). Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.

SU-E-T-512: Evaluation of Treatment Planning Dose Calculation Accuracy at the Interface of Prosthetic Devices.

PubMed

Paulu, D; Alaei, P

2012-06-01

To evaluate the ability of treatment planning algorithm to accurately predict dose delivered at the interface of high density implanted devices. A high density (7.6 g/cc) Cobalt-Chromium-Molybdenum hip prosthesis was molded into an epoxy-based cylindrical leg phantom. The phantom was designed to be separated in half to access the prosthesis and to place the TLDs. Using MVCT to image the apparatus, a simple treatment plan was developed using the Philips Pinnacle treatment planning system. Wires were placed in the molded epoxy to allow for accurate definition of measurement sites (TLD positions) along the surface of the prosthesis. Micro-cube TLDs (1 mm 3 ) were placed at six measurement locations for which the dose had been calculated by the treatment planning system. An Elekta Synergy linear accelerator was used to deliver a 400 cGy plan to the phantom with 6 MV photons in a single fraction. A total of four 10 cm × 21 cm fields were used at 0, 90, 180, and 270 degree gantry rotations. Initial results indicate that the measured dose is 7-17% lower than the dose calculated by the treatment planning system. Further study using high energy beams are also in progress. Initial results indicate that the treatment planning system does predict the dose near a high density prosthetic device within 10-15% but underestimates the dose. The results of this study could help in designing treatment plans which would reduce the uncertainty of the dose delivered in the vicinity of prosthetic hip implants and similar devices. © 2012 American Association of Physicists in Medicine.

Initial experience with xenograft bioconduit for the treatment of complex prosthetic valve endocarditis.

PubMed

Roubelakis, Apostolos; Karangelis, Dimos; Sadeque, Syed; Yanagawa, Bobby; Modi, Amit; Barlow, Clifford W; Livesey, Steven A; Ohri, Sunil K

2017-07-01

The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. Several studies support the use of biological tissues to minimize the risk of recurrent infection. We present our initial surgical experience with the use of an aortic xenograft conduit for aortic valve and root replacement. Between October 2013 and August 2015, 15 xenograft bioconduits were implanted for complex PVE with abscess (13.3% female). In 6 patients, concomitant procedures were performed: coronary bypass (n=1), mitral valve replacement (n=5) and tricuspid annuloplasty (n=1). The mean age at operation was 60.3±15.5 years. The mean Logistic European system for cardiac operating risk evaluation (EuroSCORE) was 46.6±23.6. The median follow-up time was 607±328 days (range: 172-1074 days). There were two in-hospital deaths (14.3% mortality), two strokes (14.3%) and seven patients required permanent pacemaker insertion for conduction abnormalities (46.7%). The mean length of hospital stay was 26 days. At pre-discharge echocardiography, the conduit mean gradient was 9.3±3.3mmHg and there was either none (n=6), trace (n=6) or mild aortic insufficiency (n=1). There was no incidence of mid-term death, prosthesis-related complications or recurrent endocarditis. Xenograft bioconduits may be safe and effective for aortic valve and root replacement for complex PVE with aortic root abscess. Although excess early mortality reflects the complexity of the patient population, there was good valve hemodynamics, with no incidence of recurrent endocarditis or prosthesis failure in the mid-term. Our data support the continued use and evaluation of this biological prosthesis in this high-risk patient cohort.

Development and clinical application of a new testicular prosthesis

PubMed Central

Ning, Ye; Cai, Zhikang; Chen, Huixing; Ping, Ping; Li, Peng; Wang, Zhong; Li, Zheng

2011-01-01

A new type of testicular prosthesis made of silastic with an elliptical shape to mimic a normal testis was developed by our team and submitted for patenting in China. The prosthesis was produced in different sizes to imitate the normal testis of the patient. To investigate the effects and safety of the testicular prosthesis, 20 patients receiving testicular prosthesis implantation were recruited for this study. Follow-up after 6 months revealed no complications in the patients. All the patients answered that they were satisfied with their body image and the position of the implants, 19 patients were satisfied with the size and 16 patients were satisfied with the weight. These results show that the testicular prosthesis used in this study can meet patient's expectations. Patients undergoing orchiectomy should be offered the option to receive a testicular prosthesis implantation. The dimensions and weight of the available prosthetic implants should be further addressed to improve patient satisfaction. PMID:21927041

Manufacturer-provided effective orifice area index charts and the prevention of prosthesis-patient mismatch.

PubMed

House, Chad M; Nelson, William B; Kroshus, Timothy J; Dahiya, Ranjan; Pibarot, Philippe

2012-01-01

Prosthesis-patient mismatch (PPM) occurs when an implanted prosthesis is too small relative to the patient's body surface area (BSA). However, mismatch can often be prevented by indexing the expected effective orifice area (EOA) of a prosthesis to the patient's BSA and then selecting the largest implantable prosthesis to avoid mismatch. Previously, prosthesis manufacturers have attempted to simplify this process by providing charts that include the expected EOA for their prosthesis, already indexed into an array of BSA values. One caveat with these charts is that the expected EOA data must truly be reliable, or the charts will misguide the implanting surgeon. Manufacturer-provided charts could be improved by standardizing the EOA data, with one potential source being the hemodynamic data submitted to the United States Food and Drug Administration. This review discusses PPM, manufacturer-provided EOA charts, and the regulation of EOA data.

21 CFR 888.3730 - Toe joint phalangeal (hemi-toe) polymer prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Toe joint phalangeal (hemi-toe) polymer prosthesis. 888.3730 Section 888.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-toe) polymer prosthesis. (a) Identification. A toe joint phalangeal (hemi-toe) polymer prosthesis...

21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a one...

21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one...

21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a one-piece...

21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a one-piece...

21 CFR 888.3730 - Toe joint phalangeal (hemi-toe) polymer prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Toe joint phalangeal (hemi-toe) polymer prosthesis. 888.3730 Section 888.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-toe) polymer prosthesis. (a) Identification. A toe joint phalangeal (hemi-toe) polymer prosthesis...

21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one...

21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a one...

21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a one-piece...

21 CFR 888.3730 - Toe joint phalangeal (hemi-toe) polymer prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Toe joint phalangeal (hemi-toe) polymer prosthesis. 888.3730 Section 888.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-toe) polymer prosthesis. (a) Identification. A toe joint phalangeal (hemi-toe) polymer prosthesis...

21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one...

21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a one...

21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one...

21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a one-piece...

21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a one...

21 CFR 888.3730 - Toe joint phalangeal (hemi-toe) polymer prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Toe joint phalangeal (hemi-toe) polymer prosthesis. 888.3730 Section 888.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-toe) polymer prosthesis. (a) Identification. A toe joint phalangeal (hemi-toe) polymer prosthesis...

21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a one-piece...

21 CFR 888.3730 - Toe joint phalangeal (hemi-toe) polymer prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Toe joint phalangeal (hemi-toe) polymer prosthesis. 888.3730 Section 888.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-toe) polymer prosthesis. (a) Identification. A toe joint phalangeal (hemi-toe) polymer prosthesis...

21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a one...

21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one...

Accuracy of pulse oximeter readings from probe placement on newborn wrist and ankle.

PubMed

Phattraprayoon, N; Sardesai, S; Durand, M; Ramanathan, R

2012-04-01

To compare the accuracy of pulse oximetry oxygen saturation (SpO(2)) measured on the wrist compared with the ipsilateral palm, and SpO(2) measured on the ankle compared with the ipsilateral sole. In this prospective observational study, neonates admitted to the neonatal intensive care unit were enrolled. We recorded SpO(2) (Masimo Radical-7 pulse oximeter) detected at the palm and ipsilateral wrist initially, then at 30 s, and at 1 min, and we repeated the same procedure over the sole and ipsilateral ankle. We recorded the time to obtain the SpO(2) readings from all these sites. Regression analysis was performed to determine the relationship between paired SpO(2) measurements. The mean difference (bias) and standard deviation of the paired SpO(2) differences (precision) were calculated (Bland-Altman plots). A total of 150 patients (birth weight 2381±1020 g, gestational age 34.3±4.3 weeks, median postnatal age 3.5 days (25th-75th percentile 1-16 days)) were enrolled. There was a good correlation between SpO(2) measured at the palm versus the wrist (r=0.95, P<0.001 (right); r=0.97, P< 0.001 (left)) and between SpO(2) measured at the sole versus the ankle (r=0.92, P<0.001 (right); r=0.91, P<0.001 (left)). There was also a good agreement between paired SpO(2) measurements from these sites. The bias and precision for SpO(2) at the right palm and right wrist was 0.08±0.94% and for the left palm and left wrist 0.22±0.87%. Similarly, the bias and precision for SpO(2) at the right sole and right ankle was -0.03±0.93% and for the left sole and left ankle was -0.01±0.93%. Our results show that the wrist and ankle can be used as alternative sites to measure SpO(2) in newborn infants in place of the routinely used palm or sole.

Prosthesis rejection in acquired major upper-limb amputees: a population-based survey.

PubMed

Østlie, Kristin; Lesjø, Ingrid Marie; Franklin, Rosemary Joy; Garfelt, Beate; Skjeldal, Ola Hunsbeth; Magnus, Per

2012-07-01

To estimate the rates of primary and secondary prosthesis rejection in acquired major upper-limb amputees (ULAs), to describe the most frequently reported reasons for rejection and to estimate the influence of background factors on the risk of rejection. Cross-sectional study analysing population-based questionnaire data (n = 224). Effects were analysed by logistic regression analyses and Cox regression analyses. Primary prosthesis rejection was found in 4.5% whereas 13.4% had discontinued prosthesis use. The main reasons reported for primary non-wear were a perceived lack of need and discrepancies between perceived need and the prostheses available. The main reasons reported for secondary prosthesis rejection were dissatisfaction with prosthetic comfort, function and control. Primary prosthesis rejection was more likely in ULAs amputated at high age and in ULAs with proximal amputations. Secondary prosthesis rejection was more likely in proximal ULAs and in women. Clinicians should be aware of the increased risk of rejection in proximal ULAs, elderly ULAs and in women. Emphasising individual needs will probably facilitate successful prosthetic fitting. Improved prosthesis quality and individualised prosthetic training may increase long-term prosthesis use. Further studies of the effect of prosthetic training and of the reasons for rejection of different prosthetic types are suggested.

Novel knee joint mechanism of transfemoral prosthesis for stair ascent.

PubMed

Inoue, Koh; Wada, Takahiro; Harada, Ryuchi; Tachiwana, Shinichi

2013-06-01

The stability of a transfemoral prosthesis when walking on flat ground has been established by recent advances in knee joint mechanisms and their control methods. It is, however, difficult for users of a transfemoral prosthesis to ascend stairs. This difficulty is mainly due to insufficient generation of extension moment around the knee joint of the prosthesis to lift the body to the next step on the staircase and prevent any unexpected flexion of the knee joint in the stance phase. Only a prosthesis with an actuator has facilitated stair ascent using a step-over-step gait (1 foot is placed per step). However, its use has issues associated with the durability, cost, maintenance, and usage environment. Therefore, the purpose of this research is to develop a novel knee joint mechanism for a prosthesis that generates an extension moment around the knee joint in the stance phase during stair ascent, without the use of any actuators. The proposed mechanism is based on the knowledge that the ground reaction force increases during the stance phase when the knee flexion occurs. Stair ascent experiments with the prosthesis showed that the proposed prosthesis can realize stair ascent without any undesirable knee flexion. In addition, the prosthesis is able to generate a positive knee joint moment power in the stance phase even without any power source.

BIOENERGETIC DIFFERENCES DURING WALKING AND RUNNING IN TRANSFEMORAL AMPUTEE RUNNERS USING ARTICULATING AND NON-ARTICULATING KNEE PROSTHESES

PubMed Central

Highsmith, M. Jason; Kahle, Jason T.; Miro, Rebecca M.; Mengelkoch, Larry J.

2016-01-01

Transfemoral amputation (TFA) patients require considerably more energy to walk and run than non-amputees. The purpose of this study was to examine potential bioenergetic differences (oxygen uptake (VO2), heart rate (HR), and ratings of perceived exertion (RPE)) for TFA patients utilizing a conventional running prosthesis with an articulating knee mechanism versus a running prosthesis with a non-articulating knee joint. Four trained TFA runners (n = 4) were accommodated to and tested with both conditions. VO2 and HR were significantly lower (p ≤ 0.05) in five of eight fixed walking and running speeds for the prosthesis with an articulating knee mechanism. TFA demonstrated a trend for lower RPE at six of eight walking speeds using the prosthesis with the articulated knee condition. A trend was observed for self-selected walking speed, self-selected running speed, and maximal speed to be faster for TFA subjects using the prosthesis with the articulated knee condition. Finally, all four TFA participants subjectively preferred running with the prosthesis with the articulated knee condition. These findings suggest that, for trained TFA runners, a running prosthesis with an articulating knee prosthesis reduces ambulatory energy costs and enhances subjective perceptive measures compared to using a non-articulating knee prosthesis. PMID:28066524

Postpneumonectomy syndrome in children: advantages and long-term follow-up of expandable prosthesis.

PubMed

Podevin, G; Larroquet, M; Camby, C; Audry, G; Plattner, V; Heloury, Y

2001-09-01

Pneumonectomy in children can be complicated by a severe mediastinal shift, which leads to bronchial stretching resulting in severe respiratory failure. This postpneumonectomy syndrome can be corrected by inserting a prosthesis in the empty side of the chest. Forty-two children, from 6 months to 15 years old, underwent a pneumonectomy. Seven of these patients were treated surgically for severe manifestations of postpneumonectomy syndrome. First insertion of an expandable prosthesis was followed up in 5 cases by its replacement with a breast prosthesis in adolescence. The expandable prosthesis was injected periodically with saline solution to maintain the mediastinum in a midline position as the children grew. The mean delay between pneumonectomy and first prosthesis implantation was 5 years (range, 11 months to 8 years). Pulmonary function tests showed a substantial improvement in the obstructive syndrome in all patients except one, in whom the functional improvement was moderate. The mean follow-up after the expandable prosthesis implantation was 6 years (range, 6 months to 10 years) and all patients are doing well. The insertion of an intrathoracic prosthesis can dramatically improve the clinical symptoms and reduce the functional obstructive syndrome. The expandable prosthesis allowed for progressive, well-tolerated recentering of the mediastinum and adjustment for growth. Copyright 2001 by W.B. Saunders Company.

Malrotation of the McGhan Style 510 prosthesis.

PubMed

Schots, Jeroen M P; Fechner, Maarten R; Hoogbergen, Maarten M; van Tits, Herm W H J

2010-07-01

Anatomically shaped cohesive silicone breast implants are frequently used in aesthetic and reconstructive surgery. After successful results with the Style 410 prosthesis, McGhan (Natrelle, Allergan) introduced the Style 510 prosthesis. After using this novel prosthesis, the authors encountered a high number of prosthesis malrotations on self-reported follow-up. Therefore, a retrospective medical record review was performed to determine the prevalence of malrotation of the Style 510 prosthesis. From January of 2005 to December of 2006, 73 (146 prostheses) aesthetic augmentation mammaplasty procedures were performed using Style 510 prostheses. All prostheses were placed subglandularly through an inframammary incision. The postsurgical protocol for the first 3 weeks involved wearing a nonwired compression bra, abstinence from sports activities, and abstinence from heavy labor. Standard follow-up was at 1 week, 3 months, and if necessary. On self-reported follow-up, 8.2 percent of all prostheses were rotated. These rotations all occurred unilaterally after a mean period of 10 months (range, 3 to 19 months). No relation to an inciting incident or prosthesis volume could be found. The number of rotations of the Style 510 prosthesis seen after primary aesthetic breast augmentation is high. An obvious cause of this major problem has not been found. This led the authors to discontinue using the Style 510 prosthesis for primary aesthetic mammary augmentations in their practice.

Biomechanical evaluation of two types of short-stemmed hip prostheses compared to the trust plate prosthesis by three-dimensional measurement of micromotions.

PubMed

Fottner, Andreas; Schmid, Markus; Birkenmaier, Christof; Mazoochian, Farhad; Plitz, Wolfgang; Volkmar, Jansson

2009-06-01

Stemless and short-stemmed hip prostheses have been developed to preserve femoral bone stock. While all these prostheses claim a more or less physiological load transfer, clinical long-term results are only available for the stemless thrust plate prosthesis. In this study, the in vitro primary stability of the thrust plate prosthesis was compared to two types of short-stemmed prostheses. In addition to the well-established Mayo prosthesis, the modular Metha prosthesis was tested using cone adapters with 130 degrees and 140 degrees neck-shaft-angles. The prostheses were implanted in composite femurs and loaded dynamically (300-1700 N). Three-dimensional micromotions at the bone-prosthesis interface were measured. In addition, the three-dimensional deformations at the surface of the composite femur were measured to gain data on the strain distribution. For all tested prostheses, the micromotions did not exceed 150 microm, the critical value for osteointegration. The thrust plate prosthesis revealed similar motions as the short-stemmed prostheses. The short-stemmed prosthesis with the 130 degrees cone tended to have the highest micromotions of all tested short-stemmed prostheses. The thrust plate prosthesis revealed the lowest alteration of bone surface deformation after implantation. The comparably low micromotions of the thrust plate prosthesis and the short-stemmed prostheses should be conducive to osseous integration. The higher alteration of load transmission after implantation reveals a higher risk of stress shielding for the short-stemmed prostheses.

Can We Improve the Tolerance of an Ocular Prosthesis by Enhancing Its Surface Finish?

PubMed

Litwin, Andre S; Worrell, Emma; Roos, Jonathan C P; Edwards, Barry; Malhotra, Raman

Patients who wear an ocular prosthesis frequently suffer with dry eye symptoms and socket discharge, often on a daily basis. The aim of the study was to determine whether a smoother, optical quality polish of the prosthesis' surface could improve symptoms and wear tolerance. The study was designed as single-center, single-masked, prospective randomized controlled trial. Eighty-eight consecutive patients undergoing annual ocular prosthesis maintenance review were approached from the prosthesis clinic. Forty-one out of 49 eligible patients were recruited. Participants were randomized to either a standard or a higher "optical quality" polish of their prosthesis. At entry to the trial, at 1 month, and 12 months they completed a questionnaire covering cleaning, lubricant use, inflammation, discomfort, and discharge. Lower scores indicated better tolerance of the prosthesis. At each visit, the prosthesis was stained and photographed against a standard background to assess deposit build up. Primary outcome measures were 1) a subjective questionnaire score and 2) an objective assessment of surface deposit build-up on prosthetic eyes by standardized photographic grading. Forty-one patients participated in the study. The median age of their prosthesis was 36 months (range 9 months-40 years). There was no statistically significant difference in questionnaire scores or deposit build up between the 2 groups at baseline. By 12-months, the higher optical quality polish showed a statistically significant reduction in symptoms and frequency of discharge (2.19 vs. 3.85; p = 0.05-lower scores better). Scoring of the prosthesis' deposit build-up showed a significant difference at 1 month, but this was not sustained at 12 months. Creating an optical quality finish to an ocular prosthesis reduces deposit build up on artificial eyes. The authors found this modification improved patient tolerance at 12 months.

Visualisation of upper limb activity using spirals: A new approach to the assessment of daily prosthesis usage.

PubMed

Chadwell, Alix; Kenney, Laurence; Granat, Malcolm; Thies, Sibylle; Head, John S; Galpin, Adam

2018-02-01

Current outcome measures used in upper limb myoelectric prosthesis studies include clinical tests of function and self-report questionnaires on real-world prosthesis use. Research in other cohorts has questioned both the validity of self-report as an activity assessment tool and the relationship between clinical functionality and real-world upper limb activity. Previously, 1 we reported the first results of monitoring upper limb prosthesis use. However, the data visualisation technique used was limited in scope. Methodology development. To introduce two new methods for the analysis and display of upper limb activity monitoring data and to demonstrate the potential value of the approach with example real-world data. Upper limb activity monitors, worn on each wrist, recorded data on two anatomically intact participants and two prosthesis users over 1 week. Participants also filled in a diary to record upper limb activity. Data visualisation was carried out using histograms, and Archimedean spirals to illustrate temporal patterns of upper limb activity. Anatomically intact participants' activity was largely bilateral in nature, interspersed with frequent bursts of unilateral activity of each arm. At times when the prosthesis was worn prosthesis users showed very little unilateral use of the prosthesis (≈20-40 min/week compared to ≈350 min/week unilateral activity on each arm for anatomically intact participants), with consistent bias towards the intact arm throughout. The Archimedean spiral plots illustrated participant-specific patterns of non-use in prosthesis users. The data visualisation techniques allow detailed and objective assessment of temporal patterns in the upper limb activity of prosthesis users. Clinical relevance Activity monitoring offers an objective method for the assessment of upper limb prosthesis users' (PUs) activity outside of the clinic. By plotting data using Archimedean spirals, it is possible to visualise, in detail, the temporal patterns of upper limb activity. Further work is needed to explore the relationship between traditional functional outcome measures and real-world prosthesis activity.

Analysis of the Effects of Normal Walking on Ankle Joint Contact Characteristics After Acute Inversion Ankle Sprain.

PubMed

Bae, Ji Yong; Park, Kyung Soon; Seon, Jong Keun; Jeon, Insu

2015-12-01

To show the causal relationship between normal walking after various lateral ankle ligament (LAL) injuries caused by acute inversion ankle sprains and alterations in ankle joint contact characteristics, finite element simulations of normal walking were carried out using an intact ankle joint model and LAL injury models. A walking experiment using a volunteer with a normal ankle joint was performed to obtain the boundary conditions for the simulations and to support the appropriateness of the simulation results. Contact pressure and strain on the talus articular cartilage and anteroposterior and mediolateral translations of the talus were calculated. Ankles with ruptured anterior talofibular ligaments (ATFLs) had a higher likelihood of experiencing increased ankle joint contact pressures, strains and translations than ATFL-deficient ankles. In particular, ankles with ruptured ATFL + calcaneofibular ligaments and all ruptured ankles had a similar likelihood as the ATFL-ruptured ankles. The push off stance phase was the most likely situation for increased ankle joint contact pressures, strains and translations in LAL-injured ankles.

Functional evaluation of a CAD/CAM prosthesis for immediate defect repair after total maxillectomy: a case series of 18 patients with maxillary sinus cancer.

PubMed

Jiang, Fei-Fei; Hou, Yan; Lu, Li; Ding, Xiao-Xu; Li, Wei; Yan, Ai-Hui

2015-01-01

To evaluate the facial profiles and functional recovery of 18 patients treated by a computer-aided designed/manufactured hollow obturator prosthesis (CAD/CAM prosthesis) after total maxillectomy for malignant maxillary sinus tumor. A retrospective observational study was performed to evaluate the facial profiles and functional recovery of 18 patients with T3-4a N0 M0 maxillary sinus cancer, who were treated by total maxillectomy and simultaneous implantation of a computer-aided designed/manufactured hollow obturator prosthesis (CAD/CAM prosthesis). Follow-ups were performed 1, 3, 6, and 12 months after surgery. Facial measurements, speech intelligibility, and chewing and swallowing functions were examined. Thirteen patients converted to a permanent prosthesis 6 months after surgery. Comparisons were made between patients with and without the CAD/CAM or permanent prosthesis at various times using SPSS13.0 statistical software (SPSS Inc., Chicago, IL, USA). Speech intelligibility, facial depression, and eyeball prolapse results showed improvements with prosthesis use at 1, 3, and 6 months after surgery (p < 0.05). Swallowing function improved from level V to level II-IV with prosthesis use at 1, 3, and 6 months, and reached level I or II with permanent prosthesis use at 12 months after surgery. Simultaneous CAD/CAM prosthesis implantation recovered the facial profile, enhanced the speaking, swallowing, and chewing functions, and improved the quality of life of patients. Tumor recurrence can be detected by direct observation of the postoperative maxillary cavity. Therefore, this operation is recommended for simultaneous excision repair and functional reconstruction after total maxillectomy. This surgical treatment of maxillary sinus cancer is applied rarely in China, but it has a good effect based on our observation. Simultaneous CAD/CAM prosthesis implantation after total maxillectomy can recover the facial profile, enhance the speaking, swallowing, and chewing functions, and improve the quality of life of patients. Tumor recurrence can be detected by direct observation of the postoperative maxillary cavity. This technique avoids the need for dental implants because the bottom part of the prosthesis contains a palatal plate with dentures. © 2014 Wiley Periodicals, Inc.

Joint Stability Characteristics of the Ankle Complex in Female Athletes With Histories of Lateral Ankle Sprain, Part II: Clinical Experience Using Arthrometric Measurement

PubMed Central

Kovaleski, John E.; Heitman, Robert J.; Gurchiek, Larry R.; Hollis, J. M.; Liu, Wei; IV, Albert W. Pearsall

2014-01-01

Context: This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. Objective: To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Design: Cross-sectional study. Setting: University research laboratory. Patients or Other Participants: Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. Intervention(s): All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. Main Outcome Measure(s): The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Results: Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P < .01). Conclusions: Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles. PMID:24568223

Methicillin-Resistant Staphylococcus aureus in Foot Osteomyelitis.

PubMed

Ashong, Chester N; Raheem, Shazia A; Hunter, Andrew S; Mindru, Cezarina; Barshes, Neal R

Conflicting studies exist regarding the impact of methicillin-resistant Staphylococcus aureus (MRSA) on increased time to wound healing, future need for surgical procedures, and likelihood of treatment failure in patients with diabetic foot osteomyelitis. The purpose of this study is to determine the overall significance of MRSA in predicting treatment failure in bone infections of the foot and to determine an appropriate pre-operative and empiric post-operative antibiotic regimen. Patients presenting with an initial episode of "probable" or "definite" foot osteomyelitis were included for review and analysis if the following criteria were met: (1) Osteomyelitis occurred in the foot (i.e., distal to the malleoli of the ankle); episodes occurring above the ankle were excluded. (2) Patients received either no antibiotics or only oral antibiotics for long-term treatment; episodes managed with long-term parenteral antibiotics were excluded. (3) The infection was managed initially with medical therapy or conservative surgical therapy; episodes managed with major (above-ankle) amputation as the initial treatment were excluded. The primary objective of this study was to assess whether episodes of foot osteomyelitis associated with MRSA resulted in treatment failure more frequently than not. Of 178 episodes included in the study, 50 (28.1%) episodes had treatment failure. Median time-to-treatment failure was 60 days (range 7-598 days). In 28.1% (9/32 episodes) in which treatment failure occurred and 39.0% (41/105) episodes in which no treatment failure occurred, MRSA was present. The presence of MRSA was not significantly associated with treatment failure (p = 0.99). The presence of MRSA in bone culture and whether antibiotic use had anti-MRSA activity was not associated with increased treatment failure of diabetic foot osteomyelitis in our institution. Empiric antibiotic coverage of MRSA may not be necessary for many patients presenting with foot osteomyelitis.

[Total hip endoprosthesis following resection arthroplasty].

PubMed

Engelbrecht, E; Siegel, A; Kappus, M

1995-08-01

From 1976 to December 1994, a total of 347 patients underwent implantation of a hip prosthesis at the ENDO-Klinik for treatment of an unsatisfactory condition following resection arthroplasty. From 1976 to 1987, 143 patients were treated and in 1989 the results obtained in these patients were analysed: 99 of them were available for a follow-up examination in 1989, and 64 for a further examination in 1995. In 130 cases infection had been the reason for joint resection. At the time of the prosthesis operation (1-20 years later) intraoperative biopsy revealed that infection was still present in 41 cases (31.5%). Only 15 of these infections had been detected preoperatively by joint aspiration. This shows that the value of resection arthroplasty as a method of treating periprosthetic infection is limited and lends support to the one-stage exchange operation, which is the method we prefer in cases of infected hip prostheses. The operative technique and preparation for implantation of the prosthesis are described, as are septic and aseptic complications and the measures that can be taken to treat them. In spite of the patients' generally poor initial condition and with due consideration for the further revision operations, the medium-term results finally obtained are poor in only 9%.

Evaluation of a noninvasive command scheme for upper-limb prostheses in a virtual reality reach and grasp task.

PubMed

Kaliki, Rahul R; Davoodi, Rahman; Loeb, Gerald E

2013-03-01

C5/C6 tetraplegic patients and transhumeral amputees may be able to use voluntary shoulder motion as command signals for a functional electrical stimulation system or transhumeral prosthesis. Stereotyped relationships, termed "postural synergies," among the shoulder, forearm, and wrist joints emerge during goal-oriented reaching and transport movements as performed by able-bodied subjects. Thus, the posture of the shoulder can potentially be used to infer the desired posture of the elbow and forearm joints during reaching and transporting movements. We investigated how well able-bodied subjects could learn to use a noninvasive command scheme based on inferences from these postural synergies to control a simulated transhumeral prosthesis in a virtual reality task. We compared the performance of subjects using the inferential command scheme (ICS) with subjects operating the simulated prosthesis in virtual reality according to complete motion tracking of their actual arm and hand movements. Initially, subjects performed poorly with the ICS but improved rapidly with modest amounts of practice, eventually achieving performance only slightly less than subjects using complete motion tracking. Thus, inferring the desired movement of distal joints from voluntary shoulder movements appears to be an intuitive and noninvasive approach for obtaining command signals for prostheses to restore reaching and grasping functions.

Determinants of lower extremity amputations: an institutional experience.

PubMed

Soomro, Nabila; Khan, Mahjabeen; Ahmed, Syed Imran; Minhas, Muhammad Ali

2013-07-01

To determine the determinants of lower extremity amputations in diabetics and non-diabetics in a tertiary care institute. Cross-sectional, analytical study. Outpatients Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from January 2007 to December 2010. All patients with amputations reporting at the study centre for prosthesis fitting were included in the study. Patient`s age, level of amputation, stump complications and associated risk factors of amputation were recorded on a structured proforma. Prosthesis and orthotic assessment were carried out. The frequency and determinants were collected to compare diabetic and non-diabetic amputees. The data was analyzed in SPSS windows version 16. A total of 1091 subjects were provided prosthesis, including 847 males (77.6%). Mean age in diabetic and nondiabetics being 49.6 ± 15.2 and 26.6 ± 17.9 years respectively which is significant at (p < 0.001). Socioeconomic status and educational levels were significantly associated with diabetic status (p < 0.001). Amputation was more common in non-diabetic 858 (78.6%) compared to diabetics 233 (21.4%). This study has identified that most common and significant predictors were gender, low social status and educational levels. Other significant predictors of amputation identified were type of lesion, (infections and ischaemia), initial diagnosis acute/chronic arterial insufficiency and diabetic foot.

The relationship between trans-femoral prosthesis alignment and the center trajectory of plantar pressure in the frontal plane

PubMed Central

Nomura, Tomohiro; Watanabe, Kota; Nosaka, Toshiya; Matsubara, Hiroyuki; Akiyama, Masaharu; Inui, Kimiharu

2016-01-01

[Purpose] It is difficult to identify by visual observation whether alignment abnormalities in trans-femoral prostheses in the frontal plane are attributable to the adduction angle or the abnormal alignment of the positions of the medial and lateral sides of the socket in relation to the foot. Therefore, we focused on the trajectory of the center of plantar pressure during walking, and we proposed a method for differentiating these two alignment abnormalities. [Subjects and Methods] We recruited 4 trans-femoral unilateral amputees. Bench alignment was achieved initially. We compared the amplitude of the trajectory of the center of plantar pressure when walking under 2 conditions: 1) when changing the adduction angle and 2) when changing the positional relationship between the socket and the foot. [Results] It was not possible to distinguish between the 2 types of malalignment on the prosthesis side. There was a significant difference when changing the positional relationship on the contralateral side. Thereby, the plantar pressure of the contralateral side could be used to distinguish between the 2 types of malalignment. [Conclusion] The results of this study suggested that trans-femoral prosthesis malalignment could be evaluated through the plantar pressure of the contralateral side in amputees. PMID:27065546

Physical management of the Charcot foot.

PubMed

Crews, Ryan T; Wrobel, James S

2008-01-01

Charcot arthropathy places individuals at risk of developing diabetic foot ulcers and potentially subsequent limb amputation by means of altering the anatomy of the foot and ankle. Physical trauma is an important component to the etiology of the condition. The physical management of the Charcot foot is concerned with minimizing the stress applied to the affected foot and ankle skeletal structure. The most appropriate device is temporally dependent on the progression of the disease. At the initiation of Charcot arthropathy, care by total contact cast is recommended. As the affected bones begin to heal, use of a removable cast walker may be implemented. When the bones reach a fixed state, appropriate footwear is dictated by the degree of deformity.

Replacement of the valvular prosthesis in a patient with a Bentall procedure.

PubMed

Panos, A L; Teoh, K T; Wilson, J K; Salerno, T A

1992-09-01

Patients who have had the Bentall-DeBono procedure using a composite conduit with a tissue valvular prosthesis pose a great challenge when problems develop with the tissue prosthesis. We herein report the surgical management of one such case, in which the valvular prosthesis was removed and replaced without replacement of the conduit.

Vacuum form sheet as a guide for fabrication of orbital prosthesis.

PubMed

Dugad, Jinesh A; Dholam, Kanchan P; Chougule, Arati T

2014-08-01

Rehabilitation with an orbital prosthesis is done when surgical reconstruction is not possible or affordable in patients with orbital exenteration. Fabrication of orbital prosthesis requires precision in placement of the ocular portion of the prosthesis on the facial moulage. This method describes the use of a vacuum formed sheet for making an orbital template that acts as a guide for achieving optimum orientation of the ocular portion of the prosthesis. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Management of an Anophthalmic Patient by the Fabrication of Custom Made Ocular Prosthesis

PubMed Central

SINGH, Meenakshi; NAYAK, Meghanand; SOLANKI, Jitender; GUPTA, Sarika; SINGH, Anjali

2015-01-01

The loss or disfigurement of a body parts specially that pertaining to the face has a deep psychological and social impact on the patient. After enucleation, evisceration or exteneration of the eye, the aim of an ocular prosthesis should be to restore the natural appearance, install confidence and a sense social acceptability in the patient. Custom made prosthesis has several advantages over the stock eye prosthesis. This article illustrates rehabilitation of the enucleated right eye of a patient with a custom made ocular prosthesis. PMID:26715901

Vascular surgical society of great britain and ireland: immunoglobulin A antibodies against chlamydia pneumoniae are associated with expansion of small abdominal aortic aneurysms and declining ankle blood pressure

PubMed

Lindholt; Vammen; Henneberg; Fasting

1999-05-01

BACKGROUND: The potential correlation between chronic infection with Chlamydia pneumoniae and the progression of small abdominal aortic aneurysms (AAAs) and lower limb atherosclerosis was studied. METHODS: Mass screening for AAA was carried out in outdoor clinics at all hospitals in the county. Some 139 men (aged 65-73 years) with a 3.0-4.9-cm AAA were followed prospectively for 1-3 (mean 2.7) years. Initially, an interview and examination was performed, and blood samples were taken. RESULTS: Some 62 per cent (53-71 per cent) had an immunoglobulin (Ig) A level of 40 or more, or an IgG level of 64 or above. Some 83 per cent (74-93 per cent) had an IgA level of 20 or more, or an IgG level of 32 or more. Men with an IgA level of 20 or more had 51 per cent greater AAA expansion and men with an IgA level of 40 or above had 24 per cent more expansion. An IgA level of 20 or more, or IgA of 40 or greater, were significant independent predictors of AAA expansion adjusted for age, smoking, initial AAA size, steroid treatment, diastolic blood pressure, pulmonary function and other plasma factors. The ankle blood pressure index (ABI) of the IgA-seropositive men decreased 11 per cent, while the ABI decreased by 5 per cent among IgA-seronegative men (P < 0.05). The significant difference persisted after adjusting for age, smoking, initial systolic ankle blood pressure, initial brachial systolic or diastolic blood pressure, but disappeared after adjusting for low-density lipoprotein (LDL) levels. CONCLUSION: A high proportion of men with a small AAA have signs of chronic C. pneumoniae infection. The progression of AAAs and lower limb atherosclerosis seems to be correlated to chronic infection with C. pneumoniae.

The initial safe range of motion of the ankle joint after three methods of internal fixation of simulated fractures of the medial malleolus.

PubMed

Shimamura, Yoshio; Kaneko, Kazuo; Kume, Kazuhiko; Maeda, Mutsuhiro; Iwase, Hideaki

2006-07-01

Previous studies have demonstrated the safe passive range of ankle motion for inter-bone stiffness after internal fixation under load but there is a lack of information about the safe range of ankle motion for early rehabilitation in the absence of loading. The present study was designed to assess the effect of ankle movement on inter-bone displacement characteristics of medial malleolus fractures following three types of internal fixation to determine the safe range of motion. Five lower legs obtained during autopsy were used to assess three types of internal fixation (two with Kirschner-wires alone; two with Kirschner-wires plus tension band wiring; and, one with an AO/ASIF malleolar screw alone). Following a simulated fracture by sawing through the medial malleolus the displacement between the fractured bone ends was measured during a passive range of movement with continuous monitoring using omega (Omega) shaped transducers and a biaxial flexible goniometer. Statistical analysis was performed with repeated measures analysis of variance. Inter-bone displacement was not proportional to the magnitude of movement throughout the range of ankle motion as, when separation exceeded 25 microm, there was increasingly wide separation as plantar-flexion or dorsal-flexion was increased. There was no statistical significant difference between the small amount of inter-bone displacement observed with three types of fixation within the safe range of dorsal-flexion and plantar-flexion for early rehabilitation. However the inter-bone separation when fixation utilized two Kirschner-wires alone tended to be greater than when using the other two types of fixation during dorsal-flexion and eversion. The present study revealed a reproducible range of ankle motion for early rehabilitation which was estimated to be within the range of 20 degrees of dorsal-flexion and 10 degrees of plantar-flexion without eversion. Also, internal fixation with two Kirschner-wires alone does not seem to provide stability achieved by the other two forms of fixation.

Effects of the application of ankle functional rehabilitation exercise on the ankle joint functional movement screen and isokinetic muscular function in patients with chronic ankle sprain.

PubMed

Ju, Sung-Bum; Park, Gi Duck

2017-02-01

[Purpose] This study was conducted to investigate the effects of ankle functional rehabilitation exercise on ankle joint functional movement screen results and isokinetic muscular function in patients with chronic ankle sprain patients. [Subjects and Methods] In this study, 16 patients with chronic ankle sprain were randomized to an ankle functional rehabilitation exercise group (n=8) and a control group (n=8). The ankle functional rehabilitation exercise centered on a proprioceptive sense exercise program, which was applied 12 times for 2 weeks. To verify changes after the application, ankle joint functional movement screen scores and isokinetic muscular function were measured and analyzed. [Results] The ankle functional rehabilitation exercise group showed significant improvements in all items of the ankle joint functional movement screen and in isokinetic muscular function after the exercise, whereas the control group showed no difference after the application. [Conclusion] The ankle functional rehabilitation exercise program can be effectively applied in patients with chronic ankle sprain for the improvement of ankle joint functional movement screen score and isokinetic muscular function.

Effects of the application of ankle functional rehabilitation exercise on the ankle joint functional movement screen and isokinetic muscular function in patients with chronic ankle sprain

PubMed Central

Ju, Sung-Bum; Park, Gi Duck

2017-01-01

[Purpose] This study was conducted to investigate the effects of ankle functional rehabilitation exercise on ankle joint functional movement screen results and isokinetic muscular function in patients with chronic ankle sprain patients. [Subjects and Methods] In this study, 16 patients with chronic ankle sprain were randomized to an ankle functional rehabilitation exercise group (n=8) and a control group (n=8). The ankle functional rehabilitation exercise centered on a proprioceptive sense exercise program, which was applied 12 times for 2 weeks. To verify changes after the application, ankle joint functional movement screen scores and isokinetic muscular function were measured and analyzed. [Results] The ankle functional rehabilitation exercise group showed significant improvements in all items of the ankle joint functional movement screen and in isokinetic muscular function after the exercise, whereas the control group showed no difference after the application. [Conclusion] The ankle functional rehabilitation exercise program can be effectively applied in patients with chronic ankle sprain for the improvement of ankle joint functional movement screen score and isokinetic muscular function. PMID:28265157

Initial Consideration of the Feasibility and Optimal Application of Tactile Sway Cueing to Improve Balance Among Persons Suffering from Disequilibrium

DTIC Science & Technology

2010-11-01

mouth are engineered out of the system. Fortunately, the later model of Brainport is wireless, but even so, having a device in the mouth may feel ...E. 2006. Determining the effectiveness of a vibrotactile balance prosthesis . Journal of Vestibular Research. 16: 45-56. 14 Raj, A. K., Suri, N

Joint Preservation of the Wrist Using Articulated Distraction Arthroplasty: A Case Report of a Novel Technique

PubMed Central

Fletcher, Matt D. A.

2015-01-01

Distraction arthroplasty of the ankle, elbow, and hip has become widely accepted and used within the orthopaedic community with excellent initial results which appear sustained. To date it has not been applied to the wrist in the same manner. A novel technique, drawn upon past success of articulated ankle distraction and static wrist distraction, was devised and evaluated by application of articulated wrist distraction performed over a 12-week period in a patient with poor functional outcome following limited wrist fusion. Posttreatment results showed improvement in range of motion (100-degree arc), subjective pain, and functional outcome measures (DASH 21.7, Mayo Wrist Score 80) comparable or better than either limited wrist fusion or proximal row carpectomy. Articulated wrist distraction initially appears to be a promising therapeutic option for the management of the stiff and painful wrist to maintain maximal function for which formal wrist arthrodesis may be the only alternative. PMID:25767728

Cognitive predictors of skilled performance with an advanced upper limb multifunction prosthesis: a preliminary analysis.

PubMed

Hancock, Laura; Correia, Stephen; Ahern, David; Barredo, Jennifer; Resnik, Linda

2017-07-01

Purpose The objectives were to 1) identify major cognitive domains involved in learning to use the DEKA Arm; 2) specify cognitive domain-specific skills associated with basic versus advanced users; and 3) examine whether baseline memory and executive function predicted learning. Method Sample included 35 persons with upper limb amputation. Subjects were administered a brief neuropsychological test battery prior to start of DEKA Arm training, as well as physical performance measures at the onset of, and following training. Multiple regression models controlling for age and including neuropsychological tests were developed to predict physical performance scores. Prosthetic performance scores were divided into quartiles and independent samples t-tests compared neuropsychological test scores of advanced scorers and basic scorers. Baseline neuropsychological test scores were used to predict change in scores on physical performance measures across time. Results Cognitive domains of attention and processing speed were statistically significantly related to proficiency of DEKA Arm use and predicted level of proficiency. Conclusions Results support use of neuropsychological tests to predict learning and use of a multifunctional prosthesis. Assessment of cognitive status at the outset of training may help set expectations for the duration and outcomes of treatment. Implications for Rehabilitation Cognitive domains of attention and processing speed were significantly related to level of proficiencyof an advanced multifunctional prosthesis (the DEKA Arm) after training. Results provide initial support for the use of neuropsychological tests to predict advanced learningand use of a multifunctional prosthesis in upper-limb amputees. Results suggest that assessment of patients' cognitive status at the outset of upper limb prosthetictraining may, in the future, help patients, their families and therapists set expectations for theduration and intensity of training and may help set reasonable proficiency goals.

Reconstruction of a mandibular segmental defect with a customized 3-dimensional-printed titanium prosthesis in a cat with a mandibular osteosarcoma.

PubMed

Liptak, Julius M; Thatcher, Graham P; Bray, Jonathan P

2017-04-15

CASE DESCRIPTION A 12-year-old neutered male domestic shorthair cat had been treated for a mass arising from the lingual aspect of the caudal right mandibular body. Cytoreductive surgery of the mass had been performed twice over a 2-year period, but the mass recurred following both surgeries. The mass was diagnosed as an osteosarcoma, and the cat was referred for further evaluation and treatment. CLINICAL FINDINGS Clinical findings were unremarkable, except for a 2-cm-diameter mass arising from the lingual aspect of the right mandible and mild anemia and lymphopenia. Pre- and postcontrast CT scans of the head, neck, and thorax were performed, revealing that the osteosarcoma was confined to the caudal right mandibular body, with no evidence of lymph node or pulmonary metastasis. TREATMENT AND OUTCOME The stereolithographic files of the CT scan of the head were sent for computer-aided design and manufacture of a customized 3-D-printed titanium prosthesis. Segmental mandibulectomy was performed, and the mandibular defect was reconstructed in a single stage with the 3-D-printed titanium prosthesis. The cat had 1 minor postoperative complication but had no signs of eating difficulties at any point after surgery. The cat was alive and disease free 14 months postoperatively. CLINICAL RELEVANCE Reconstruction of the mandible of a cat following mandibulectomy was possible with computer-aided design and manufacture of a customized 3-D-printed titanium prosthesis. Cats have a high rate of complications following mandibulectomy, and these initial findings suggested that mandibular reconstruction may reduce the risk of these complications and result in a better functional outcome.

Controlling a multi-degree of freedom upper limb prosthesis using foot controls: user experience.

PubMed

Resnik, Linda; Klinger, Shana Lieberman; Etter, Katherine; Fantini, Christopher

2014-07-01

The DEKA Arm, a pre-commercial upper limb prosthesis, funded by the DARPA Revolutionizing Prosthetics Program, offers increased degrees of freedom while requiring a large number of user control inputs to operate. To address this challenge, DEKA developed prototype foot controls. Although the concept of utilizing foot controls to operate an upper limb prosthesis has been discussed for decades, only small-sized studies have been performed and no commercial product exists. The purpose of this paper is to report amputee user perspectives on using three different iterations of foot controls to operate the DEKA Arm. Qualitative data was collected from 36 subjects as part of the Department of Veterans Affairs (VA) Study to Optimize the DEKA Arm through surveys, interviews, audio memos, and videotaped sessions. Three major, interrelated themes were identified using the constant comparative method: attitudes towards foot controls, psychomotor learning and physical experience of using foot controls. Feedback about foot controls was generally positive for all iterations. The final version of foot controls was viewed most favorably. Our findings indicate that foot controls are a viable control option that can enable control of a multifunction upper limb prosthesis (the DEKA Arm). Multifunction upper limb prostheses require many user control inputs to operate. Foot controls offer additional control input options for such advanced devices, yet have had minimal study. This study found that foot controls were a viable option for controlling multifunction upper limb prostheses. Most of the 36 subjects in this study were willing to adopt foot controls to control the multiple degrees of freedom of the DEKA Arm. With training and practice, all users were able to develop the psychomotor skills needed to successfully operate food controls. Some had initial difficulty, but acclimated over time.

Simulated bone remodeling around two types of osseointegrated implants for direct fixation of upper-leg prostheses.

PubMed

Tomaszewski, P K; Verdonschot, N; Bulstra, S K; Rietman, J S; Verkerke, G J

2012-11-01

Direct attachment of an upper leg prosthesis to the skeletal system by a percutaneous implant is an alternative solution to the traditional socket fixation. In this study, we investigated long-term periprosthetic bone changes around two types of fixation implants using two different initial conditions, namely immediate post-amputation implantation and the conventional implantation after considerable time of socket prosthesis use. We questioned the difference in bone modeling response the implants provoked and if it could lead to premature bone fracture. Generic CT-based finite element models of an intact femoral bone and amputated bone implanted with models of two existing direct-fixation implants, the OPRA system (Integrum AB) and the ISP Endo/Exo prosthesis (ESKA Implants AG) were created for this study. Adaptive bone-remodeling simulations used the heel-strike and toe-off loads from a normal walking cycle. The bone loss caused by prolonged use of socket prosthesis had more severe effects on the ultimate bone quality than adaptation induced by the direct-fixation implants. Both implants showed considerable bone remodeling; the titanium screw implant (OPRA system) provoked more bone loss than the porous coated CoCrMo stem (ISP implant). The chance of the peri-prosthetic bone fracture remained higher for the post-socket case as compared to the direct amputation cases. In conclusion, both direct-fixation implants lead to considerable bone loss and bone loss is more severe after a prolonged period of post-socket use. Hence, from a biomechanical perspective it is better to limit the post-socket time and to re-design direct fixation devices to reduce bone loss and the probability of peri-prosthetic bone fractures. Copyright © 2012 Elsevier Ltd. All rights reserved.

Microsystems Technology for Retinal Implants

NASA Astrophysics Data System (ADS)

Weiland, James

2005-03-01

The retinal prosthesis is targeted to treat age-related macular degeneration, retinitis pigmentosa, and other outer retinal degenerations. Simulations of artificial vision have predicted that 600-1000 individual pixels will be needed if a retinal prosthesis is to restore function such as reading large print and face recognition. An implantable device with this many electrode contacts will require microsystems technology as part of its design. An implantable retinal prosthesis will consist of several subsystems including an electrode array and hermetic packaging. Microsystems and microtechnology approaches are being investigated as possible solutions for these design problems. Flexible polydimethylsiloxane (PDMS) substrate electrode arrays and silicon micromachined electrode arrays are under development. Inactive PDMS electrodes have been implanted in 3 dogs to assess mechanical biocompatibility. 3 dogs were followed for 6 months. The implanted was securely fastened to the retina with a single retinal tack. No post-operative complications were evident. The array remained within 100 microns of the retinal surface. Histological evaluation showed a well preserved retina underneath the electrode array. A silicon device with electrodes suspended on micromachined springs has been implanted in 4 dogs (2 acute implants, 2 chronic implants). The device, though large, could be inserted into the eye and positioned on the retina. Histological analysis of the retina from the spring electrode implants showed that spring mounted posts penetrated the retina, thus the device will be redesigned to reduce the strength of the springs. These initial implants will provide information for the designers to make the next generation silicon device. We conclude that microsystems technology has the potential to make possible a retinal prosthesis with 1000 individual contacts in close proximity to the retina.

Does flip-flop style footwear modify ankle biomechanics and foot loading patterns?

PubMed

Price, Carina; Andrejevas, Vaidas; Findlow, Andrew H; Graham-Smith, Philip; Jones, Richard

2014-01-01

Flip-flops are an item of footwear, which are rubber and loosely secured across the dorsal fore-foot. These are popular in warm climates; however are widely criticised for being detrimental to foot health and potentially modifying walking gait. Contemporary alternatives exist including FitFlop, which has a wider strap positioned closer to the ankle and a thicker, ergonomic, multi-density midsole. Therefore the current study investigated gait modifications when wearing flip-flop style footwear compared to barefoot walking. Additionally walking in a flip-flop was compared to that FitFlop alternative. Testing was undertaken on 40 participants (20 male and 20 female, mean ± 1 SD age 35.2 ± 10.2 years, B.M.I 24.8 ± 4.7 kg.m(-2)). Kinematic, kinetic and electromyographic gait parameters were collected while participants walked through a 3D capture volume over a force plate with the lower limbs defined using retro-reflective markers. Ankle angle in swing, frontal plane motion in stance and force loading rates at initial contact were compared. Statistical analysis utilised ANOVA to compare differences between experimental conditions. The flip-flop footwear conditions altered gait parameters when compared to barefoot. Maximum ankle dorsiflexion in swing was greater in the flip-flop (7.6 ± 2.6°, p = 0.004) and FitFlop (8.5 ± 3.4°, p < 0.001) than barefoot (6.7 ± 2.6°). Significantly higher tibialis anterior activation was measured in terminal swing in FitFlop (32.6%, p < 0.001) and flip-flop (31.2%, p < 0.001) compared to barefoot. A faster heel velocity toward the floor was evident in the FitFlop (-.326 ± .068 m.s(-1), p < 0.001) and flip-flop (-.342 ± .074 m.s(-1), p < 0.001) compared to barefoot (-.170 ± .065 m.s(-1)). The FitFlop reduced frontal plane ankle peak eversion during stance (-3.5 ± 2.2°) compared to walking in the flip-flop (-4.4 ± 1.9°, p = 0.008) and barefoot (-4.3 ± 2.1°, p = 0.032). The FitFlop more effectively attenuated impact compared to the flip-flop, reducing the maximal instantaneous loading rate by 19% (p < 0.001). Modifications to the sagittal plane ankle angle, frontal plane motion and characteristics of initial contact observed in barefoot walking occur in flip-flop footwear. The FitFlop may reduce risks traditionally associated with flip-flop footwear by reducing loading rate at heel strike and frontal plane motion at the ankle during stance.

Design and preliminary biomechanical analysis of artificial cervical joint complex.

PubMed

Jian, Yu; Lan-Tao, Liu; Zhao, Jian-ning; Jian-ning, Zhao

2013-06-01

To design an artificial cervical joint complex (ACJC) prosthesis for non-fusion reconstruction after cervical subtotal corpectomy, and to evaluate the biomechanical stability, preservation of segment movements and influence on adjacent inter-vertebral movements of this prosthesis. The prosthesis was composed of three parts: the upper/lower joint head and the middle artificial vertebrae made of Cobalt-Chromium-Molybdenum (Co-Cr-Mo) alloy and polyethylene with a ball-and-socket joint design resembling the multi-axial movement in normal inter-vertebral spaces. Biomechanical tests of intact spine (control), Orion locking plate system and ACJC prosthesis were performed on formalin-fixed cervical spine specimens from 21 healthy cadavers to compare stability, range of motion (ROM) of the surgical segment and ROM of adjacent inter-vertebral spaces. As for stability of the whole lower cervical spine, there was no significant difference of flexion, extension, lateral bending and torsion between intact spine group and ACJC prosthesis group. As for segment movements, difference in flexion, lateral bending or torsion between ACJC prosthesis group and control group was not statistically significant, while ACJC prosthesis group showed an increase in extension (P < 0.05) compared to that of the control group. In addition, ACJC prosthesis group demonstrated better flexion, extension and lateral bending compared to those of Orion plating system group (P < 0.05). Difference in adjacent inter-vertebral ROM of the ACJC prosthesis group was not statistically significant compared to that of the control group. After cervical subtotal corpectomy, reconstruction with ACJC prosthesis not only obtained instant stability, but also reserved segment motions effectively, without abnormal gain of mobility at adjacent inter-vertebral spaces.

Use of prostheses in lower limb amputee patients due to peripheral arterial disease

PubMed Central

Chamlian, Therezinha Rosane

2014-01-01

Objective To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. Methods A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. Results Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. Conclusion The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients. PMID:25628194

Prosthesis use in adult acquired major upper-limb amputees: patterns of wear, prosthetic skills and the actual use of prostheses in activities of daily life.

PubMed

Østlie, Kristin; Lesjø, Ingrid Marie; Franklin, Rosemary Joy; Garfelt, Beate; Skjeldal, Ola Hunsbeth; Magnus, Per

2012-11-01

To describe patterns of prosthesis wear and perceived prosthetic usefulness in adult acquired upper-limb amputees (ULAs). To describe prosthetic skills in activities of daily life (ADL) and the actual use of prostheses in the performance of ADL tasks. To estimate the influence of prosthetic skills on actual prosthesis use and the influence of background factors on prosthetic skills and actual prosthesis use. Cross-sectional study analysing population-based questionnaire data (n = 224) and data from interviews and clinical testing in a referred/convenience sample of prosthesis-wearing ULAs (n = 50). Effects were analysed using linear regression. 80.8% wore prostheses. 90.3% reported their most worn prosthesis as useful. Prosthetic usefulness profiles varied with prosthetic type. Despite demonstrating good prosthetic skills, the amputees reported actual prosthesis use in only about half of the ADL tasks performed in everyday life. In unilateral amputees, increased actual use was associated with sufficient prosthetic training and with the use of myoelectric vs cosmetic prostheses, regardless of amputation level. Prosthetic skills did not affect actual prosthesis use. No background factors showed significant effect on prosthetic skills. Most major ULAs wear prostheses. Individualised prosthetic training and fitting of myoelectric rather than passive prostheses may increase actual prosthesis use in ADL.

Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis.

PubMed

Kim, Young-Hoo; Yoon, Sung-Hwan; Kim, Jun-Shik

2009-02-01

Although the design features of the Medial Pivot fixed-bearing prosthesis reportedly improve kinematics compared with TKAs using fixed-bearings, clinical improvements have not been reported. We asked whether the clinical and radiographic outcomes, ranges of motion of the knee, patient satisfaction, and complication rates would be better in knees with a Medial Pivot fixed-bearing prosthesis than in those with a PFC Sigma mobile-bearing prosthesis. We compared the results of 92 patients who had a Medial Pivot fixed-bearing prosthesis implanted in one knee and a PFC Sigma mobile-bearing prosthesis implanted in the other. There were 85 women and seven men with a mean age of 69.5 years (range, 55-81 years). The minimum followup was 2 years (mean, 2.6 years; range, 2-3 years). The patients were assessed clinically and radiographically using the rating systems of the Hospital for Special Surgery and the Knee Society at 3 months, 1 year, and annually thereafter. Contrary to expectations, we found worse early clinical outcomes, smaller ranges of knee motion, less patient satisfaction, and a higher complication rate for the Medial Pivot fixed-bearing prosthesis than for the PFC Sigma mobile-bearing prosthesis. Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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.

Frequency of technical complications in fixed implant prosthesis: the effect of prosthesis screw emergence correction by CAD-CAM.

PubMed

Anitua, Eduardo; Flores, Carlos; Piñas, Laura; Alkhraisat, Mohammad

2018-06-05

CAD-CAM technology permits the angular correction of screw emergence into the prosthesis, however there is lack of controlled clinical studies that assess the frequency of technical complications in angled screw channel restorations. This controlled clinical study was designed to assess technical incidences in angled screw channel restorations. Patients having implant prosthesis placed between November, 2014 and December, 2015 were screened. The patients were selected if they received prosthesis with up to 30º correction of the prosthesis screw emergence and had at least one non-angulated prosthesis (screw-retained). All the prostheses were located completely/partially in the posterior region. The frequency of technical complications was the principal variable. A total of 52 patients with a mean age of 62 ± 10 years participated with a total 110 prostheses (55 in the test group and 55 in the control group). A total of 11 technical complications occurred (7 in the test group and 4 in the control group). These differences were not statistically significant. All the prostheses in both groups survived the follow-up. The correction of the screw emergence into the prosthesis has not increased the risk of technical complications in CAD-CAM implant prostheses.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Janik, Gregory

Renders, saves, and analyzes pressure from several sensors in a prosthesis™ socket. The program receives pressure data from 64 manometers and parses the pressure for each individual sensor. The program can then display those pressures as number in a table. The program also interpolates pressures between manometers to create a larger set of data. This larger set of data is displayed as a simple contour plot. That same contour plot can also be placed on a three-dimensional surface in the shape of a prosthesis.This program allows for easy identification of high pressure areas in a prosthesis to reduce the user™smore » discomfort. The program parses the sensor pressures into a human-readable numeric format. The data may also be used to actively adjust bladders within the prosthesis to spread out pressure in real time, according to changing demands placed on the prosthesis. Interpolation of the pressures to create a larger data set makes it even easier for a human to identify particular areas of the prosthesis that are under high pressure. After identifying pressure points, a prosthetician can then redesign the prosthesis and/or command the bladders in the prosthesis to attempt to maintain constant pressures.« less

Allograft-prosthesis composites after bone tumor resection at the proximal tibia.

PubMed

Biau, David Jean; Dumaine, Valérie; Babinet, Antoine; Tomeno, Bernard; Anract, Philippe

2007-03-01

The survival of irradiated allograft-prosthesis composites at the proximal tibia is mostly unknown. However, allograft-prosthesis composites have proved beneficial at other reconstruction sites. We presumed allograft-prosthesis composites at the proximal tibia would improve survival and facilitate reattachment of the extensor mechanism compared with that of conventional (megaprostheses) reconstructions. We retrospectively reviewed 26 patients who underwent resection of proximal tibia tumors followed by reconstruction with allo-graft-prosthesis composites. Patients received Guepar massive custom-made fully constrained prostheses. Allografts were sterilized with gamma radiation, and the stems were cemented into the allograft and host bone. The minimum followup was 6 months (median, 128 months; range, 6-195 months). Fourteen patients had one or more components removed. The median allograft-prosthesis composite survival was 102 months (95% confidence interval, 64.2-infinity). Of the 26 allografts, seven fractured, six showed signs of partial resorption, and six had infections develop. Seven allografts showed signs of fusion with the host bone. Six extensor mechanism reconstructions failed. Allograft-prosthesis composites sterilized by gamma radiation yielded poor results for proximal tibial reconstruction as complications and failures were common. We do not recommend irradiated allograft-prosthesis composites for proximal tibia reconstruction.

Syndesmotic ankle sprain.

PubMed

Childs, Sharon G

2012-01-01

Ankle sprain injuries are the most common type of joint sprain. The prevalence of ankle joint sprains accounts for 21% of joint injuries in the body. Although somewhat rare, high-ankle or syndesmotic ankle sprains occur in up to 15% of ankle trauma. This article will present the pathomechanics of the high-ankle or syndesmotic sprain.

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…

Contribution of ankle-foot orthosis moment in regulating ankle and knee motions during gait in individuals post-stroke.

PubMed

Kobayashi, Toshiki; Orendurff, Michael S; Singer, Madeline L; Gao, Fan; Foreman, K Bo

2017-06-01

Ankle-foot orthosis moment resisting plantarflexion has systematic effects on ankle and knee joint motion in individuals post-stroke. However, it is not known how much ankle-foot orthosis moment is generated to regulate their motion. The aim of this study was to quantify the contribution of an articulated ankle-foot orthosis moment to regulate ankle and knee joint motion during gait in individuals post-stroke. Gait data were collected from 10 individuals post-stroke using a Bertec split-belt instrumented treadmill and a Vicon 3-dimensional motion analysis system. Each participant wore an articulated ankle-foot orthosis whose moment resisting plantarflexion was adjustable at four levels. Ankle-foot orthosis moment while walking was calculated under the four levels based on angle-moment relationship of the ankle-foot orthosis around the ankle joint measured by bench testing. The ankle-foot orthosis moment and the joint angular position (ankle and knee) relationship in a gait cycle was plotted to quantify the ankle-foot orthosis moment needed to regulate the joint motion. Ankle and knee joint motion were regulated according to the amount of ankle-foot orthosis moment during gait. The ankle-foot orthosis maintained the ankle angular position in dorsiflexion and knee angular position in flexion throughout a gait cycle when it generated moment from -0.029 (0.011) to -0.062 (0.019) Nm/kg (moment resisting plantarflexion was defined as negative). Quantifying the contribution of ankle-foot orthosis moment needed to regulate lower limb joints within a specific range of motion could provide valuable criteria to design an ankle-foot orthosis for individuals post-stroke. Copyright © 2017 Elsevier Ltd. All rights reserved.

Influence of Passive Joint Stiffness on Proprioceptive Acuity in Individuals With Functional Instability of the Ankle.

PubMed

Marinho, Hellen Veloso Rocha; Amaral, Giovanna Mendes; de Souza Moreira, Bruno; Araújo, Vanessa Lara; Souza, Thales Rezende; Ocarino, Juliana Melo; da Fonseca, Sérgio Teixeira

2017-12-01

Study Design Controlled laboratory study, cross-sectional. Background Deficits in ankle proprioceptive acuity have been reported in persons with functional instability of the ankle. Passive stiffness has been proposed as a possible mechanism underlying proprioceptive acuity. Objective To compare proprioceptive acuity and passive ankle stiffness in persons with and without functional ankle instability, and to assess the influence of passive joint stiffness on proprioceptive acuity in persons with functional ankle instability. Methods A sample of 18 subjects with and 18 without complaints of functional ankle instability following lateral ankle sprain participated. An isokinetic dynamometer was used to compare motion perception threshold, passive position sense, and passive ankle stiffness between groups. To evaluate the influence of passive stiffness on proprioceptive acuity, individuals in the lateral functional ankle instability group were divided into 2 subgroups: "high" and "low" passive ankle stiffness. Results The functional ankle instability group exhibited increased motion perception threshold when compared with the corresponding limb of the control group. Between-group differences were not found for passive position sense and passive ankle stiffness. Those in the functional ankle instability group with higher passive ankle stiffness had smaller motion perception thresholds than those with lower passive ankle stiffness. Conclusion Unlike motion perception threshold, passive position sense is not affected by the presence of functional ankle instability. Passive ankle stiffness appears to influence proprioceptive acuity in persons with functional ankle instability. J Orthop Sports Phys Ther 2017;47(12):899-905. Epub 7 Oct 2017. doi:10.2519/jospt.2017.7030.

Ankle sprain (image)

MedlinePlus

An ankle sprain is a common injury to the ankle. The most common way the ankle is injured is when ... swelling, inflammation, and bruising around the ankle. An ankle sprain injury may take a few weeks to many ...

Influence of ankle joint plantarflexion and dorsiflexion on lateral ankle sprain: A computational study.

PubMed

Purevsuren, Tserenchimed; Kim, Kyungsoo; Batbaatar, Myagmarbayar; Lee, SuKyoung; Kim, Yoon Hyuk

2018-05-01

Understanding the mechanism of injury involved in lateral ankle sprain is essential to prevent injury, to establish surgical repair and reconstruction, and to plan reliable rehabilitation protocols. Most studies for lateral ankle sprain posit that ankle inversion, internal rotation, and plantarflexion are involved in the mechanism of injury. However, recent studies indicated that ankle dorsiflexion also plays an important role in the lateral ankle sprain mechanism. In this study, the contributions of ankle plantarflexion and dorsiflexion on the ankle joint were evaluated under complex combinations of internal and inversion moments. A multibody ankle joint model including 24 ligaments was developed and validated against two experimental cadaveric studies. The effects of ankle plantarflexion (up to 60°) and dorsiflexion (up to 30°) on the lateral ankle sprain mechanism under ankle inversion moment coupled with internal rotational moment were investigated using the validated model. Lateral ankle sprain injuries can occur during ankle dorsiflexion, in which the calcaneofibular ligament and anterior talofibular ligament tears may occur associated with excessive inversion and internal rotational moment, respectively. Various combinations of inversion and internal moment may lead to anterior talofibular ligament injuries at early ankle plantarflexion, while the inversion moment acts as a primary factor to tear the anterior talofibular ligament in early plantarflexion. It is better to consider inversion and internal rotation as primary factors of the lateral ankle sprain mechanism, while plantarflexion or dorsiflexion can be secondary factor. This information will help to clarify the lateral ankle sprain mechanism of injury.

Static analysis of C-shape SMA middle ear prosthesis

NASA Astrophysics Data System (ADS)

Latalski, Jarosław; Rusinek, Rafał

2017-08-01

Shape memory alloys are a family of metals with the ability to change specimen shape depending on their temperature. This unique property is useful in many areas of mechanical and biomechanical engineering. A new half-ring middle ear prosthesis design made of a shape memory alloy, that is undergoing initial clinical tests, is investigated in this research paper. The analytical model of the studied structure made of nonlinear constitutive material is solved to identify the temperature-dependent stiffness characteristics of the proposed design on the basis of the Crotti-Engesser theorem. The final integral expression for the element deflection is highly complex, thus the solution has to be computed numerically. The final results show the proposed shape memory C-shape element to behave linearly in the analysed range of loadings and temperatures. This is an important observation that significantly simplifies the analysis of the prototype structure and opens wide perspectives for further possible applications of shape memory alloys.

[Posturographic study of total prostheses in the leg. Apropos of 88 patients examined].

PubMed

Lord, G; Gentaz, R; Gagey, P M; Baron, J B

1976-01-01

By suppressing certain articular sensory receptors, the reconstructive surgery of joints using total prostheses modifies tonic postural activity and, by this means, alters the regulation of balance in the subjects of operation. This doubtless explains certain discrepancies between the apparently excellent results in respect of joint movement and muscle strength and poor utilisation of the joint in every day life (instability, use of sticks or failure to use the joint in walking). Drawing on the experience and basic work of specialists in posture, the authors have undertaken a study of tonic postural activity in patients who had received a total prosthesis in the lower limb, both from the clinical aspect and by graphic measurement using an electronic apparatus, the statokinesiometer. Fourteen normal subjects were tested to calibrate the apparatus and 8 patients suffering from established osteoarthritis of the hip were studied as controls. Analysis of tonic postural activity was made in 66 patients who had received total prostheses in the lower limb. The results showed significant disturbance in balance in ankle prostheses, minimal disturbance in knee prostheses and not significant disturbance in hip prostheses. Certain therapeutic implications are derived from this study.

IMU-Based Joint Angle Measurement for Gait Analysis

PubMed Central

Seel, Thomas; Raisch, Jorg; Schauer, Thomas

2014-01-01

This contribution is concerned with joint angle calculation based on inertial measurement data in the context of human motion analysis. Unlike most robotic devices, the human body lacks even surfaces and right angles. Therefore, we focus on methods that avoid assuming certain orientations in which the sensors are mounted with respect to the body segments. After a review of available methods that may cope with this challenge, we present a set of new methods for: (1) joint axis and position identification; and (2) flexion/extension joint angle measurement. In particular, we propose methods that use only gyroscopes and accelerometers and, therefore, do not rely on a homogeneous magnetic field. We provide results from gait trials of a transfemoral amputee in which we compare the inertial measurement unit (IMU)-based methods to an optical 3D motion capture system. Unlike most authors, we place the optical markers on anatomical landmarks instead of attaching them to the IMUs. Root mean square errors of the knee flexion/extension angles are found to be less than 1° on the prosthesis and about 3° on the human leg. For the plantar/dorsiflexion of the ankle, both deviations are about 1°. PMID:24743160

Anatomy of the ankle ligaments: a pictorial essay

PubMed Central

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

2010-01-01

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. PMID:20309522

Physical examination variables predict response to conservative treatment of non-chronic plantar fasciitis: Secondary analysis of a randomized placebo controlled footwear study

PubMed Central

Matzkin-Bridger, Jonathon; Fascione, Jeanna; Crews, Ryan; Bruning, Nicholas; Jarrett, Beth

2016-01-01

Background Plantar fasciitis is a common disabling condition and the prognosis of conservative treatment is difficult to predict. Objective To determine whether initial clinical findings could help predict patient response to conservative treatment primarily consisting of supportive footwear and stretching. Setting Patients were recruited and seen at two outpatient podiatric clinics in the Chicago, Illinois metropolitan area. Patients Seventy-seven patients with non-chronic plantar fasciitis were recruited. Patients were excluded if they had a heel injection in the previous six months or were currently utilizing custom foot orthoses at the time of screening. Sixty-nine patients completed the final follow-up visit three months after receiving the footwear intervention. Methods Treatment failure was considered a <50% reduction in heel pain at three month follow23 Logistic regression models evaluated the possible association between over thirty clinical and physical exam findings prospectively assessed at enrollment, and treatment response. Results Inability to dorsiflex the ankle past −5° (OR 27 3.9, p=.024), non-severe (≤ 7 on ordinal scale) first-step pain (OR 3.8, p=.021), and heel valgus in relaxed stance (OR 4.0, p=.014) each predicted treatment failure in multivariable analysis (Receiver operating characteristic area under the curve=.769). Limited ankle dorsiflexion also correlated with higher heel pain severity at initial presentation (r = −.312, p =.006). Conclusions Patients with severe ankle equinus were nearly four times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy. Thus earlier use of more advanced therapies may be most appropriate in those presenting without severe ankle equinus or without severe first step pain. The findings from our study may not be clinically intuitive as patients with less severe equinus and less severe pain at presentation did worse with conservative care. PMID:26409199

Physical Examination Variables Predict Response to Conservative Treatment of Nonchronic Plantar Fasciitis: Secondary Analysis of a Randomized, Placebo-Controlled Footwear Study.

PubMed

Wrobel, James S; Fleischer, Adam E; Matzkin-Bridger, Jonathon; Fascione, Jeanna; Crews, Ryan T; Bruning, Nicholas; Jarrett, Beth

2016-05-01

Plantar fasciitis is a common, disabling condition, and the prognosis of conservative treatment is difficult to predict. To determine whether initial clinical findings could help predict patient response to conservative treatment that primarily consisted of supportive footwear and stretching. Patients were recruited and seen at 2 outpatient podiatric clinics in the Chicago, Illinois, metropolitan area. Seventy-seven patients with nonchronic plantar fasciitis were recruited. Patients were excluded if they had a heel injection in the previous 6 months or were currently using custom foot orthoses at the time of screening. Sixty-nine patients completed the final follow-up visit 3 months after receiving the footwear intervention. Treatment failure was considered a <50% reduction in heel pain at 3 month follow-up. Logistic regression models evaluated the possible association between more than 30 clinical and physical examination findings prospectively assessed at enrollment, and treatment response. Inability to dorsiflex the ankle past -5° (odds ratio [OR] 3.9, P = .024), nonsevere (≤7 on ordinal scale) first-step pain (OR 3.8, P = .021), and heel valgus in relaxed stance (OR 4.0, P = .014) each predicted treatment failure in multivariable analysis (receiver operating characteristic area under the curve = .769). Limited ankle dorsiflexion also correlated with greater heel pain severity at initial presentation (r = - 0.312, P = .006). Patients with severe ankle equinus were nearly 4 times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy. Thus, earlier use of more advanced therapies may be most appropriate in those presenting without severe ankle equinus or without severe first step pain. The findings from our study may not be clinically intuitive because patients with less severe equinus and less severe pain at presentation did worse with conservative care. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Coordination and Symmetry Patterns During the Drop Vertical Jump in People With Chronic Ankle Instability and Lateral Ankle Sprain Copers.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Patterson, Matthew R; Delahunt, Eamonn

2016-08-01

The drop vertical jump (DVJ) task has previously been used to identify movement patterns associated with a number of injury types. However, no current research exists evaluating people with chronic ankle instability (CAI) compared with people coping with lateral ankle sprain (LAS) (referred to as "LAS copers") during this task. The aim of this study was to identify the coping movement and motor control patterns of LAS copers in comparison with individuals with CAI during the DVJ task. This was a case-control study. Seventy individuals were recruited at convenience within 2-weeks of sustaining a first-time acute LAS injury. One year following recruitment, these individuals were stratified into 2 groups: 28 with CAI and 42 LAS copers. They attended the testing laboratory to complete a DVJ task. Three-dimensional kinematic and sagittal-plane kinetic profiles were plotted for the lower extremity joints of both limbs for the drop jump phase (phase 1) and drop landing phase (phase 2) of the DVJ. The rate of impact modulation relative to body weight during both phases of the DVJ also was determined. Compared with LAS copers, participants with CAI displayed significant increases in hip flexion on their "involved" limb during phase 1 of the DVJ (23° vs 18°) and bilaterally during phase 2 (15° vs 10°). These movement patterns coincided with altered moment-of-force patterns at the hip on the "uninvolved" limb. It is unknown whether these movement and motor control patterns preceded or occurred as a result of the initial LAS injury. Participants with CAI displayed hip-centered changes in movement and motor control patterns during a DVJ task compared with LAS copers. The findings of this study may give an indication of the coping mechanism underlying outcome following initial LAS injury. © 2016 American Physical Therapy Association.

Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle.

PubMed

Seidel, Angela; Krause, Fabian; Weber, Martin

2017-07-01

Isolated lateral malleolar fractures may result from a supination-external rotation (SER) injury of the ankle. Stable fractures maintain tibiotalar congruence due to competent medial restraints and can be treated nonoperatively with excellent functional results and long-term prognosis. Stability might be assessed with either stress radiographs or weightbearing radiographs. A consecutive series of patients with closed SER fractures (presumed AO 44-B1) were prospectively enrolled from 2008 to 2015. Patients with clearly unstable fractures (medial clear space more than 7 mm) on the initial nonweightbearing radiograph were excluded and operated on. All other patients were examined with a gravity stress and a weightbearing anteroposterior radiograph. Borderline instability of the fracture was assumed when the medial clear space was 4 to 7 mm. Those were treated nonoperatively. Of 104 patients with isolated lateral malleolar fractures of the SER type, 14 patients were treated operatively because of clear instability (displacement) on the initial radiographs. Of the nonoperative patients, 44 patients demonstrated borderline instability on the gravity stress but stability on the weightbearing radiograph ("gravity borderline"); the remaining 46 were stable in both tests ("gravity stable"). At an average follow-up of 23 months, no significant differences were seen in the American Orthopaedic Foot & Ankle Society hindfoot score (92 points gravity-borderline group vs 93 points gravity-unstable group), the Foot Functional Index score (11 vs 10 points), the Short Form 36 (SF-36) physical component (86 vs 85 points), and SF-36 mental component (84 vs 81 points). Radiographically, all fractures had healed with anatomic congruity of the ankle. Weightbearing radiographs provided a reliable basis to decide about stability and nonoperative treatment in isolated lateral malleolar fractures of the SER type with excellent clinical and radiographic outcome at short-term follow-up. Gravity stress radiographs appear to overrate the need for operative treatment. Level III, prospective comparative study.

A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types.

PubMed

Kemler, Ellen; van de Port, Ingrid; Backx, Frank; van Dijk, C Niek

2011-03-01

Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip™, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of ankle brace, to examine the strengths and weaknesses of ankle braces for the treatment of acute ankle sprains. © 2011 Adis Data Information BV. All rights reserved.

Inverse dynamic investigation of voluntary trunk movements in weightlessness: a new microgravity-specific strategy.

PubMed

Pedrocchi, Alessandra; Pedotti, Antonio; Baroni, Guido; Massion, Jean; Ferrigno, Giancarlo

2003-11-01

Present investigation faces the question of quantitative assessment of exchanged forces and torques at the restraints during whole body posture exercises in long-term microgravity. Inverse dynamic modelling and total angular momentum at the ankle joint were used in order to reconstruct movement dynamics at the restraining point, represented by the ankle joint. The hypothesis is that the minimisation of the torques at the interface point assumes a key role in movement planning in 0 g. This hypothesis would respond to an optimisation of muscles activity, a minimisation of energy expenditure and therefore an accurate control of body movement. Results show that the 0 g movement strategy adopted ensures that the integral of the net ankle moment between the beginning and the end of the movement is zero. This expected mechanical constraint is not satisfied when 0 g movement dynamics is simulated using terrestrial kinematics. This accounts for a significant imposed change of movement strategy. Particularly, the efficient compensation of the inertial effects of the segments in terms of total angular momentum at the ankle joint was evidenced. These results explain the exaggerated axial synergies, observed on kinematics and which moved centre of mass (CM) backward from its already backward initial positioning, as a tool for enhancing the compensation and achieving the desired minimisation of the torques exchanges at the restraints.

Sodium magnetic resonance imaging of ankle joint in cadaver specimens, volunteers, and patients after different cartilage repair techniques at 7 T: initial results.

PubMed

Zbýň, Štefan; Brix, Martin O; Juras, Vladimir; Domayer, Stephan E; Walzer, Sonja M; Mlynarik, Vladimir; Apprich, Sebastian; Buckenmaier, Kai; Windhager, Reinhard; Trattnig, Siegfried

2015-04-01

The goal of cartilage repair techniques such as microfracture (MFX) or matrix-associated autologous chondrocyte transplantation (MACT) is to produce repair tissue (RT) with sufficient glycosaminoglycan (GAG) content. Sodium magnetic resonance imaging (MRI) offers a direct and noninvasive evaluation of the GAG content in native cartilage and RT. In the femoral cartilage, this method was able to distinguish between RTs produced by MFX and MACT having different GAG contents. However, it needs to be clarified whether sodium MRI can be useful for evaluating RT in thin ankle cartilage. Thus, the aims of this 7-T study were (1) to validate our sodium MRI protocol in cadaver ankle samples, (2) to evaluate the sodium corrected signal intensities (cSI) in cartilage of volunteers, (3) and to compare sodium values in RT between patients after MFX and MACT treatment. Five human cadaver ankle samples as well as ankles of 9 asymptomatic volunteers, 6 MFX patients and 6 MACT patients were measured in this 7-T study. Sodium values from the ankle samples were compared with histochemically evaluated GAG content. In the volunteers, sodium cSI values were calculated in the cartilages of ankle and subtalar joint. In the patients, sodium cSI in RT and reference cartilage were measured, morphological appearance of RT was evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system, and clinical outcome before and after surgery was assessed using the American Orthopaedic Foot and Ankle Society score and Modified Cincinnati Knee Scale. All regions of interest were defined on morphological images and subsequently transferred to the corresponding sodium images. Analysis of variance, t tests, and Pearson correlation coefficients were evaluated. In the patients, significantly lower sodium cSI values were found in RT than in reference cartilage for the MFX (P = 0.007) and MACT patients (P = 0.008). Sodium cSI and MOCART scores in RT did not differ between the MFX and MACT patients (P = 0.185). No significant difference in sodium cSI was found between reference cartilage of the volunteers and the patients (P = 0.355). The patients showed significantly higher American Orthopaedic Foot and Ankle Society and Modified Cincinnati scores after treatment than they did before treatment. In the volunteers, sodium cSI was significantly higher in the tibial cartilage than in the talar cartilage of ankle joint (P = 0.002) and in the talar cartilage than in the calcaneal cartilage of subtalar joint (P < 0.001). Data from the cadaver ankle samples showed a strong linear relationship between the sodium values and the histochemically determined GAG content (r = 0.800; P < 0.001; R = 0.639). This study demonstrates the feasibility of in vivo quantification of sodium cSI, which can be used for GAG content evaluation in thin cartilages of ankle and subtalar joints at 7 T. A strong correlation observed between the histochemically evaluated GAG content and the sodium values proved the sufficient sensitivity of sodium MRI to changes in the GAG content of cartilages in the ankle. Both MFX and MACT produced RT with lower sodium cSI and, thus, of lower quality compared with reference cartilage in the patients or in the volunteers. Our results suggest that MFX and MACT produce RT with similar GAG content and similar morphological appearance in patients with similar surgery outcome. Sodium MRI at 7 T allows a quantitative evaluation of RT quality in the ankle and may thus be useful in the noninvasive assessment of new cartilage repair procedures.

Interventions for treating chronic ankle instability.

PubMed

de Vries, Jasper S; Krips, Rover; Sierevelt, Inger N; Blankevoort, Leendert; van Dijk, C N

2011-08-10

Chronic lateral ankle instability occurs in 10% to 20% of people after an acute ankle sprain. Initial treatment is conservative but if this fails and ligament laxity is present, surgical intervention is considered. To compare different treatments, conservative or surgical, for chronic lateral ankle instability. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and reference lists of articles, all to February 2010. All identified randomised and quasi-randomised controlled trials of interventions for chronic lateral ankle instability were included. Two review authors independently assessed risk of bias and extracted data from each study. Where appropriate, results of comparable studies were pooled. Ten randomised controlled trials were included. Limitations in the design, conduct and reporting of these trials resulted in unclear or high risk of bias assessments relating to allocation concealment, assessor blinding, incomplete and selective outcome reporting. Only limited pooling of the data was possible.Neuromuscular training was the basis of conservative treatment evaluated in four trials. Neuromuscular training compared with no training resulted in better ankle function scores at the end of four weeks training (Ankle Joint Functional Assessment Tool (AJFAT): mean difference (MD) 3.00, 95% CI 0.3 to 5.70; 1 trial, 19 participants; Foot and Ankle Disability Index (FADI) data: MD 8.83, 95% CI 4.46 to 13.20; 2 trials, 56 participants). The fourth trial (19 participants) found no significant difference in the functional outcome after six weeks training programme on a cyclo-ergometer with a bi-directional compared with a traditional uni-directional pedal. Longer-term follow-up data were not available for these four trials.Four studies compared surgical procedures for chronic ankle instability. One trial (40 participants) found more nerve injuries after tenodesis than anatomical reconstruction (risk ratio (RR) 5.50, 95% CI 1.39 to 21.71). One trial (99 participants) comparing dynamic versus static tenodesis excluded 17 patients allocated dynamic tenodesis because their tendons were too thin. The same trial found that dynamic tenodesis resulted in higher numbers of people with unsatisfactory function (RR 8.62, 95% CI 1.97 to 37.77, 82 participants). One trial comparing techniques of lateral ankle ligament reconstruction (60 participants) found that operating time was shorter using the reinsertion technique than the imbrication method (MD -9.00 minutes, 95% CI -13.48 to -4.52). Two trials (70 participants) compared functional mobilisation with immobilisation after surgery. These found early mobilisation led to earlier return to work (MD -2.00 weeks, 95% CI -3.06 to -0.94; 1 trial) and to sports (MD -3.00 weeks, 95% CI -4.49 to -1.51; 1 trial). Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.

In vitro biomechanical comparison after fixed- and mobile-core artificial cervical disc replacement versus fusion

PubMed Central

Lou, Jigang; Li, Yuanchao; Wang, Beiyu; Meng, Yang; Wu, Tingkui; Liu, Hao

2017-01-01

Abstract In vitro biomechanical analysis after cervical disc replacement (CDR) with a novel artificial disc prosthesis (mobile core) was conducted and compared with the intact model, simulated fusion, and CDR with a fixed-core prosthesis. The purpose of this experimental study was to analyze the biomechanical changes after CDR with a novel prosthesis and the differences between fixed- and mobile-core prostheses. Six human cadaveric C2–C7 specimens were biomechanically tested sequentially in 4 different spinal models: intact specimens, simulated fusion, CDR with a fixed-core prosthesis (Discover, DePuy), and CDR with a mobile-core prosthesis (Pretic-I, Trauson). Moments up to 2 Nm with a 75 N follower load were applied in flexion–extension, left and right lateral bending, and left and right axial rotation. The total range of motion (ROM), segmental ROM, and adjacent intradiscal pressure (IDP) were calculated and analyzed in 4 different spinal models, as well as the differences between 2 disc prostheses. Compared with the intact specimens, the total ROM, segmental ROM, and IDP at the adjacent segments showed no significant difference after arthroplasty. Moreover, CDR with a mobile-core prosthesis presented a little higher values of target segment (C5/6) and total ROM than CDR with a fixed-core prosthesis (P > .05). Besides, the difference in IDP at C4/5 after CDR with 2 prostheses was without statistical significance in all the directions of motion. However, the IDP at C6/7 after CDR with a mobile-core prosthesis was lower than CDR with a fixed-core prosthesis in flexion, extension, and lateral bending, with significant difference (P < .05), but not under axial rotation. CDR with a novel prosthesis was effective to maintain the ROM at the target segment and did not affect the ROM and IDP at the adjacent segments. Moreover, CDR with a mobile-core prosthesis presented a little higher values of target segment and total ROM, but lower IDP at the inferior adjacent segment than CDR with a fixed-core prosthesis. PMID:29019902

Chronic ankle instability: Current perspectives

PubMed Central

Al-Mohrej, Omar A.; Al-Kenani, Nader S.

2016-01-01

Ankle sprain is reported to be among the most common recurrent injuries. About 20% of acute ankle sprain patients develop chronic ankle instability. The failure of functional rehabilitation after acute ankle sprain leads to the development of chronic ankle instability. Differentiation between functional and anatomical ankle instability is very essential to guide the proper treatment. Stability testing by varus stress test and anterior drawer test should be carried out. Subtalar instability is an important pathology that is commonly by passed during the assessment of chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability might require surgical intervention. The surgical and conservative management options can be very much developed by in-depth knowledge of the ankle anatomy, biomechanics, and pathology. Anatomical repair, augmentation by tendon, or both are the basic methods of surgical intervention. Arthroscopy is becoming more popular in the management of chronic ankle instability. PMID:27843798