Orthopedics

As we see more adults entering comprehensive orthodontic treatment, we must be more attuned to the implications of periodontal issues. In this updated chapter, Robert Vanarsdall, Ignacio Blasi and Antonino Secchi review periodontal issues that impact orthodontic tooth movement. They describe periodontal "high risk" factors, mucogingival considerations, and problems with ectopic as well as ankylosed teeth. A new section on alveolar decortication and augmentation grafting has been added to address the increased use of these procedures designed to develop the alveolar housing and potentially increase the speed of tooth movement. Excellent clinical examples are pictured throughout the chapter.

Purpose To describe a series of ring and little finger metacarpal fractures with regard to mechanism, location, midshaft diameter, and isthmus diameter, to better define injury patterns and assist the surgeon in selection of appropriately sized implants.

Purpose Despite the ubiquitous use of manual goniometry in measuring objective outcomes of hand surgery and therapy, there are limited data concerning its accuracy or repeatability for wrist motion. The purpose of this study was to evaluate the accuracy and reliability (both inter-and intra-rater) in measuring wrist flexion and extension using 3 manual goniometric alignment techniques (ulnar, radial, and dorsal-volar) in cadaveric upper extremities, using fluoroscopic verification of posture as a gold standard. In addition, we sought to assess the accuracy and reliability of the dorsal-volar technique for measurement of radioulnar deviation.

Golomb MR, McDonald BC, Warden SJ, Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B, AbdelBaky M, Nwosu ME, Barkat-Masih M, Burdea GC. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy. Arch Phys Med Rehabil 2010;91:1-8.

Background. Surgical treatment and conservative treatment is the options to improve pain, function, and range of motion following rotator cuff tear. In this study, we aimed to compare the effects of physiotherapy and corticosteroid injections on the function, pain, and range of motion in patients with full-thickness rotator cuff tearing separately and simultaneously. Methods. A total of 96 patients were randomly assigned to the study and divided into 3 groups of 32 patients. DASH questionnaire and VAS criterion were completed by all three groups, and the range of motions of all groups was measured by a goniometer. Then, the first group underwent 12 sessions of physiotherapy twice a week for 6 weeks; the second group received 80 mg of methylprednisolone and 1 ml of lidocaine 2% in two stages, 21 days apart; and the third group received 80 mg of methylprednisolone and 1 ml of lidocaine 2%, and after 2 days, 6 sessions of physiotherapy twice a week for 3 weeks were prescribed. In the e...

Introduction This project surveyed a group of orthopedic surgeons in order to identify the skills related to arthroscopic surgery which practicing surgeons consider important for surgical trainees to possess before performing in the operating room. Materials and methods The survey was composed of 35 questions outlining fundamental skills of arthroscopy and methods that a surgical trainee might use to develop such skills.

Background: The benefit of pre and post-operative administration of non-steroidal anti-inflammatory drugs for the relief of post-operative pain and control of inflammation in horses following orthopaedic surgery has not been previously investigated in controlled clinical field trials, and the utility of such treatment is a matter of ongoing dispute. Recently the utility of post-operative pain management was emphasized. It was therefore our aim to determine the efficacy of meloxicam in horses following partial resection of fractured splint bones. This condition was selected since the limited extent of the insult and the defined surgical intervention allowed the conduct of a randomized, double blinded, placebo-controlled, parallel group, multi-centre clinical field study in a homogenous patient population. Results: Sixty-six client owned horses requiring unilateral partial splint bone resection were recruited in 15 centres in Germany and were allocated in a 1:1 ratio to receive meloxicam, 0.6 mg/kg for 5 days. Lameness at trot grades prior to surgery were similar in the meloxicam and placebo treatment groups but were significantly lower in the meloxicam group on day 6 post surgery. Clinical scores for soft tissue swelling and assessment of analgesic and anti-inflammatory efficacy by the investigators at the end of the study were significantly better for the meloxicam compared to the placebo group. No treatment-related adverse reactions were observed.

Purpose/Hypothesis: To determine if people with low back pain (LBP) who regularly participated in a rotation-related activity displayed more rotation-related impairments than people without LBP who did and did not participate in the activity.

Subjects: A convenience sample of 55 participants with LBP who participated in a rotation-related sport, 26 back healthy controls who participated in a rotation-related sport (BHC+RRS) and 42 back healthy controls who did not participate in a rotation-related sport (BHC-RRS). Participants were matched based on age, gender, and activity level.

Methods and Materials: Participants completed self-report measures and participated in a standardized clinical examination. The number of impairments exhibited during the clinical examination was calculated for each participant. One-way ANOVA tests were used to test for differences among groups in the (1) number and type of rotation-related impairments, i.e., occur during extremity movement test vs. overt trunk movement test, and (2) number of asymmetric rotation-related impairments. Tukey’s HSD statistic was calculated in the instance that an ANOVA test was significant. Chi-square tests were used to test for differences between groups in the prevalence of individual impairments.  Eta squared, the phi coefficient, Cohen’s d statistics and standard error were calculated as appropriate to index effect sizes for the different comparisons.

Results: Compared to the BHC-RRS group, both the LBP and BHC+RRS groups displayed significantly more (1) rotation-related impairments (LBP: p<.001; BHC+RRS: p=.015) (2) asymmetric rotation-related impairments (LBP: p=.006; BHC+RRS: p=.020) and (3) rotation-related impairments with trunk movement tests (LBP: p=.002; BHC+RRS: p<.001). The LBP group had significantly more rotation-related impairments with extremity movement tests than both of the back healthy groups (BHC+RRS: p=.011; BHC-RRS: p<.001).

Conclusions: LBP and BHC+RRS groups demonstrated a similar number of total rotation-related impairments and asymmetric rotation-related impairments, and these numbers were greater than those of the BHC-RRS group. Compared to people without LBP, people with LBP displayed more rotation-related impairments when moving an extremity. These findings suggest that impairments associated with extremity movements may be associated with having a LBP condition.

Objective: Although boys are frequently reported to have flatter feet than girls, there has been little systematic research to confirm or explain this structural difference between the genders. The objective of this study was to determine whether flat-footedness was moderated by gender in Australian preschool children and, if so, to determine the cause of this between-gender difference in structure of the plantar surface of the foot. Methods: Foot anthropometry, Arch Index derived from plantar footprints, and midfoot plantar fat pad thickness measured by ultrasound were obtained for the left and right feet of 52 girls and 36 boys (mean age, 4.2 T 0.6 years). The children were recruited from 10 randomly selected preschools from the Illawarra region of New South Wales, Australia. Results: In agreement with previous research, the preschool boys displayed significantly flatter feet than the girls (P e 0.04). Although there were no between-gender differences in structural foot dimensions, the boys had a significantly thicker midfoot fat pad than the girls by approximately 0.4 and 0.5 mm on both the right and left feet, respectively. Conclusions: The increased incidence of flat-footedness in boys compared with girls of the same age seems to be caused by a thicker plantar fat pad in the medial midfoot in boys. This suggests that the development of the medial longitudinal arch may be progressing at a slower rate in boys than in girls, and that intervention for a flexible flat foot, particularly for young boys, may be unnecessary.