Vol 2-1 Research Article

Joint internal moments in subjects with unilateral transtibial amputation during walking

Francisco Molina-Rueda1, Alicia Cuesta-Gómez1*, María Carratalá-Tejada1, Pilar Fernández-González1, Juan Carlos Miangolarra-Page1,2, Isabel Mª Alguacil-Diego1

1Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine. Faculty of Health of Sciences. Rey Juan Carlos University, Madrid, Spain

2Physical Medicine and Rehabilitation Service of the University Hospital of Fuenlabrada, Madrid, Spain

Background: Subjects with a unilateral transtibial amputation (UTA) that have used prosthesis for over five years have a higher occurrence rate of osteoarthritis at the knee and hip joints of the intact limb.
Objective: To research the joint internal moments of the hip, knee, and ankle in the sagittal and frontal planes during gait in persons with UTA.
Methods: 25 individuals with UTA (50.26 years ± 13.76) and 25 subjects without amputation (46.71 years ± 13.76) participated in this study. Gait analysis was carried out using a Vicon® Motion System (Oxford Metrics, Oxford, UK) with eight 100 Hz cameras with infrared strobes, two 1000 Hz AMTI® force-plates.
Results: People with UTA walk with a greater hip extensor moment in both intact and prosthetic limbs. The hip abductor moment was lower on the prosthetic limb compared to the intact limb and the control group. At the knee joint, the subjects with UTA walked with a reduced knee extensor and valgus moment on their prosthetic limb compared to the control group. At the ankle joint, the statistical analysis showed that the individuals with UTA walked with a reduced plantarflexor moment during the stance period on the intact limb compared to the people without amputation.
Conclusions: Subjects with UTA walk with a different joint kinetic pattern in the sagittal and frontal planes compared to non-disabled individuals.

DOI: 10.29245/2767-5130/2021/1.1118 View / Download Pdf
Vol 2-1 Mini Review Article

Transolecranon Distal Humerus Fractures: A Mini Review

Shaan S. Patel*, Julian Gatta, Adrienne Lee, Blaine T. Bafus

Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA

Background: Transolecranon distal humerus fractures are uncommon injuries. The purpose of this study is to review the outcomes and complications associated with transolecranon distal humerus fractures.

Material and Methods: We performed a systematic search of PubMed for articles published between 1990 and 2021. Included studies reported outcomes and complications of transolecranon distal humerus fractures. Data was extracted from the included studies to describe patient demographics, injury characteristics, outcome measurements, and complications.

Results: A total of 4 studies met inclusion criteria for data extraction and analysis. Two studies evaluated an adult cohort of a total of 18 patients. The average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 40 (range 4.2 – 76.5). Fifteen patients (83%) had a complication. Elbow stiffness (11/18, 61%) was the most common complication. Eleven patients (61%) underwent more than one procedure. Two studies evaluated a pediatric cohort of a total of 9 patients. Five patients (56%) underwent non-operative treatment with immobilization and four patients (44%) underwent open reduction and internal fixation. There were no complications reported. All the pediatric patients regained near full range of motion of the elbow at their final follow-up.

Conclusion: Transolecranon distal humerus fractures are complex elbow injuries. In the adult population, they remain a challenge for orthopaedic surgeons. Complications, including elbow stiffness and infection, are high with frequent long-term functional limitations as represented by DASH scores. In contrast, pediatric patients have good outcomes and minimal complications that are similar to isolated olecranon and distal humerus fractures in children.

DOI: 10.29245/2767-5130/2021/1.1129 View / Download Pdf
Vol 2-1 Review Article

Risk of Anterior Cruciate Ligament Injury in Female Soccer Athletes: A Review

Sophia L. Mancini1, Clark Dickin1, Dorice A. Hankemeier2, Lindsey Rolston3, Henry Wang1*

1Biomechanics Laboratory, Ball State University, Muncie, IN, USA

2Ball State University, Muncie, IN, USA

3Henry County Center for Orthopedic Surgery & Sports Medicine, New Castle, IN, USA

Soccer is becoming an increasingly popular sport amongst women. Common movements during play, such as jumping and cutting, require rapid acceleration and deceleration of multiple lower-limb joints. The anterior cruciate ligament (ACL), which contributes to stabilization of the knee, is often injured during these events. ACL injury typically requires costly surgery, extended time away from sports, and jeopardizes long-term joint health. Due to sex-specific factors such as menstruation and anatomical disadvantages, women are more susceptible to tearing their ACL. Injury often occurs in non-contact scenarios during rapid acceleration or deceleration movements. Research has examined these movements and established several kinematic and kinetic mechanisms as well as muscle activation patterns that frequently occur at the time of injury, however results tend to vary based on population. This article summarizes recent and relevant literature of ACL injury mechanisms and highlights the lack of specific research in the high-risk female soccer athlete population. Due to inconclusive risk factors, injury prevention programs within this population have been inconsistent. ACL injury risk for female soccer athletes should be closer examined so that more specific injury risks can be established, and effective protective measures can be taken. Raised awareness of this need may capture attention in the research and medical communities and potentially stimulate the development of strategies that limit future ACL injury and thus the challenges it brings to the high-risk female soccer athlete.

DOI: 10.29245/2767-5130/2021/1.1128 View / Download Pdf
Vol 2-1 Review Article

Conservative Treatment for Primary Metatarsalgia

Kentaro Amaha

Department of Orthopedic Surgery, Foot and Ankle; St. Luke's International Hospital, Tokyo, Japan

Metatarsalgia is one of the most common causes of forefoot pain, and it is characterized by pain in the front part of the foot under the head of the metatarsal bones. Primary metatarsalgia is idiopathic, but it has been suggested to be related to forefoot plantar compression. Because of the various causes of metatarsalgia, there is the need to thoroughly consider the etiology of metatarsalgia to find novel, effective, and conservative treatments for metatarsalgia to avoid surgical treatment. Pressure reduction or redistribution can be achieved using toe exercise, flat shoe inserts, metatarsal pads, custom-molded inserts, and rockerbars. There was no need for one treatment. If toe function was poor, toe exercises were recommended. If dorsiflexion of the ankle joint was limited, the Achilles tendon was stretched. If the pain was localized to the plantar aspect of the 2nd MTP, a decompression insole was applied. If the pain was limited to the plantar aspect of the 2nd MTP, a decompression insole was worn. If swelling occurred, anti-inflammatory drugs were indicated to reduce inflammation. The combination of the two was appropriate for this condition. Toe exercises can improve balance and are worth trying. An in-depth understanding of the various etiologies of metatarsal and toe deformities is essential for successful treatment.

DOI: 10.29245/2767-5130/2021/1.1131 View / Download Pdf
Vol 2-2 Commentary

Commentary: Regulation of autoimmune arthritis by the SHP-1 tyrosine phosphatase

Adrienn Markovics1*, Daniel M. Toth2, Tibor T. Glant1, Katalin Mikecz1

1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

2Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Rheumatoid arthritis (RA) is a systemic autoimmune disease leading primarily to the inflammatory destruction of the synovial joints, ultimately resulting in loss of mobility and a decreased quality of life. Recent advances in RA-related research resulted in the introduction of Janus kinase (JAK) inhibitors to the therapeutic arsenal. JAK inhibitors are orally available and provide efficacy similar to that of disease-modifying anti-rheumatic drugs. However, due to the limited selectivity of these drugs, many RA patients experience adverse effects. The potential benefit of modulating protein tyrosine phosphatases, instead of inhibiting kinases, has not been explored. Using an animal model of RA, our group investigated the role of the Src homology region 2 domain-containing phosphatase 1 (SHP-1) in inflammatory arthritis. The purpose of the present article is to highlight important conclusions of our previous paper entitled “Regulation of autoimmune arthritis by the SHP-1 tyrosine phosphatase”. Herein we briefly present and discuss the observations of this study. We also outline future directions toward investigating the therapeutic potential of targeting SHP-1 in inflammatory arthritis in order to develop a new type of orally available drugs for the treatment of RA.

DOI: 10.29245/2767-5130/2021/2.1134 View / Download Pdf
Vol 2-2 Mini Review

Endoprosthetic Reconstruction in Limb Salvage for Malignant Bone Tumours in Children

Sagar Tontanahal1, Gahukamble Abhay Deodas1, Deeptiman James1, Anand Kurian2, Thomas Palocaren1*

1Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India

2Department of Orthopaedics, Christian Medical College, Vellore, India

Background: The management of malignant bone tumors in children has come a long way in the past few decades. The transition from amputation to limb salvage has been made possible due to the rapid development in the diagnosis and the oncological management of these malignant tumors. However, there exist significant reservations regarding endoprosthetic reconstruction in children.

Material and methods: A mini-review was conducted of articles detailing the use of prosthetic reconstruction following tumor resection in children. The data regarding complications and functional outcomes following surgery were collected and presented.

Results: The studies reviewed reported a 5-year survival rate between 60 – 70 %. Uniform across the studies was the need for multiple surgeries when endoprosthesis was used for limb reconstruction, ranging between 2.8 – 3.5 surgeries. The most common complication noted across the studies was related to soft tissue problems such as joint instability followed by structural failure of the prosthesis. Infections were noted with a frequency of 10 – 15 %. Studies showed successful management of limb length discrepancy with expandible prosthesis. Musculoskeletal Tumor Society (MSTS) score used to evaluate the functional outcome showed satisfactory outcomes.

Conclusion: Limb salvage surgery, with recent advances in technique and prosthesis design, is an attractive option in children with extremity malignant bone tumors. In recent time, endoprosthetic reconstruction of extremities have yielded good functional results and are well accepted by the child and the parents. The purpose of this mini-review is to shed some light on the use of endoprosthetic reconstruction in children following tumor resection with its potential benefits and drawbacks.

DOI: 10.29245/2767-5130/2021/2.1135 View / Download Pdf