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At least 919 records · Page 51Linked to original sources
PubMed2003

Range of motion and stroke frequency differences between manual wheelchair propulsion and pushrim-activated power-assisted wheelchair propulsion.

BACKGROUND/OBJECTIVE: The objective of this study was to examine the use and efficacy of a pushrim-activated power-assist wheelchair (PAPAW) in the reduction of upper extremity range of motion (ROM) and stroke frequency in manual wheelchair users. METHODS: Ten manual wheelchair users were evaluated using a repeated-measures design with and without the use of a PAPAW for maximum ROM of shoulder flexion/extension, abduction/adduction, internal/external rotation, and horizontal flexion/extension; elbow flexion/extension; wrist flexion/extension, supination/pronation, and ulnar/radial deviation; and stroke frequency. Participants propelled a Quickie 2 manual wheelchair configured as a PAPAW and their own wheelchair on a computer-controlled dynamometer at 3 different resistance levels and 2 different speeds. RESULTS: The use of the PAPAW significantly (P < 0.05) decreased shoulder flexion/extension and horizontal flexion/extension, elbow flexion/extension, and wrist flexion/extension and ulnar/radial deviation for many speed and resistance combinations. Univariate analysis revealed that stroke frequency was unaltered in all cases. CONCLUSION: These findings provide the foundation for studying the utility of the PAPAW in reducing the risk of upper limb injury and neuropathy in the manual wheelchair user population.

Adult↗
PubMed1995

Elbow problems in the athlete.

Athletes expose their elbows to significantly high forces, in addition to multiple repetitive motions. Athletic injuries about the elbow include ligamentous, tendon, articular, and nerve injuries. The proper diagnosis requires a thorough knowledge of the anatomy, pathomechanics, and physical findings associated with these injuries. Treatment entails a methodical progression from nonoperative to operative intervention.

Adolescent↗
PubMed1995

Heterotopic ossification: treatment of established bone with radiation therapy.

Ectopic bone formation or heterotopic ossification (HO) is frequently seen on rehabilitation units after total hip arthroplasties, burns, and neurological injuries. Currently the major role for treatment is in prophylaxis and the major methods include anti-inflammatory medications, irradiation, and diphosphanate administration. These prophylactic measures are generally considered to be ineffective for the treatment of ectopic bone once it has already formed. We describe two cases of HO for which a radiation therapy protocol was used to treat established, ectopic bone after it had become problematic. Both patients were found to have increased range of motion and decreased complaints of pain after treatment, though no gross plain film x-ray changes were noted. We conclude that radiation therapy may be useful not only for prophylaxis of heterotopic ossification but for ectopic bone after it has been formed, especially when pain and progressively decreased range of motion are problematic.

Adult↗
PubMed1997

Neonatal transphyseal supracondylar fracture detected by ultrasound.

Fractures in young infants are often difficult to detect on plain radiographs when they involve the cartilaginous growth plate. We report a case of a neonatal transphyseal fracture which was detected by the use of ultrasound and magnetic resonance imaging. With shortened postnatal hospitalization becoming increasingly common, these and other birth injuries are more likely to present for the first time in the emergency department. The authors recommend the use of ultrasound as the screening modality of choice in the emergency department.

Birth Injuries↗
PubMed2004

Osteochondritis dissecans of the elbow.

Osteochondritis dissecans of the elbow is a localized condition of the articular surface that is commonly seen in the young athlete. This disorder refers primarily to lesions of the capitellum and can be difficult to treat. Although trauma and ischemia play significant roles, the exact etiology remains unknown. The natural history is poorly understood and long-term sequelae include degenerative arthritis. The integrity of the articular surface and the stability of the lesion can be carefully evaluated with MRI and arthroscopy. Management is based mainly upon these two factors, yet no good universal outcomes exist among the varied treatment options. Stable lesions identified early appear to have the best prognosis with conservative management. Indications for surgery include persistent or worsening symptoms despite prolonged conservative care, loose bodies, or evidence of instability. Whether to excise and débride or to fix an unstable fragment is a highly controversial topic. The clinician should recognize osteochondritis dissecans of the elbow as a potentially disabling condition where the prognosis for return to sport is guarded.

Athletic Injuries↗
PubMed1994

A contemporary approach to the management of complex fractures of the distal humerus and their sequelae.

Improvements in both surgical implants and techniques for their application have enhanced the functional outcome after complex distal humeral fractures. Complication rates remain high, however, emphasizing the demanding nature of treatment of these injuries. This article focuses on the recognition and treatment of complex and previously poorly described distal humeral injuries and the prevention and treatment of complications commonly seen with these fractures.

Adult↗
PubMed2005

Location of treatment of supracondylar fractures of the humerus in children.

A change in the locations where children are treated for supracondylar fractures of the humerus has occurred during the past 13 years. Pediatric orthopaedic surgeons at specialist centers are seeing an increased number of such fractures. In New England, the number of supracondylar fractures of the humerus treated by closed reduction and percutaneous pinning has remained relatively constant between 1991 and 1999 with a range of 276 to 346 fractures per year, averaging 320 per year. In 1991, 63% of patients were treated by general orthopaedic surgeons in a nonspecialist setting. By 1999, 68% of the fractures were treated at centers with pediatric orthopaedic specialists available whereas only 32% were treated in a general orthopaedic setting. Associated with this change is a decreased length of stay from 2.2 (+/- 0.6) days in nonspecialist centers to 1.4 (+/- 0.4) days average in specialist centers.

Age Distribution↗
PubMed1995

Traumatic anterior dislocation of the radial head in an adult.

We report an isolated anterior dislocation of the radial head in an adult after sustaining a fall on the outstretched arm. Based on history and presentation, we speculate that the injury occurred in a position of hyperextension and supination. Reduction was achieved by a pronation maneuver.

Accidental Falls↗
PubMed1995

Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children.

From 1985 to 1991, 623 cases of supracondylar fracture of the humerus in children were admitted to one center, of which 403 were analyzed in detail. Of these, 180 cases were classified as Gartland type III extension fractures, and 111 were treated via primary closed reduction and percutaneous smooth Kirschner wire pinning, of which 82 were followed up for an average of 3.5 years and were studied in detail clinically and radiologically. There were two cases of superficial pin tract infection and one of ulnar nerve palsy associated with the pinning. Nineteen fractures (10.5%) had an initial nerve palsy related to the injury. All recovered completely from 4 weeks to 40 weeks postinjury. Only one of nine cases (5%) with absent radial pulse required exploration. Eighty percent of all cases had excellent or good function according to the Flynn criteria of elbow assessment. The most important factor correlating with the final varus deformity was found to be the difference in Baumann's angle between the injured and the normal side after closed reduction and pin fixation. The results of cross pinning in eight cases were not found to be different from those of the lateral pinning group (74 cases). Ipsilateral fracture of the same limb occurred in 4.4% of the cases, the majority being a fracture of the distal radius. The average anesthetic time for the procedure was 54 min, and the average hospital stay was 2.9 days. Our study shows that cross or lateral percutaneous pinning was found to be effective in the treatment of Gartland type III extension fractures with a high success rate and minimal complications.

Bone Wires↗
PubMed2001

Surgical treatment of olecranon fractures.

Fractures of the olecranon are common injuries with no single accepted treatment. Numerous clinical factors and biomechanical studies guide the surgeon in determining a treatment plan. The goals of surgical management include anatomical reduction and stable fixation, which allow early range of motion of the elbow joint. Numerous fixation methods have been described and include screw fixation, cerclage wiring, modified tension-band wiring, and plate fixation. The surgical technique depends on a combination of patient factors, the fracture pattern, and the mechanical stability of the fixation construct. Postoperative rehabilitation includes early active range-of-motion exercises and follows clinical and radiographic healing. Complications are related to the fracture, choice of implant, and surgical technique.

Adolescent↗
PubMed1989

[Therapy of persistent dislocation of the radius head in children].

In contrast to the Monteggia-fracture the chronical condition of the luxation of radial capitulum in infants represents a serious clinical problem. Uncertainties concerning the etiology are documented by numerous methods of treatment. Due to the results in 8 infants which were operated on because of persistent luxation of radial capitulum (some of them remained untreated at their parents request) therapy and prognosis of this rare consequence of the injury in infants are to be discussed.

Child↗