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PubMed2002

Forced use treatment of childhood hemiparesis.

OBJECTIVE: Forced use, or constraint-induced, movement therapy has shown some efficacy in the rehabilitation of adults with chronic hemiparesis as a result of stroke. We used restraint of the unimpaired arm to ascertain whether this would improve function of the paretic arm in children with chronic (>1 year) hemiparesis. METHODS: Twelve hemiparetic treatment children (age 1-8 years) received a plaster cast on the unimpaired arm for 1 month; 13 hemiparetic control children did not. Peabody Developmental Motor Scales (PDMS) were performed on all treatment and control children immediately before and after casting and again 6 months later when controls crossed over to receive casts. Thus, PDMS were performed at entry, then 1 month, 6 months, and 7 months after entry. Any noted change in functional ability was also elicited by parental report. The frequency of visits to physical and occupational therapy was recorded. RESULTS: The 12 treatment (casted) children improved 12.6 PDMS points after 1 month of casting; the 13 control children improved 2.5 points. Improved PDMS scores persisted 6 months later when 7 treatment children returned. Similar results were obtained in the crossover when 10 control children received casts. Parental report corroborated improvement in casted children (22 of 22 parents) and its persistence at follow-up (21 of 22 parents). Receiving ongoing physical/occupational therapy did not seem to account for these results: control children received more (2.1 visits/wk) than treatment children (1.4 visits/wk). CONCLUSIONS: Forced use can be an effective rehabilitation technique in children with chronic hemiparesis.

Age Factors↗
PubMed2006

Rat hindlimb joint immobilization with acrylic resin orthoses.

The objective of the present study was to propose an orthosis of light material that would be functional for the animal and that would maintain only the ankle joint immobilized. Male Wistar rats (3 to 4 months old, 250-300 g) were divided into 2 groups (N = 6): control and immobilized for 7 days. Rats were anesthetized with sodium pentobarbital (40 mg/kg weight) and the left hindlimb was immobilized with the orthoses composed of acrylic resin model, abdominal belt and lateral supports. The following analyses were performed: glycogen content of the soleus, extensor digitorum longus, white gastrocnemius, red gastrocnemius, and tibialis anterior muscles by the phenol sulfuric method, and the weight, fiber area and intramuscular connective tissue of the soleus by the planimetric system. Data were analyzed statistically by the Kolmogorov-Smirnov, Student t and Wilcoxon tests. Immobilization decreased glycogen in all muscles (P < 0.05; soleus: 31.6%, white gastrocnemius: 56.6%, red gastrocnemius: 39%, extensor digitorum longus: 41.7%, tibialis anterior: 45.2%) in addition to reducing soleus weight by 34% (P < 0.05). Furthermore, immobilization promoted reduction of the fiber area (43%, P < 0.05) and increased the connective tissue (200%, P < 0.05). The orthosis model was efficient comparing with another alternative immobilization model, like plaster casts, in promoting skeletal muscle alterations, indicating that it could be used as a new model in other studies related to muscle disuse.

Acrylic Resins↗
PubMed2006

Early postnatal development of the mandible in children with isolated cleft palate and children with nonsyndromic Robin sequence.

OBJECTIVE: Analysis of early postnatal mandibular size and growth velocity in children with untreated isolated cleft palate (ICP), nonsyndromic Robin sequence (RS), and a control group of children with unilateral incomplete cleft lip (UICL). MATERIAL: 114 children (66 isolated cleft palate, 7 Robin sequence, 41 unilateral incomplete cleft lip) drawn from a group representing all Danish cleft children born from 1976 through 1981. All children were examined at both 2 and 22 months of age. METHODS: Cephalometric x-rays and maxillary plaster casts. Mandibular length and height were measured and mandibular growth velocity (mm/year) was calculated. Cleft width was measured on the casts at 2 months of age. RESULTS: Mean mandibular length and posterior height were significantly smaller in isolated cleft palate and Robin sequence, compared with unilateral incomplete cleft lip. Mandibular length in Robin sequence was also significantly shorter, compared with isolated cleft palate. No significant difference was found between mean mandibular growth velocities in the three groups. No significant correlation was found between mandibular length and cleft width in either isolated cleft palate or Robin sequence at 2 months of age. CONCLUSION: The children with isolated cleft palate and Robin sequence had small mandibles shortly after birth, but with a relatively normal growth potential. No true mandibular catch-up growth was found up to 22 months of age in either group. No significant correlation was found between mandibular size and cleft width in either group at 2 months of age. However, there was a significant trend toward the shorter the mandible, the more severe the sagittal extension of the cleft.

Age Distribution↗
PubMed1996

Timing of exchange of the maxillary deciduous and permanent teeth in boys with three types of orofacial clefts.

Timing of exchange of the deciduous and permanent maxillary teeth was investigated using dental plaster casts of 163 boys with total unilateral cleft (UCLP), 82 boys with bilateral cleft (BCLP), and 97 boys with isolated cleft palate (CP). All patients were treated at the Prague Plastic Surgery Clinic. The results were compared with a control group of 294 schoolboys. To evaluate the course of eruption, the proportion of each erupted teeth in each year of age was employed. In boys with UCLP, eruption of the permanent maxillary lateral incisors and the permanent maxillary second molar was retarded on the cleft side. On the non-affected side, no delay of eruption was observed, but earlier eruption was found in the permanent maxillary canine and in the permanent maxillary first and second premolars. In boys with BCLP, the highest retardation of eruption was found in the permanent maxillary lateral incisor and in the permanent maxillary first molar. The permanent maxillary canine and both permanent maxillary premolars erupted earlier than in the control group. In boys with CP, only the permanent maxillary central incisors erupted earlier. The maxillary deciduous canines and the second molars were both lost early. We conclude that the developmental disturbances of the maxillary jaw and teeth in patients with orofacial clefts are also associated with alteration of timing of dental exchange.

Adolescent↗
PubMed1999

Factors influencing changes in maxillary arch dimensions in unilateral cleft lip and palate patients until six months of age.

OBJECTIVE: The objectives of the present study were (1) to investigate whether growth increments until 6 months of age are influenced by particular factors, (2) to analyze whether anterior cleft reduction is dependent on the extent of the cleft width at birth, and (3) to examine the correlation between maxillary measurements at birth and the anterior cleft width at 6 months of age. DESIGN: The study design was prospective and longitudinal. SETTING: Heidelberg University Hospital Interdisciplinary Cleft/Craniofacial Center. PATIENTS AND METHOD: The longitudinal records of 34 patients (24 male and 10 female) with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were included in this study. All patients were treated with the same protocol. All participants were assessed at 0 and 6 months of age. Maxillary plaster casts of the patients were analyzed using a computer-controlled three-dimensional digitizing system. MAIN OUTCOME MEASURE: Maxillary models were measured and compared to putative factors influencing growth. RESULTS: No statistically significant differences were found between maxillary growth changes and increases in weight and length. Similarly, there was no significant interaction between the extent of the alveolar cleft width at birth and its reduction prior to lip closure. In contrast, significant differences of maxillary growth increments could be found between male and female patients. Stepwise regression analysis demonstrated a correlation between maxillary measurements at birth and growth increments. CONCLUSION: The results of the study indicate that gender plays a certain role in growth changes within the first 6 months of age.

Aging↗
PubMed2001

Pure ectodermal dysplasia: retrospective study of 16 cases and literature review.

OBJECTIVE: To review the possible craniomaxillofacial deformative consequences associated with ectodermal dysplasias and embryonic malformations, which include dental ageneses. SETTING: Oral and Maxillofacial Surgery Department, University Hospital, Lille, France. PATIENTS: Sixteen patients (seven boys and nine girls, aged 4 to 34 years) with pure ectodermal dysplasia (no ectodermal dysplasia syndromes). INTERVENTIONS: All patients had a clinical examination. Seven (two boys and five girls, aged 4 to 25 years) had undergone plaster casts and radiographic and Delaire's cephalometric studies before being treated. MAIN OUTCOME MEASURES: All patients had tooth ageneses (from hypodontia to anodontia), associated with cutaneous dyshidrosis and hair and nail dystrophy. Most of them had a short face, with an unusual facial concavity, a maxillary retrusion, and a relative mandibular protrusion. MANAGEMENT RESULTS AND DISCUSSION: Depending on their ages and their orthopedic abnormalities, patients underwent either dental or prosthodontic, orthodontic, orthopedic, orthognathic, or implant treatment. So as not to interfere with the growth pattern, we preferred to reserve implant and orthognathic surgery for full-grown cases. CONCLUSIONS: Oral and maxillofacial surgeons must undertake a comprehensive approach to these patients to improve their dental, masticatory, growing, and orthognathic conditions.

Adolescent↗
PubMed2001

Facial anthropometry in cleft patients: a historical appraisal.

OBJECTIVE: To present a historical appraisal of the use of anthropological and cephalometrical facial soft tissue measurements in cleft patients. DESIGN: The McDowell Indexes and a Medline search were used to trace references up to 1999. Also, references listed with chapters and articles on facial clefts were searched for anthropometrical studies. Twenty-six retrieved articles and book chapters on soft tissue anthropometry and 12 cephalometric publications on soft tissue measurements on radiographs and plaster casts of cleft patients were reviewed. RESULTS AND CONCLUSIONS: Since 1931, the facial soft tissue appearance of cleft patients has been evaluated by means of anthropometric and cephalometric techniques. Not all of the older studies were performed in a statistically correct fashion. Many of the conclusions of the studies overlap despite differences in technique of assessment. Most studies demonstrate the deficient growth of the maxilla and the deformities of the facial profile in cleft patients.

Anthropometry↗
PubMed2006

Connective tissue graft for gingival recession treatment: assessment of the maximum graft dimensions at the palatal vault as a donor site.

BACKGROUND: The palatal masticatory mucosa is widely used as a connective tissue donor site in gingival recession treatment. However, concern has been raised regarding the potential risk of damaging the greater palatine artery (GPA) due to anatomical variations in the palatal vault. The anatomy of the palatal vault in terms of size and shape may affect the maximum dimensions of the graft that can be safely taken from the palatal vault. In a cohort of patients free of periodontal disease, the purpose of this study was to assess the maximum dimensions of the graft, particularly the height and length, that could be safely taken from the palatal vault. METHODS: Plaster impressions were made from 198 patients free of periodontal disease. Because the connective tissue graft is usually taken from an area extending from the mid-palatal aspect of the canine to the mid-palatal aspect of the second molar, this interval was measured and represented the maximum length dimension. The emergence of the GPA was assumed to be localized at the junction of the vertical and horizontal palatal walls of vault, and its course was marked on the plaster casts. The maximum height of the graft corresponded to the distances measured from the gingival margin to the marked course of the GPA of each tooth at its interproximal and mid-palatal aspects. RESULTS: The length of the maximum available tissue graft was 31.7 +/- 4.0 mm. The distance extending from the gingival margin to the greater palatine artery ranged from 12.07 +/- 2.9 mm at the canine level to 14.7 +/- 2.9 mm at the mid-palatal aspect of the second molar level. Therefore, in the premolar area, it was possible to harvest a connective tissue graft measuring 5 mm in height in all cases and 8 mm in height in 93% of cases. CONCLUSION: Our findings suggest that the maximum available tissue graft as measured in the palatal vault was large enough to allow a safe withdrawal from this donor site in a high percentage of our patient population free of periodontal disease.

Adult↗
PubMed1993

Arthroscopically assisted reconstruction of the anterior cruciate ligament with use of autogenous patellar-ligament grafts. Results after twenty-four to forty-two months.

The results of the first sixty-nine consecutive patients who had had seventy arthroscopically assisted reconstructions of the anterior cruciate ligament with use of an autogenous patellar-ligament graft at our institution were reviewed retrospectively. Sixty-seven patients (sixty-eight knees) were available for evaluation after a minimum of two years. All patients had been managed with early, postoperative range-of-motion exercises and a standardized program of physical therapy. At the time of the most recent follow-up evaluation, the median ligament score, according to the rating system of The Hospital for Special Surgery, was 93 of a possible 100 points. Of the sixty-eight knees, forty-four were rated excellent; fifteen, good; six, fair; and three, poor. Eighteen knees had symptoms related to the patellofemoral joint and sixty-three had a full range of motion; two knees had had manipulation for loss of flexion. At the follow-up evaluation, KT-1000 arthrometric measurements were obtained for both knees of fifty-six patients. Eighty-four per cent of the patients had an increase of three millimeters or less in anterior-posterior displacement of the tibia on the reconstructed side compared with the normal side, while 93 per cent had an increase of four millimeters or less. Postoperatively, there was no apparent association between changes in the Insall-Salvati patellar ligament-to-patella ratios and pain in the patellofemoral joint. The results of the arthroscopically assisted reconstructions combined with use of early range-of-motion exercises were comparable with those reported after open reconstruction and immobilization of the limb in a plaster cast. The frequency of pain in the patellofemoral joint and the need for manipulation because of loss of motion were decreased after the arthroscopically assisted procedures.

Adolescent↗
PubMed1994

The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up.

Forty-one of fifty patients (fifty knees) who had had a repair of an acute tear of the medial ligaments, a procedure in which repair of the posterior oblique ligament and the semimembranosus complex was emphasized, were re-evaluated after an average duration of follow-up of twenty-two years (range, eighteen to thirty years). The ages of the patients at the time of the injury had ranged from fifteen to twenty-one years. In twenty-four of the forty-one knees, the anterior cruciate ligament had been torn. In seventeen of these knees, the torn ligament had been debrided; in six others, which had had avulsion of a bone fragment or a terminal tear, the ligament had been repaired with absorbable sutures; and in the remaining knee, the repaired anterior cruciate ligament had been augmented. Four patients had had a pes anserinus transfer to supplement the medial repair. The medial meniscus had been intact or repaired in twenty-five of the forty-one knees and had been removed from the remaining sixteen. The lateral meniscus had been retained in thirty-nine knees and removed from two. Postoperatively, all knees had been immobilized for six weeks in 60 degrees of flexion by means of a plaster cast. This had not caused lasting loss of motion, persistent muscle atrophy, or clinically demonstrable deterioration of the articular cartilage. In the twenty-four knees that had had a tear of the anterior cruciate ligament, the rates of instability, meniscal injury, and deterioration of the joint had not increased since the time of treatment, compared with those in the knees with an intact ligament, even though repair and augmentation of this ligament had not been performed (except in one patient, in whom it was unsuccessful). Thirty-eight patients had good stability and a normal range of motion, as well as little or no muscle atrophy. Radiographic changes were slight or absent in all but four knees. Most patients had maintained a high level of physical fitness and recreational athletic activity. There were three failures of treatment (7 per cent). This previously described treatment of acute tears of the medial ligaments, with or without an associated tear of the anterior cruciate ligament, provides good long-term results and is still recommended.

Acute Disease↗
PubMed1996

Treatment of equinocavovarus deformity in adults with the use of a hinged distraction++ apparatus.

We evaluated the results following the use of the Volkov-Oganesyan-Povarov hinged distraction apparatus to correct equinocavovarus deformity of the foot in sixty-five adults (eighty-three feet). The deformity was secondary to ischemic and neuropathic changes after trauma to the foot and ankle, poliomyelitis, Charcot-Marie-Tooth disease, or untreated clubfoot. The deformity often was associated with severe neurotrophic changes, extensive scarring of the skin, callosities, or osteomyelitis of the foot, all of which usually preclude operative reconstruction. The average age of the patients was twenty-six years (range, sixteen to fifty-six years). The average duration of follow-up was ten years (range, three to nineteen years). The duration of distraction was three to thirteen weeks, and the apparatus usually was kept in place for an additional two months after the desired position of correction had been achieved. The patient then wore a plaster cast for an average of eight weeks and custom-molded shoe-inserts for at least one year. A plantigrade foot was obtained with this external transosseous distraction device. Eight patients had inflammation of pin tracks, which was treated with local injection of antibiotics into the soft tissues and application of bandages soaked in antibiotics to the area around the pin sites. The pins were removed from five of the eight patients, and the apparatus was removed from three additional patients because of osteomyelitis. The results were classified as good in fifty-nine feet, satisfactory in twenty, and unsatisfactory in four. In the four feet (three patients) with an unsatisfactory result, a good result was obtained after an arthrodesis was done.

Adolescent↗
PubMed1997

Functional bracing for rupture of the Achilles tendon. Clinical results and analysis of ground-reaction forces and temporal data.

Fifteen patients who had sustained a rupture of the Achilles tendon were managed non-operatively with use of a functional bracing protocol, and clinical and functional performance measures were assessed after a mean duration of follow-up of thirty-one months (range, twenty-four to forty-five months). An age and gender-matched group of fifteen subjects was assessed to provide normative data for the comparison of side-to-side differences. Numerical scores were generated on the basis of subjective responses to a questionnaire, clinical measurements of the range of motion of the ankle and the circumference of the calf, and the results of the Thompson squeeze test and a single-limb heel-rise test. A 100-point scoring system was used to categorize the outcome as excellent, good, fair, or poor. In addition, ground-reaction forces and temporal data were assessed during functional dynamic activities that included walking, a single-limb power hop, and a thirty-second single-limb heel-rise endurance test. The result was graded as excellent for three patients, good for nine, fair for two, and poor for one. An increase in passive dorsiflexion of the treated ankle was the only clinical measure that was significantly different between the groups (p = 0.02). This increase in dorsiflexion was positively correlated with vertical force output between the mid-stance and terminal-stance phases of gait (r = 0.40, p = 0.05). With the numbers available, we could detect no significant differences between the groups with regard to the kinetic or temporal variables that were measured during functional dynamic activities. Patients who generated less peak vertical force and vertical height during the single-limb power-hop test tended to have poorer clinical scores. We believe that non-operative functional bracing may prove to be a viable alternative to operative intervention or use of a plaster cast for the treatment of acute ruptures of the Achilles tendon. The goals of treatment are to prevent the musculoskeletal changes that are associated with immobilization, to reduce the time needed for rehabilitation, and to facilitate an early return to work and to preinjury activities.

Achilles Tendon↗
PubMed1998

A randomized, prospective study of operative and non-operative treatment of injuries of the fibular collateral ligaments of the ankle.

One hundred and forty-six adults who had an isolated injury of the fibular collateral ligaments of the ankle were randomized to be managed operatively or non-operatively. Disruption of the ligaments was diagnosed by means of a physical examination and on the basis of stress radiographs of the ankle made with use of a specially designed device to hold the leg. Operative treatment, performed in seventy-three patients, consisted of suture repair of the disrupted ligaments within seventy-two hours after the injury, followed by immobilization of the ankle in a below-the-knee plaster cast for six weeks. Non-operative treatment, used for seventy-three patients, consisted of the use of an ankle orthosis for six weeks. After a minimum of two years of follow-up, we could detect no significant differences, with the numbers available, between the two groups with regard to the functional result or the degree of joint laxity that was evident on stress radiographs. The non-operative group lost a mean of 1.6 weeks from work, and the operative group lost a mean of 7.0 weeks. We concluded that non-operative treatment of an injury of the fibular collateral ligaments of the ankle yields results that are comparable with those of operative repair and is associated with a shorter period of recovery.

Adolescent↗
PubMed2000

Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones.

BACKGROUND: Unicameral bone cyst is characterized by its tenacity and risk of recurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of flexible intramedullary nailing for the treatment of a unicameral bone cyst with or without a pathological fracture. METHODS: Flexible intramedullary nailing for the treatment of a unicameral bone cyst was performed in thirty-two patients. Thirty of these patients presented with a pathological fracture; twenty-four were managed immediately with intramedullary nailing, and the other six had been managed conservatively at other clinics before they were referred to our department. The remaining two cysts were detected incidentally. The cyst was located in the humerus in twenty-one patients, in the femur in nine, and in the radius in two. The mean age of the patients at the time of surgery was 9.8 years, and the mean duration of follow-up was 53.7 months. Radiographic evaluation was performed according to the criteria of Capanna et al., and the cyst was classified as completely healed, healed with residual radiolucency (osteolysis), recurred, or having no response. RESULTS: The healing period ranged from three to 105 months. Fourteen cysts healed completely, and sixteen healed with residual radiolucent areas visible on radiographs. There was recurrence of two cysts that had healed with residual radiolucency. All of the cysts in the present study responded to treatment. A change of nails was necessary in nine patients, as the nails had become too short after bone growth. No major complications were observed. CONCLUSIONS: Flexible intramedullary nailing provides early stability, which allows early mobilization and thus obviates the need for a plaster cast and decreases the prevalence of the most common complication: a pathological fracture. This method of treatment also allows for an early return to normal activity.

Bone Cysts↗
PubMed2001

Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases.

BACKGROUND: The radiographic characteristics and treatment of radiocarpal dislocation are not well defined. There have been only two reported series of more than eight patients. Thus, there are many questions concerning treatment and functional results. METHODS: Two groups of patients were defined. Group 1 included all patients with pure radiocarpal dislocation and patients with only a fracture of the tip of the radial styloid process. Group 2 included patients with radiocarpal dislocation and an associated fracture of the radial styloid process that involved more than one-third of the width of the scaphoid fossa. A retrospective review and a clinical evaluation were performed. RESULTS: From 1975 to 1998, we observed twenty-seven cases of radiocarpal dislocation. Four were displaced volarly, and twenty-three were displaced dorsally. Fourteen patients presented with associated lesions. Four patients were treated with closed reduction and immobilization in a plaster cast; five, with percutaneous Kirschner wire fixation and cast immobilization; and two, with an external fixator. Eleven patients had open reduction with Kirschner wire fixation and cast immobilization. The seven patients in Group 1 had a highly unstable injury, and four of the seven patients presented with ulnar translation of the carpus. At the time of follow-up, at an average of 26.8 months, pronation averaged 76 degrees; supination, 66 degrees; wrist flexion, 54 degrees; wrist extension, 54 degrees; radial inclination, 15 degrees; and ulnar inclination, 18 degrees. The average grip strength was 27 kg. Group 2 included twenty patients. Only thirteen, with dorsal dislocation, were evaluated at the time of follow-up, which averaged fifty-one months. At that time, six reported no pain; four, slight pain; and two, moderate pain. Pronation averaged 63 degrees; supination, 76 degrees; wrist flexion, 51 degrees; wrist extension, 56 degrees; radial inclination, 21 degrees; and ulnar inclination, 39 degrees. Grip strength averaged 38 kg. Seven patients had complications. CONCLUSIONS: On the basis of our experience and a review of the literature, we believe that patients with pure radiocarpal dislocation or with radiocarpal dislocation with a fracture of the tip of the radial styloid process should be treated with reattachment of the ligaments through a volar approach. In patients with radiocarpal dislocation and a fracture of the radial styloid process that involves more than one-third of the width of the scaphoid fossa, the ligaments are still attached to the radial fragment. We believe that in this group of patients, exact articular reduction should be performed through a dorsal approach. Additional studies are needed to support these hypotheses.

Adolescent↗
PubMed2003

Long-term comparative results in patients with congenital clubfoot treated with two different protocols.

BACKGROUND: Long-term follow-up studies of adults who had been treated for congenital clubfoot as infants are rare. The purpose of this study was to review and compare the long-term results in two groups of patients with congenital clubfoot treated with two different techniques. In both groups, treatment was started within the first three weeks of life by manipulation and application of toe-to-groin plaster casts, with a different technique in each group. At the end of the manipulative treatment, a posteromedial release was performed when the patient was between eight and twelve months of age in the first group and a limited posterior release was performed when the patient was between two and four months of age in the second group. METHODS: At the follow-up evaluations, all patients were interviewed and examined, and standing anteroposterior and lateral radiographs and computed tomography scans of the foot were made. The results of treatment were graded according to the system of Laaveg and Ponseti. Numerous angular measurements were made on the radiographs, and the measurements in the two groups were compared. RESULTS: The first group, which included thirty-two patients (forty-seven clubfeet), was followed until an average age of twenty-five years. The second group, with thirty-two patients (forty-nine clubfeet), was followed until an average age of nineteen years. In the first group, there were two excellent, eighteen good, eleven fair, and sixteen poor results. In the second group, there were eighteen excellent, twenty good, six fair, and five poor results. According to the system of Laaveg and Ponseti, the mean rating in the first group was 74.7 points and that in the second group was 85.4 points. CONCLUSIONS: In the second group, use of Ponseti's manipulation technique and cast immobilization followed by an open heel-cord lengthening and a limited posterior ankle release gave much better long-term results than those obtained in the first group, treated with our manipulation technique and cast immobilization followed by an extensive posteromedial release of the foot. In our hands, this operation did not prevent relapse, and neither cavovarus nor forefoot adduction was completely corrected.

Achilles Tendon↗
PubMedDate not supplied

Management and rehabilitation of ligamentous injuries to the ankle.

The management of ligamentous injuries to the ankle is controversial. Neither the methods for classification and diagnosis, or the procedures for treatment are clear cut. Ankle sprains are a common occurrence, with the majority involving the lateral ligament complex. Within this complex, the anterior talofibular ligament is injured most frequently, usually while the foot is in the plantar flexed position. Ankle injuries can be diagnosed through physical exam, including the anterior drawer test and/or a stress exam, or through roentgenographic evaluation. The purpose of the stress roentgenogram is to measure the degree of talar tilt. However, it does not always yield consistent, reliable results. This inconsistency has led to the use of arthrography. There is debate over its use as well, however, Ankle sprains can be classified into three groups, according to functional loss. Treatment for first and second degree sprains is usually non-operative. The best approach to Grade III sprains is debatable. The issues in the treatment of Grade III sprains are first, whether treatment should be operative or non-operative, and second, whether non-operative treatment should emphasise immobilisation or mobilisation. Brostrom's work is cited as noteworthy. He recommended adhesive strapping followed by mobilisation as the treatment of choice, and reserves surgery for cases of chronic instability. Results demonstrated that strapping yielded shorter disability periods, while surgery produced less instability. The prevention of functional instability is a major concern in the treatment of ankle injuries. There is no consensus for treating a lateral ligament rupture. The authors suggest immobilisation followed by a rehabilitative programme. Three methods of immobilisation are plaster casting, adhesive strapping, and the air-stirrup. The physiological mechanism of cryotherapy and thermotherapy are discussed briefly and recommendations for their use are provided. Aspiration is also discussed. Loss of motion is designated as a primary cause of chronic pain and reinjury, and exercises intended to restore range of motion are provided. Exercises aimed at restoring strength and proprioception are also presented. This allows for return to activity and serves to prevent reinjury.

Ankle Injuries↗
PubMed2006

Estrogen administration attenuates immobilization-induced skeletal muscle atrophy in male rats.

We tested the hypothesis that estrogen administration would retard immobilization-induced muscle atrophy in adult male rats. The rats were injected for 24 days with either estrogen (40 microg/kg(-1), beta-estradiol 3-benzoate in olive oil vehicle), or vehicle alone. At day 14 of estrogen treatment, the hindlimb muscles of one leg were immobilized in plantar flexion position by the use of a plaster cast. Following 10 days of immobilzation, the atrophic and the contralateral soleus muscles were both removed and analyzed to determine the level of muscle atrophy along with the measurement of the protein levels of Cu-Zn-superoxide dismutase (Cu-Zn-SOD), heat shock protein 72 (HSP72), and selected proteases. Compared to placebo animals, estrogen treatment significantly reduced (-35%) muscle atrophy. Further, estrogen significantly abridged the expression of the calcium-activated protease, calpain, in the atrophied hindlimb muscle. In contrast, estrogen treatment did not alter the protein levels of HSP72 in the immobilized soleus muscle. These results support the postulate that estrogen attenuates the rate of disuse muscle atrophy, partly because of reductions in immobilization-induced calcium-activated protease levels.

Animals↗