scholarly journals Radiocapitellar joint pressures following transradial amputation increase during elbow motion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Young-Hoon Jo ◽  
Bong-Gun Lee ◽  
Chang-Hun Lee ◽  
Kwang-Hyun Lee ◽  
Dong-Hong Kim ◽  
...  
Keyword(s):  
Upper Limb ◽  
Contact Area ◽  
Peak Pressure ◽  
Elbow Flexion ◽  
Styloid Process ◽  
Upper Limbs ◽  
Forearm Rotation ◽  
Myoelectric Prosthesis ◽  
Significant Difference ◽  
Mean Pressure

AbstractThis study aimed to compare the contact area, mean pressure, and peak pressure of the radiocapitellar joint (RCJ) in the upper limb after transradial amputation with those of the normal upper limb during elbow flexion and forearm rotation. Testing was performed using ten fresh-frozen upper limbs, and the transradial amputation was performed 5 cm proximal to the radial styloid process. The specimens were connected to a custom-designed apparatus for testing. A pressure sensor was inserted into the RCJ. The biomechanical indices of the RCJ were measured during elbow flexion and forearm rotation in all specimens. There was no significant difference in the contact area between the normal and transradial amputated upper limbs. However, in the upper limbs after transradial amputation, the mean pressure was higher than that in the normal upper limbs at all positions of elbow flexion and forearm rotation. The peak pressure was significantly higher in the upper limbs after transradial amputation than in the normal upper limbs, and was especially increased during pronation at 45° of elbow flexion. In conclusion, these results could cause cartilage erosion in the RCJ of transradial amputees. Thus, methods to reduce the pressure of the RCJ should be considered when a myoelectric prosthesis is developed.

Biomechanics of axial load transmission across the native human elbow

2020 ◽  
pp. 175857322096102
Author(s):  
Kaleb Smithson ◽  
Jacob Smith ◽  
William Hogue ◽  
Erin Mannen ◽  
Shahryar Ahmadi
Keyword(s):  
Elbow Joint ◽  
Elbow Flexion ◽  
Upper Extremities ◽  
Forearm Rotation ◽  
Contact Areas ◽  
Load Transmission ◽  
Pressure Mapping ◽  
Average Maximum ◽  
Significant Difference ◽  
Fresh Frozen

Background Elbow and forearm motion are thought to affect elbow load transmission, yet little empirical evidence exists to quantify the biomechanics. Methods Eight fresh-frozen human cadaver upper extremities were utilized. A 100 N axial force was applied across the elbow joint at elbow flexion angles of (0°, 30°, 60°, and 90°) and forearm rotation angles (0°, 45° supination, and 45° pronation). Pressure mapping sensors were placed in both the radiocapitellar and ulnotrochlear joints. Force distributions and contact areas were measured, and paired t-tests were used for comparison (p < 0.05). Results The average maximum loading percentage of the radiocapitellar and ulnotrochlear joint pressures were 57.8 ± 4.6% and 42.2 ± 4.6%, respectively. Elbow flexion angle and forearm rotation did not significantly affect the joint loading. There was no significant difference between the contact areas of each joint, although ulnotrochlear and radiocapitellar joints demonstrated an inverse relationship. Conclusion Our study is the only one to date to comprehensively evaluate loading mechanics throughout both functional elbow flexion and forearm rotation across both articulations. The load sharing ratio across the radiocapitellar and ulnotrochlear joints was 58%:42%, agreeing with previously reported ratios with limited parameters. A relationship may be present between increasing radiocapitellar and decreasing ulnotrochlear contact areas as elbow flexion increases.

scholarly journals ATFL repair alone versus combined repairs of ATFL and CFL

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Kenneth Hunt ◽  
Judas Kelley ◽  
Richard Fuld ◽  
Nicholas Anderson ◽  
Todd Baldini
Keyword(s):  
Contact Area ◽  
Peak Pressure ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Lateral Ligament ◽  
Joint Stability ◽  
Intact Specimen ◽  
Significant Difference ◽  
The Impact

Category: Ankle Introduction/Purpose: The standard for lateral ligament stabilization is direct repair of the ATFL by open or arthroscopic technique. The implications and necessity of repairing the CFL are not well understood. The purpose of this study was to assess the impact of repairing the ATFL alone compared to repairing both the ATFL and CFL, in a biomechanical cadaver model. We hypothesized that repairing the CFL will substantially augment ankle and subtalar joint stability during weight-bearing ankle inversion compared to ATFL repair alone. Methods: Ten matched pairs of fresh frozen human cadaveric ankles were dissected to expose intact ATFL and CFL. Ankles were mounted to an Instron at 20° plantar flexion and 15° of internal rotation. Each ankle was loaded to body weight and then tested from 0 to 20° of inversion for three cycles; stiffness and torque were recorded, peak pressure and contact area were recorded using a calibrated Tekscan sensor system, and rotational displacement of the talus and calcaneus relative to the ankle mortise was recorded using a three-dimensional motion capture system. Ankles then underwent sectioning of ATFL and CFL and were randomly assigned to ATFL only repair using two arthroscopic Broström all-soft anchors, or combined ATFL and CFL repair. Testing was repeated after repair to 20° of inversion, then load-to-failure (LTF). Results: The predominant mode of failure after repair was at the tissue/suture. There were no instances of anchor pullout. There was an 11.7% increase in stiffness in combined repairs, and only a 1.6% increase in ATFL-only repairs. CFL failed at lower torque and rotation than the ATFL in combined repairs. There were strong correlations between intact stiffness and stiffness after repair (r=.74) and ATFL torque in LTF testing (r=.77), across both groups. There was no significant difference in peak pressure or contact area in the tibiotalar joint between the intact ankle and ATFL or combined repair. Conclusion: We found a greater increase in stiffness following combined ATFL and CFL repair compared to ATFL repair alone. This added stability is due to complimentary contributions of the CFL, not augmented LTF strength of the ATFL. Intact specimen stiffness correlated strongly with stiffness after repair and LTF torque, suggesting that a patient’s inherent tissue laxity or inelasticity is likely a meaningful predictor of strength after repair. Restoring the CFL plays a relevant role in lateral ligament repair, however sufficient time for ligament healing should be allowed before substantial inversion stresses are applied.

scholarly journals Efeito de posturas estáticas e dinâmicas na distribuição da pressão nádega-almofada em um caso de tetraplegia por lesão medular/The effect of statistical and dynamic positions in the distribution of buttock-cushion pressure in a case of tetraplegia

2018 ◽  
Vol 2 (3) ◽  
pp. 555-566
Author(s):  
Paulo Vinicius Braga Mendes ◽  
Daniel Marinho Cezar Da Cruz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Contact Area ◽  
Pressure Ulcers ◽  
Peak Pressure ◽  
Interface Pressure ◽  
High Profile ◽  
Cord Injury ◽  
Mean Pressure ◽  
Pressure Peak

Introdução: as úlceras por pressão são complicações frequentes em pacientes com lesão medular. Almofadas de ar são apontadas como as mais indicadas para aliviar a pressão de interface e prevenir úlceras. Objetivo: Analisar, em um caso de tetraplegia por lesão medular, o efeito da distribuição da pressão de interface nádega/almofada em posturas estáticas e dinâmicas e verificar se o uso de uma almofada nova interfere na distribuição da pressão. Método: A análise da pressão de interface foi realizada durante duas situações distintas: com o participante sentado em postura estática; e mais uma etapa utilizando a cadeira de rodas para a locomoção. Para a avaliação da pressão de interface foram utilizadas duas almofadas Roho® Quadtro Select High Profileâ„¢: uma em uso pela participante e outra fornecida pelos pesquisadores. Resultados: Foram analisados: pressão média, pico de pressão e área de contato na interface nádega/almofada nas duas etapas de coletas de dados. A almofada fornecida pelo estudo apresentou índices melhores para pressão média, pico de pressão e área de contato. Conclusão: O estudo traz evidências da importância de manter a calibração de almofadas para sujeitos lesados medulares para prevenção de úlceras de pressão. Abstract  Introduction: pressure ulcers are frequent complications in patients with spinal cord injury. Air cushions are appointed as the most appropriate to relieve the interface pressure and prevent pressure ulcers. Objective: To analyze the effect of the distribution of the buttock / cushion interface pressure under static and dynamic posture and check the use of a new cushion interferes with the pressure distribution in a case of tetraplegia after spinal cord injury. Method: Analysis of interface pressure was performed for two different situations, with the participant sitting in static and one more step using the wheelchair for locomotion. For the evaluation of interface pressure were used two Roho® Quadtro Select High Profile â„¢ cushions: one used by the participant and another provided by the researchers. Resulted: Was analyzed the mean pressure, peak pressure and the contact area in buttock/cushion in both data collect. The cushion provided by the study presented better indices for mean pressure, peak pressure and contact area. Conclusion: The study provides evidence of the importance of maintaining cushion calibration for spinal cord injured individuals to prevent pressure ulcers.Keywords: Cushion; Spinal Cord Injury; Assistive Technology. 

scholarly journals Effects of Minimalist Footwear and Foot Strike Pattern on Plantar Pressure during a Prolonged Running

2022 ◽  
Vol 12 (1) ◽  
pp. 506
Author(s):  
Marta Izquierdo-Renau ◽  
Roberto Sanchis-Sanchis ◽  
Jose I. Priego-Quesada ◽  
Alberto Encarnación-Martínez ◽  
Ana Queralt ◽  
...  
Keyword(s):  
Contact Area ◽  
Plantar Pressure ◽  
Contact Time ◽  
Peak Pressure ◽  
Maximal Aerobic Speed ◽  
Mean Pressure ◽  
Pressure Peak ◽  
Foot Strike ◽  
Running Mechanics ◽  
Lower Contact

The use of minimalist shoes (MS) in running involves changes in running mechanics compared to conventional shoes (CS), but there is still little research analysing the effects of this footwear on plantar pressure, which could help to understand some risk injury factors. Moreover, there are no studies examining the effects of a prolonged running and foot strike patterns on baropodometric variables in MS. Therefore, the aim of this study was to analyse the changes produced using MS on plantar pressure during a prolonged running, as well as its interaction with the time and foot strike pattern. Twenty-one experienced minimalist runners (age 38 ± 10 years, MS running experience 2 ± 1 years) ran with MS and CS for 30 min at 80% of their maximal aerobic speed, and mean pressure, peak pressure, contact time, centre of pressure velocity, relative force and contact area were analysed using a pressure platform. Foot strike pattern and time were also considered as factors. The multivariable linear regression mixed models showed that the use of MS induced, at the end of a prolonged running, higher peak pressure (p = 0.008), lower contact time (p = 0.004) and lower contact area (p < 0.001) than using CS. Also, runners with forefoot strike pattern using MS, compared to midfoot and rearfoot patterns, showed higher mean and peak pressure (p < 0.001) and lower contact time and area (p < 0.05). These results should be considered when planning training for runners using MS, as higher peak pressure values when using this type of footwear could be a risk factor for the development of some foot injuries.

scholarly journals Effect of Achilles tendon lengthening on ankle and subtalar joint orientation and load distribution utilizing a novel cadaveric model to simulate weight bearing

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Naven Duggal ◽  
Patrick Williamson ◽  
Stephen Okajima ◽  
Peter Biggane ◽  
Michael Nasr ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Contact Area ◽  
Subtalar Joint ◽  
Peak Pressure ◽  
Weight Bearing ◽  
Joint Orientation ◽  
Ankle Arthroplasty ◽  
Tendon Lengthening ◽  
Mean Pressure ◽  
Achilles Tendon Lengthening

Category: Basic Sciences/Biologics Introduction/Purpose: Ankle arthroplasties are increasingly performed to address ankle arthritis. Patients with long standing ankle arthritis often present with an associated achilles tendon contracture. An open or percutaneous lengthening of the Achilles is commonly performed at the same time as the ankle arthroplasty to improve range of motion. Current ankle arthroplasty implants include mobile bearing and fixed bearing systems. Lengthening the achilles tendon improves dorsiflexion, however the effect of the lengthening on the ankle and subtalar joint is not well documented in the literature. Using a novel system to simulate weight bearing in a cadaveric model, we evaluated achilles tendon lengthening and its effect on ankle and subtalar joint orientation and load distribution. This may have potential implications to polyethylene implant longevity in total ankle arthroplasties. Methods: Five fresh frozen lower limb cadaveric specimens without known skeletal condition were used. The femoral head was potted with PMMA and TekScan pressure sensors were inserted into the ankle and subtalar joint. The specimens were placed on a custom jig, which allowed for load cell modulated loading of the leg; 75 lb load (half body weight)(4) was applied at the femoral head while the foot was supported against a fixed plate keeping the ankle in neutral position. Mean pressure (MP), peak pressure (PP), contact area (CA), and center of force (COF) were measured in both joints under two conditions; baseline (BASE), and following Achilles tendon release (TENDON) to simulate lengthening. Each condition was tested three times per specimen; the results were averaged per specimen and used for final analysis. Displacement of COF was calculated relative to its location at baseline. Results: The Mean Pressure (MP), Peak Pressure (PP) and Contact Area (CA) did not show a statistical difference in the ankle and subtalar joints between baseline (BASE) and TENDON (Achilles tendon release) conditions. (Table 1). Further, the displacement of the COF from the BASE to TENDON was 0.5 mm. In our model, the contracture of the muscle was not fully simulated. Further hindfoot kinetic studies with active achilles contracture may demonstrate a difference in contact forces in the ankle and subtalar joint as compared to normal. Conclusion: Ankle arthroplasty is becoming an effective treatment option for ankle joint arthritis. Our novel study demonstrates that Achilles tendon lengthening did not change the mean pressure, peak pressure, contact area center of force in the ankle and subtalar joint. This model provides validation for further studies evaluating tendon release and contact pressure changes in a cadaver with an implanted fixed bearing versus mobile bearing total ankle prosthesis. Difference in polyethylene wear may effect the longevity of ankle replacements. This study will provide clinicians additional information when evaluating the benefit/risks associated with lengthening the Achilles tendon for ankle arthroplasty patients.

Pressure Distribution in the Ankle and Subtalar Joint With Routine and Oversized Foot Orthoses

2018 ◽  
Vol 39 (8) ◽  
pp. 994-1000 ◽  
Author(s):  
Patrick Williamson ◽  
Aron Lechtig ◽  
Philip Hanna ◽  
Stephen Okajima ◽  
Peter Biggane ◽  
...  
Keyword(s):  
Contact Area ◽  
Lower Limb ◽  
Subtalar Joint ◽  
Peak Pressure ◽  
Weight Bearing ◽  
Force Distribution ◽  
Foot Orthoses ◽  
Pressure Mapping ◽  
Mean Pressure ◽  
Pressure Peak

Background: Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing. Methods: Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses. Results: The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint. Conclusion: The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint. Clinical Relevance: The use of inappropriate orthoses could negatively impact the force distribution in the lower limb.

scholarly journals The nature and extent of upper limb associated reactions during walking in people with acquired brain injury

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Michelle B. Kahn ◽  
Ross A. Clark ◽  
Gavin Williams ◽  
Kelly J. Bower ◽  
Megan Banky ◽  
...  
Keyword(s):  
Upper Limb ◽  
Walking Speed ◽  
Outcome Measure ◽  
Acquired Brain Injury ◽  
Elbow Flexion ◽  
Group Differences ◽  
Shoulder Abduction ◽  
Wrist Flexion ◽  
Forearm Rotation ◽  
Shoulder Flexion

Abstract Background Upper limb associated reactions (ARs) are common in people with acquired brain injury (ABI). Despite this, there is no gold-standard outcome measure and no kinematic description of this movement disorder. The aim of this study was to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort at matched walking speed intention. Methods A convenience sample of 36 healthy control adults (HCs) and 42 people with ABI who had upper limb ARs during walking were recruited and underwent assessment of their self-selected walking speed using the criterion-reference three dimensional motion analysis (3DMA) at Epworth Hospital, Melbourne. Shoulder flexion, abduction and rotation, elbow flexion, forearm rotation and wrist flexion were assessed. The mean angle, standard deviation (SD), peak joint angles and total joint angle range of motion (ROM) were calculated for each axis across the gait cycle. On a group level, ANCOVA was used to assess the between-group differences for each upper limb kinematic outcome variable. To quantify abnormality prevalence on an individual participant level, the percentage of ABI participants that were outside of the 95% confidence interval of the HC sample for each variable were calculated. Results There were significant between-group differences for all elbow and shoulder abduction outcome variables (p < 0.01), most shoulder flexion variables (except for shoulder extension peak), forearm rotation SD and ROM and for wrist flexion ROM. Elbow flexion and shoulder abduction were the axes most frequently affected by ARs. Despite the elbow being the most prevalently affected (38/42, 90%), a large proportion of participants had abnormality, defined as ±1.96 SD of the HC mean, present at the shoulder (32/42, 76%), forearm (20/42, 48%) and wrist joints (10/42, 24%). Conclusion This study provides valuable information on ARs, and highlights the need for clinical assessment of ARs to include all of the major joints of the upper limb. This may inform the development of a criterion-reference outcome measure or classification system specific to ARs.

scholarly journals Effect of Distal Tibial Varus and Valgus Deformity on Tibiotalar Joint Contact

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0025
Author(s):  
Zhao Hong-Mou
Keyword(s):  
Contact Pressure ◽  
Ankle Joint ◽  
Contact Area ◽  
Peak Pressure ◽  
Tibiotalar Joint ◽  
Force Center ◽  
Fibular Osteotomy ◽  
Group I ◽  
Joint Contact ◽  
Group A

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: To study the effect of different degrees of distal tibial varus and valgus deformities on the tibiotalar joint contact, and to understand the role of fibular osteotomy. Methods: Eight cadaveric lower legs were used for biomechanical study. Nine conditions were included: normal ankle joint (group A), 10° varus (group B), 5° varus (group C), 5° valgus (group D), 10° valgus (group E) with fibular preserved, and 10° varus (group F), 5° varus (group G), 5° valgus (group H), and 10° valgus (group I) after fibular osteotomy. The joint contact area, contact pressure, and peak pressure were tested; and the translation of contact force center was observed. Results: The joint contact area, contact pressure, and peak pressure had no significant difference between group A and groups B to E (P>0.05). After fibular osteotomy, the contact area decreased significantly in groups F and I when compared with group A (P<0.05); the contact pressure increased significantly in groups F, H, and I when compared with group A (P<0.05); the peak pressure increased significantly in groups F and I when compared with group A (P<0.05). There were two main anterior-lateral and anterior-medial contact centers in normal tibiotalar joint, respectively; and the force center was in anterior-lateral part, just near the center of tibiotalar joint. While the fibula was preserved, the force center transferred laterally with increased varus angles; and the force center transferred medially with increased valgus angles. However, the force center transferred oppositely to the medial part with increased varus angles, and laterally with increased valgus angles after fibular osteotomy. Conclusion: Fibular osteotomy facilitates the tibiotalar contact pressure translation, and is helpful for ankle joint realignment in suitable cases.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

The Safety of the Esmarch Tourniquet

Foot & Ankle ◽  
1993 ◽  
Vol 14 (5) ◽  
pp. 278-283 ◽  
Author(s):  
William C. Biehl ◽  
James M. Morgan ◽  
F. William Wagner ◽  
Rodney A. Gabriel
Keyword(s):  
Learning Curve ◽  
Clinical Application ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Surgical Case ◽  
Significant Difference ◽  
Mean Pressure ◽  
Continued Use

The use of an Esmarch bandage as a tourniquet in surgery has been criticized. Many authors claim that the pressures under the Esmarch are inconsistent and may be extremely high. We have seen few, if any, problems from the use of an Esmarch in surgery of the foot and ankle. The purpose of this study was to evaluate the pressures generated under the Esmarch tourniquet in a situation that mimics its clinical application, and to determine whether pressures of appropriate magnitude and consistency are obtained in order to recommend its continued use in surgery. Ten volunteers performed numerous applications of the Esmarch. The number of wraps and the width of the Esmarch bandage used were varied. The Esmarch was applied as it would be for a surgical case. Pressures directly beneath the Esmarch were recorded 8 cm proximal to the distal tip of the medial malleolus. Considering all volunteers and all pressures generated, a 3-in Esmarch applied with three wraps gave a mean pressure (±SD) of 225 ± 46 mm Hg. A 3-in Esmarch applied with four wraps gave a mean pressure of 291 ± 53 mm Hg. A 4-in Esmarch applied with three wraps gave a mean pressure of 233 ± 35 mm Hg, and a 4-in Esmarch with four wraps gave a mean pressure of 284 ± 42 mm Hg. The maximum pressures generated by any individual were as follows: 3-in three wraps, 321 mm Hg; 3-in four wraps, 413 mm Hg; 4-in three wraps, 328 mm Hg; and 4-in four wraps, 380 mm Hg. There was no significant difference in the magnitude or consistency of pressures generated between the experienced and inexperienced wrappers. There did not appear to be a learning curve for the application of the Esmarch bandage. We conclude that an Esmarch bandage, used as a tourniquet, can generate safe and reliable pressures. Either a 3-in or 4-in Esmarch bandage applied above the ankle with three circumferential overlapping wraps consistently results in pressures that are in a safe range.

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