Pediatric Replantation after Traumatic Amputation at the Distal Forearm: Rehabilitation Protocol and Outcomes

2020 ◽  
Author(s):  
Nicholas C. Oleck ◽  
Radhika Malhotra ◽  
Haripriya S. Ayyala ◽  
Ramazi O. Datiashvili
Keyword(s):  
Operating Room ◽  
Multidisciplinary Team ◽  
Distal Forearm ◽  
Left Forearm ◽  
Traumatic Amputation ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Microsurgical Technique ◽  
Optimal Function ◽  
And Function

AbstractMajor limb replantation is a formidable task, especially in the pediatric setting. While meticulous microsurgical technique is required in the operating room, the authors aim to highlight the importance of postoperative rehabilitation therapy for optimal function. We highlight the case of a 12-year-old boy who suffered complete traumatic amputation through the distal left forearm. The limb was successfully replanted with successful restoration of sensation and function with the aid of intensive postoperative occupational therapy. A multidisciplinary team is of paramount importance to maximize function of a replanted upper extremity.

scholarly journals Retear rates after rotator cuff surgery: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Umile Giuseppe Longo ◽  
Arianna Carnevale ◽  
Ilaria Piergentili ◽  
Alessandra Berton ◽  
Vincenzo Candela ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Meta Analysis ◽  
Fatty Infiltration ◽  
Surgical Techniques ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Factors Influencing ◽  
Main Factors ◽  
Tear Size

Abstract Background Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. Methods A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. Results Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). Conclusions Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

scholarly journals Multidisciplinary conservative management in classical Volkmann's contracture: A case report

1996 ◽  
Vol 20 (3) ◽  
pp. 199-202 ◽  
Author(s):  
M. F. Reinders ◽  
J. H. B. Geertzen ◽  
W. H. Eisma
Keyword(s):  
Case Report ◽  
Conservative Management ◽  
Multidisciplinary Team ◽  
Left Forearm ◽  
Clinical Note ◽  
Volkmann’S Contracture ◽  
Volkmann's Contracture

This clinical note describes the case of a nine-year-old girl with classical Volkmann's contracture of the left forearm. The report demonstrates the results and follow-up of conservative orthotic management used as a mode of treatment by a multidisciplinary team. When using an orthosis it is essential to check regularly to attain the desired result.

Importance of Maintaining Normal Nasal Function in the Cleft Palate Patient

1992 ◽  
Vol 29 (6) ◽  
pp. 498-506 ◽  
Author(s):  
Ralph F. Wetmore
Keyword(s):  
Chronic Infection ◽  
Adenoid Tissue ◽  
External Nose ◽  
Nasal Anatomy ◽  
Optimal Function ◽  
The Face ◽  
And Function ◽  
Nasal Function ◽  
Palate Patient ◽  
Lateral Walls

The external nose is a structure that provides prominence to the face. The internal nose is a paired nasal cavity that extends from the face to the pharynx. Turbinates are major structures within the lateral walls of the nose. They perform the major functions of the nose that include respiration, humidification, temperature regulation, and filtration of the inspired air. Conditions that obstruct the nose interfere with its optimal function. These range from acute or chronic infection to enlarged tonsils and adenoid tissue to nasal septal deviation. Surgeons caring for patients with clefts must have familiarity with nasal anatomy and function and conditions that alter them. Correction of these conditions may require medical and/or surgical treatment.

Effect of Suture Caliber and Number of Core Strands on Repair of Acute Achilles Ruptures: A Biomechanical Study

2017 ◽  
Vol 38 (5) ◽  
pp. 564-570 ◽  
Author(s):  
Jonathon D. Backus ◽  
Daniel Cole Marchetti ◽  
Erik L. Slette ◽  
Kimi D. Dahl ◽  
Travis Lee Turnbull ◽  
...  
Keyword(s):  
Biomechanical Study ◽  
Published Data ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Advanced Stages ◽  
Number Of Cycles ◽  
Active Patients ◽  
Repair Group ◽  
Cycles To Failure ◽  
The Ideal

Background: Controversy exists regarding the ideal Achilles rupture treatment; however, operative treatment is considered for athletes and active patients. The ideal repair construct is evolving, and the effect of suture caliber or number of core strands has not been studied. Methods: Simulated mid-substance Achilles ruptures were performed in 24 cadavers. Specimens were randomized to three 6-core-strand style repair constructs: (1) 4 No. 2 sutures and two 2-mm tapes (2T); (2) 2 No. 2 sutures and four 2-mm tapes (4T); (3) 12 (double-6-strand) strand repair (12 No. 2-0 sutures [12S]). Repairs were subjected to a cyclic loading protocol representative of postoperative rehabilitation. These data were compared to a previously published standard open repair technique (6-core strands with No. 2 sutures) on 9 specimens tested under the same conditions.6 Results: No significant elongation differences were observed between the repair groups and the previously published standard repair group in the first 2 stages of the simulated rehabilitation protocol. Both the 2T and 12S repairs survived a significantly greater number of cycles to failure ( P = 0.0005, P = 0.0267, respectively) and had a significantly higher failure load ( P = .0005, P = .0118, respectively) compared to the previously published data. These 2 constructs consistently survived the advanced stages of the simulated rehabilitation protocol. The majority of repairs failed at the knots. Conclusions: In this study, the 2T and 12S constructs survived the later stages of our simulated rehabilitation protocol, suggesting that they may be able to accommodate a more aggressive clinical rehabilitation protocol. Substituting suture-tape for 2 core strands or doubling the core strands with a smaller-caliber suture created a biomechanically stronger construct. Clinical Relevance: Achilles repair with an added nonabsorbable, high–tensile strength tape allowed for a stronger construct that may allow for a more aggressive, early rehabilitation protocol and earlier return to function.

scholarly journals The Hsp70 chaperone system: distinct roles in erythrocyte formation and maintenance

Haematologica ◽  
2021 ◽  
Author(s):  
Yasith Mathangasinghe ◽  
Bruno Fauvet ◽  
Stephen M. Jane ◽  
Pierre Goloubinoff ◽  
Nadinath B. Nillegoda
Keyword(s):  
Cell Differentiation ◽  
Protein Quality ◽  
Cellular Protein ◽  
Ineffective Erythropoiesis ◽  
Protein Repair ◽  
Hematological Diseases ◽  
Wide Range ◽  
Hsp70 Chaperone ◽  
Optimal Function ◽  
And Function

Erythropoiesis is a tightly regulated cell differentiation process in which specialized oxygen- and carbon dioxide-carrying red blood cells are generated in vertebrates. Extensive reorganization and depletion of the erythroblast proteome leading to the deterioration of general cellular protein quality control pathways and rapid hemoglobin biogenesis rates could generate misfolded/aggregated proteins and trigger proteotoxic stresses during erythropoiesis. Such cytotoxic conditions could prevent proper cell differentiation resulting in premature apoptosis of erythroblasts (ineffective erythropoiesis). The heat shock protein 70 (Hsp70) molecular chaperone system supports a plethora of functions that help maintain cellular protein homeostasis (proteostasis) and promote red blood cell differentiation and survival. Recent findings show that abnormalities in the expression, localization and function of the members of this chaperone system are linked to ineffective erythropoiesis in multiple hematological diseases in humans. In this review, we present latest advances in our understanding of the distinct functions of this chaperone system in differentiating erythroblasts and terminally differentiated mature erythrocytes. We present new insights into the protein repair-only function(s) of the Hsp70 system, perhaps to minimize protein degradation in mature erythrocytes to warrant their optimal function and survival in the vasculature under healthy conditions. The work also discusses the modulatory roles of this chaperone system in a wide range of hematological diseases and the therapeutic gain of targeting Hsp70.

scholarly journals Clinical Case Report: Postoperative Rehabilitation Protocol for Spondylolisthesis in Korean Medicine Treatment

2021 ◽  
Vol 31 (1) ◽  
pp. 165-173
Author(s):  
Eun-Byeol Lee ◽  
Na-Ri Park ◽  
Yun-Jin Lee ◽  
Seok-Beom Kang ◽  
Chang-Hoon Woo ◽  
...  
Keyword(s):  
Case Report ◽  
Clinical Case ◽  
Postoperative Rehabilitation ◽  
Korean Medicine ◽  
Rehabilitation Protocol

scholarly journals Long-term evaluation of pediatric ACL reconstruction: high risk of further surgery but a restrictive postoperative management was related to a lower revision rate

2021 ◽  
Author(s):  
Frida Hansson ◽  
Eva Bengtsson Moström ◽  
Magnus Forssblad ◽  
Anders Stålman ◽  
Per-Mats Janarv
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Revision Rate ◽  
Weight Bearing ◽  
Multivariable Logistic Regression Analysis ◽  
Return To Sports ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
The Mean

Abstract Introduction The guidelines regarding rehabilitation after pediatric anterior cruciate ligament reconstruction (ACLR) are sparse. The aim of the study was to retrospectively describe the long-term outcome regarding further surgery and with special emphasis on the revision rate after two different postoperative rehabilitation programs following pediatric ACLR. Material and methods 193 consecutive patients < 15 years of age who had undergone ACLR at two centers, A (n = 116) and B (n = 77), in 2006–2010 were identified. Postoperative rehabilitation protocol at A: a brace locked in 30° of flexion with partial weight bearing for 3 weeks followed by another 3 weeks in the brace with limited range of motion 10°–90° and full weight bearing; return to sports after a minimum of 9 months. B: immediate free range of motion and weight bearing as tolerated; return to sports after a minimum of 6 months. The mean follow-up time was 6.9 (range 5–9) years. The mean age at ACLR was 13.2 years (range 7–14) years. The primary outcome measurement in the statistical analysis was the occurrence of revision. Multivariable logistic regression analysis was performed to investigate five potential risk factors: surgical center, sex, age at ACLR, time from injury to ACLR and graft diameter. Results Thirty-three percent had further surgery in the operated knee including a revision rate of 12%. Twelve percent underwent ACLR in the contralateral knee. The only significant variable in the statistical analysis according to the multivariable logistic regression analysis was surgical center (p = 0.019). Eight percent of the patients at center A and 19% of the patients at B underwent ACL revision. Conclusions Further surgery in the operated knee could be expected in one third of the cases including a revision rate of 12%. The study also disclosed a similar rate of contralateral ACLR at 12%. The revision rate following pediatric ACLR was lower in a center which applied a more restrictive rehabilitation protocol. Level of evidence Case-control study, Level III.

scholarly journals Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711875511 ◽  
Author(s):  
Harry M. Lightsey ◽  
David E. Kantrowitz ◽  
Hasani W. Swindell ◽  
David P. Trofa ◽  
Christopher S. Ahmad ◽  
...  
Keyword(s):  
United States ◽  
Range Of Motion ◽  
Tendon Repair ◽  
Hamstring Tendon ◽  
Search Term ◽  
Postoperative Rehabilitation ◽  
Professional Literature ◽  
Rehabilitation Protocol ◽  
Rehabilitation Protocols ◽  
Proximal Hamstring

Background: The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities. Purpose: To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs. Study Design: Cross-sectional study. Methods: Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term complete proximal hamstring repair rehabilitation protocol provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced. Results: Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises. Fifteen protocols (43%) required completion of specific return-to-sport criteria before resuming training. Conclusion: Marked variability is found in both the composition and timing of rehabilitation components across the various complete proximal hamstring repair rehabilitation protocols published online. This finding mirrors the variability of proposed rehabilitation protocols in the professional literature and represents an opportunity to improve patient care.

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