Parameters of functional activity in elderly and senile women with polymorbidity and risk of sarcopenia

Objectives to identify the correlations between the Charlson comorbidity index and the results of functional activity tests as predictors of sarcopenia among elderly and senile women with polymorbidity. Material and methods. The study included 269 elderly and senile women aged from 65 to 84 years, having polypathology. Results. Sarcopenia was detected in 14.63% of the elderly, and in 27.40% of senile women. The Charlson comorbidity index was associated with the risk of progression of frailty, a decrease in basic functional activity, increased muscle weakness and impaired function of skeletal muscles. Conclusion. Dynamometry and functional activity tests can be used in clinical practice to diagnose sarcopenia syndrome in elderly and senile women.

Can PROMIS measures be used to create subgroups for patients seeking orthopaedic care?

Aims Patient-reported outcome measures have become an important part of routine care. The aim of this study was to determine if Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used to create patient subgroups for individuals seeking orthopaedic care. Methods This was a cross-sectional study of patients from Duke University Department of Orthopaedic Surgery clinics (14 ambulatory and four hospital-based). There were two separate cohorts recruited by convenience sampling (i.e. patients were included in the analysis only if they completed PROMIS measures during a new patient visit). Cohort #1 (n = 12,141; December 2017 to December 2018,) included PROMIS short forms for eight domains (Physical Function, Pain Interference, Pain Intensity, Depression, Anxiety, Sleep Quality, Participation in Social Roles, and Fatigue) and Cohort #2 (n = 4,638; January 2019 to August 2019) included PROMIS Computer Adaptive Testing instruments for four domains (Physical Function, Pain Interference, Depression, and Sleep Quality). Cluster analysis (K-means method) empirically derived subgroups and subgroup differences in clinical and sociodemographic factors were identified with one-way analysis of variance. Results Cluster analysis yielded four subgroups with similar clinical characteristics in Cohort #1 and #2. The subgroups were: 1) Normal Function: within normal limits in Physical Function, Pain Interference, Depression, and Sleep Quality; 2) Mild Impairment: mild deficits in Physical Function, Pain Interference, and Sleep Quality but with Depression within normal limits; 3) Impaired Function, Not Distressed: moderate deficits in Physical Function and Pain Interference, but within normal limits for Depression and Sleep Quality; and 4) Impaired Function, Distressed: moderate (Physical Function, Pain Interference, and Sleep Quality) and mild (Depression) deficits. Conclusion These findings suggest orthopaedic patient subgroups differing in physical function, pain, and psychosocial distress can be created from as few as four different PROMIS measures. Longitudinal research is necessary to determine whether these subgroups have prognostic validity. Cite this article: Bone Jt Open 2021;2(7):493–502.

The state of the problem of fractures of the distal metepiphysis of the humerus in children and adolescents

Annotation. One of the most frequent injuries of the distal end of the humerus is the trans-condylar and supracondylar fractures of the humerus, which make up 47.5-80% of all intraarticular fractures of the elbow joint in children. Among the injuries of the distal humerus, the supracondylar and supracondylar fractures occur with the greatest frequency and is one of the most common domestic injuries in children aged 3 to 12 years. Our work is based on a retrospective analysis of the treatment of 255 patients treated in the Lviv City Children's Hospital for the period 2013-2017. 83.1% of patients were diagnosed with flexion fracture, 16.9% – flexion fracture. Transvertebral fractures of the shoulder were diagnosed in 85.5% of cases of the study array, supragingival – in 14.5%. The treatment of patients with the consequences of injuries of the elbow joint presents great difficulties and remains one of the most difficult problems in pediatric traumatology. Depending on the presence of rotational displacement and the severity of the fracture, the following types of treatment are most often used: conservative, osteosynthesis with spokes or Ilizarov apparatus. An ideal reposition and stable fixation of fragments during these injuries is necessary not only to ensure timely consolidation of the fracture, restoration of the anatomical integrity and shape of the distal humerus, but also to prevent the development of deformation in the elbow joint. Deformations of the elbow joint during supracondylar and supracondylar fractures of the shoulder, unlike deformation of another localization, cannot be adjusted and subsequently only increase and as a result can lead to impaired function of the elbow joint, and often to disability already in childhood. Thus, complicated anatomical localization of supracondylar and supracondylar fractures of the humerus in children, great technical difficulties in comparing and fixing fragments, there is a high probability of neurological and vascular disorders, both at the time of injury and during the provision of medical care, impaired function of the elbow joint determine the need for further study of this problem.

Cervico-thoracic pain and associated impairments in air force personnel: a cross-sectional study

Background Pain and impaired function in the cervical region are common in Air Force personnel (AFP), but evidence is limited regarding the thoracic region. This cross-sectional cohort study examined associations between cervico-thoracic pain and physical performance among Swedish AFP and explored possible differences and similarities in test performance between fighter pilots (FP), helicopter pilots (HP) and rear crew (RC). Methods AFP (n = 73) from one airbase performed eight tests of movement control of the spine, active cervical range of motion (ROM) in all six directions and isometric strength and endurance of the cervical flexors and extensors. The association between test performance and cervico-thoracic pain (based on the ‘Musculoskeletal screening protocol’ questionnaire) were analysed in a multiple binary logistic regression model. Results For AFP with cervico-thoracic pain (30%), movement control was impaired in the ‘neck flexion test’ (OR [95%CI] =3.61 [1.06–12.34]) and the ‘forward lean test’ (OR [95%CI] =3.43[1.04–11.37]), together with reduced flexion ROM (OR [95%CI] =0.93 [0.87–0.99]). Test performance was in general similar between the three groups, but FP and HP could control the ‘forward lean test’ to a significantly higher degree than RC (p = 0.000). Further, FP showed significantly greater ROM in lateral flexion to the right compared to HP and RC (mean: 40.3°, 36.2° and 33.4°, respectively, p = 0.000), and they showed higher, although not significant, flexor strength than RC (p = 0.026). Conclusions The impaired function associated with cervico-thoracic pain highlights the need for a deeper understanding of such relationships when designing tools to systematically optimize the physical performance and prevent pain among AFP. Studies with a longitudinal design are warranted to examine any causative associations between pain and impairments.

Cervico-thoracic pain and associated impairments in air force personnel: a cross-sectional cohort study

Background:Pain and impaired function in the cervical region is common in Air Force personnel (AFP), but evidence is limited regarding the thoracic region. This cross-sectional cohort study examined associations between cervico-thoracic pain and physical performance among Swedish AFP and explored possible differences and similarities in test performance between fighter pilots (FP), helicopter pilots (HP) and rear crew (RC).Methods:AFP (n=73) from one airbase performed eight tests of movement control of the spine, active cervical range of motion (ROM) in all six directions and isometric strength and endurance of the cervical flexors and extensors. The association between test performance and cervico-thoracic pain (based on the ´Musculoskeletal screening protocol´ questionnaire) were analysed in a multiple binary logistic regression model.Results:For AFP with cervico-thoracic pain (30%), movement control was impaired in neck flexion (OR=3.61) and forward lean (OR=3.43) tests, together with reduced flexion ROM (OR=0.93). Test performance was in general similar between the three groups, but FP and HP could control the forward lean test to a higher degree than RC (p=0.000), FP were more flexible in lateral flexion to the right compared to HP and RC (p=0.000) and they showed higher flexor strength than RC (p=0.015).Conclusions:The impaired function associated with cervico-thoracic pain highlights the need for a deeper understanding of such relationships when designing tools to systematically optimize the physical performance and prevent pain among AFP. Studies with a longitudinal design are warranted to examine any causative associations between pain and impairments.