Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery

The objective of this study was to assess the effectiveness of, and the correlation between, an average of 42 supervised physiotherapy (SVPh) visits for the vertical ground reaction forces component (vGRF) using ankle hops during two- and one-legged vertical hops (TLH and OLH, respectively), six months after the surgical suturing of the Achilles tendon using the open method (SSATOM) via Keesler’s technique. Hypothesis: Six months of supervised physiotherapy with a higher number of visits (SPHNVs) was positively correlated with higher vGRF values during TLH and OLH. Group I comprised male patients (n = 23) after SSATOM (SVPh x = 42 visits), and Group II comprised males (n = 23) without Achilles tendon injuries. In the study groups, vGRF was measured during TLH and OLH in the landing phase using two force plates. The vGRF was normalized to the body mass. The limb symmetry index (LSI) of vGRF values was calculated. The ranges of motion of the foot and circumferences of the ankle joint and shin were measured. Then, 10 m unassisted walking, the Thompson test, and pain were assessed. A parametric test for dependent and independent samples, ANOVA and Tukey’s test for between-group comparisons, and linear Pearson’s correlation coefficient calculations were performed. Group I revealed significantly lower vGRF values during TLH and OLH for the operated limb and LSI values compared with the right and left legs in Group II (p ≤ 0.001). A larger number of visits correlates with higher vGRF values for the operated limb during TLH (r = 0.503; p = 0.014) and OLH (r = 0.505; p = 0.014). An average of 42 SVPh visits in 6 months was insufficient to obtain similar values of relative vGRF and their LSI during TLH and OLH, but the hypothesis was confirmed that SPHNVs correlate with higher relative vGRF values during TLH and OLH in the landing phase.

On rehabilitation of patients with severe traumatic hand injury (case history)

Reconstruction of flexor tendons anatomic continuity at the level of osteofibrous canals is one of the most challenging in hand surgery. Due to the complex anatomy of the hand and a high risk of developing postoperative adhesions choosing the optimal treatment protocol remains crucial during flexor tendons rehabilitation period. Surgeons and rehabilitation specialists agree that a number of poor results of flexor tendon surgery can be caused by a wrong postoperative treatment, violation of treatment protocols or just by the lack of adequate rehabilitation measures. The aim of this study is analysis and the description of the case history of treating the teenager with concomitant hand injury after staged reconstructive and restorative nerve and tendon surgery. Materials and methods. The study analyses the use of intratissual electric stimulation (ITES) combined with the complex of special exercises for recovery of upper extremity function at the outpatient rehabilitation stage in patients who underwent nerve and tendon surgery. The objective pain syndrome and trophic innervation of the injured extremity assessment was performed by measuring skin surface electric potential using Gerasimov’s method. The results were interpreted according to “Personalized system of assessing the results of treating trauma and orthopedic patients”. Results. “Combination treatment in the rehabilitation of the upper extremity” proved to be effective to fight pain syndrome and trophic dysfunction of the nervous system. It allows the patient to do the complex of special exercises to prevent limb contracture if used during the late rehabilitation period. It is an efficient method of preventing and treating neurotrophic dysfunctions. Conclusion. The pathogenetically substantiated method of treating upper extremity, the use of intratissual electric stimulation at the outpatient rehabilitation stage of humerus fractures prove to be effective.

Corrective Osteotomies for Digital Overlap in Phalangeal and Metacarpal Fracture Malunion Using Wide Awake Local Anesthesia No Tourniquet (WALANT) Technique: A Technical Note

The use of wide-awake local anesthesia with no tourniquet (WALANT) in surgical procedures of the hand is well described and extends to tendon surgery, carpal tunnel release, trapeziectomy and phalangeal fracture fixation. Its use has not been described in corrective osteotomies of phalangeal or metacarpal fracture malunion. In our series of five patients who underwent phalangeal and metacarpal osteotomies under WALANT, all of the patients achieved union at a mean of 3.5 months and were satisfied with the results. All digital malrotations were corrected. There was an improvement of motion and grip strength by 24% and 29.3% respectively compared to pre-surgery. Corrective osteotomies under WALANT is a safe and effective means of achieving correction of scissoring. With the patient wide awake and cooperating, precise correction of rotational alignment can be ascertained. Concomitant tenolysis allows motion gains to be made over and above the restoration of rotational alignment.

Contamination of the Mini C-Arm During Foot and Ankle Surgery

Background: Many orthopedic surgeries utilize intraoperative fluoroscopy. The mini C-arm is an advantageous device as it can be easily used without the need for a dedicated radiology technician. However, there are concerns that the mini C-arm may represent a potential source of contamination and subsequent postoperative infection. Previous investigations of standard C-arm drapes have shown high rates of contamination. Similar contamination rates would be even more concerning for the mini C-arm as it requires physically maneuvering the machine. This study aimed to determine the rate of mini C-arm drape contamination and identify high-risk areas. Methods: Fifty foot and ankle surgeries requiring the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were sampled at the conclusion of each procedure. Culture Q-swabs were used for sampling defined locations. Swab samples were then assessed for bacterial growth on a 5% blood agar plate using a semiquantitative technique. Results: In 70% of surgical cases, contamination was observed in at least 1 location. Six of the 8 evaluated locations were found to have significantly higher contamination in comparison with their corresponding negative controls (Mann-Whitney U test, P < .05). The “outer portion of the upper arm” (location 1) exhibited bacteria growth in 26% ( P < .0001) of cases. The “superior portion of the x-ray source” (location 2) exhibited growth in 30% ( P < .0001) of cases. These were the highest-risk areas for contamination and were both significantly more likely to be involved than the “inferior portion of the x-ray source” and “superior portion of the beam receiver,” locations 4 and 5, respectively. Fourteen percent (7/50) C-arm cases and 1.72% (1/58) Achilles tendon surgery control cases developed surgical site infection ( P = .0234; OR, 9.27). Conclusion: Bacterial contamination of the mini C-arm drape was found to be common after foot and ankle procedures. Contamination was more prevalent on the outer ring areas of the C-arm, both at the emitter and receiver. Level of Evidence: Level III.