A Comparative Study of Pediatric Fracture Shaft Femur Fixating by Plate and Screws Using Lateral Approach Between Subvastus Lateralis and Transvastus Lateralis Outcome

BACKGROUND: Femoral shaft fracture is a common fracture in pediatric age group reaching 62% of all fracture shaft femur in children in spite of rapid union rate and successful conservative treatment but some cases need surgical intervention and one of the methods using plate and screw by the lateral approach. AIM: This study aims to compare functional outcome fixation of mid-shaft femur fracture in children by plate and screws between (subvastus lateralis and transvastus lateralis) regarding infection, union, and limitation of knee movement. PATIENT AND METHOD: The study was done on 30 children who had diaphyseal fracture femur in Al-Kindy Teaching Hospital in period (April 2018–April 2020) with 6 months follow-up, and the patient was divided into two groups: Group A first treated by subvastus lateral approach 15 patients and the second group, Group B by transvastus lateral approach 15 patients and follow-up done for them after 2 weeks, 4 weeks, 6 weeks, 3 months, and 6 months. RESULTS: At week 16 of follow-up all patients in Group A had union, while in Group B, 14 of 50 patients had union and one patient had no union and one patient in Group B had an infection when compared to Group A. From 15 patients of Group A, two patients had limitation of knee movement in the 1st month of follow-up then in the 3rd month of follow-up, no patient had limitation of knee joint movement, while five patients had limitation of knee joint movement in Group B in the 1st month of follow-up and one patient had limitation knee joint movement in the 3rd month of follow-up. CONCLUSIONS: The subvastus lateralis approach results better than transvastus lateralis in union.

Transient Thermal Analysis of a Magnetorheological Knee for Prostheses and Exoskeletons during Over-Ground Walking

Proper knee movement is essential for accomplishing the mobility daily tasks such as walking, get up from a chair and going up and down stairs. Although the technological advances in active knee actuators for prostheses and exoskeletons to help impaired people in the last decade, they still present several usage limitations such as overweight or limited mechanical power and torque. To address such limitations, we developed the Active Magnetorheological Knee (AMRK) that comprises a Motor Unit (MU), which is a motor-reducer (EC motor and Harmonic Drive) and a MR clutch, that works in parallel to a magnetorheological (MR) brake. Magnetorheological fluids, employed in the MR clutch and brake, are smart materials that have their rheological properties controlled by an induced magnetic field and have been used for different purposes. With this configuration the actuator can work as a motor, clutch or brake and can perform similar movements than a healthy knee. However, the stability, control, and life of magnetorheological fluids critically depend on the working temperature. By reaching a certain temperature limit, the fluid additives quickly deteriorate, leading to irreversible changes of the MR fluid. In this study, we perform a transient thermal analysis of the AMRK, when it is used for walking over-ground, to access possible fluid degradation and user’s discomfort due overheating. The resulting shear stress in the MR clutch and brake generates heat, increasing the fluid temperature during the operation. However, to avoid overheating, we proposed a mode of operation for over-ground walking aiming to minimize the heat generation on the MR clutch and brake. Other heat sources inside the actuator are the coils, which generate the magnetic fields for the MR fluid, bearings, EC motor and harmonic drive. Results show that the MR fluid of the brake can reach up to 31°C after a 6.0 km walk, so the AMRK can be used for the proposed function without risks of fluid degradation or discomfort for the user.

Modeling the resistance mechanism of passive knee joint flexion and extension for use in rehabilitation equipment

The purpose of this study was to model the resistance mechanism of Passive Knee Joint Flexion and Extension to create a similar torque mechanism in rehabilitation equipment. In order to better model the behavior of passive knee tissues, it is necessary to exactly calculate the two coefficients of elasticity of time-independent and time-dependent parts. Ten healthy male volunteers (mean height 176.4+/−4.59 cm) participated in this study. Passive knee joint flexion and extension occurred at velocities of 15, 45, and 120 (degree/s), and in five consecutive cycles and within the range of 0 to 100° of knee movement on the sagittal plane on Cybex isokinetic dynamometer. To ensure that the muscles were relaxed, the electrical activity of knee muscles was recorded. The elastic coefficient, (KS) increased with elevating the passive velocity in flexion and extension. The elastic coefficient, (KP) was observed to grow with the passive velocity increase. While, the viscous coefficient (C) diminished with passive velocity rise in extension and flexion. The heightened passive velocity of the motion resulted in increased hysteresis (at a rate of 42%). The desired of passive velocity is lower so that there is less energy lost and the viscoelastic resistance of the tissue in the movement decreases. The Coefficient of Determination, R2 between the model-responses and experimental curves in the extension was 0.96 < R2 < 0.99 and in flexion was 0.95 < R2 < 0.99. This modeling is capable of predicting the true performance of the components of passive knee movement and we can create a resistance mechanism in the rehabilitation equipment to perform knee joint movement. Quantitative measurements of two elastic coefficients of Time-independent and Time-dependent parts passive knee joint coefficients should be used for better accurate simulation the behavior of passive tissues in the knee which is not seen in other studies.

The Medial-Lateral Pedal Force Component Correlates with Q-Angle during Steady-State Cycling at Different Workloads and Cadences

Leg movement during cycling is constrained to the pedal/crank path and predominantly occurs in a sagittal plane. Medial-lateral force (FML) applied to the pedals is considered as a waste and does not contribute to the pedaling. The aim of this study was to examine the changes in FML across different cadences and workloads, and to examine the correlation with lateral knee movement (Q-angle). Twenty-two cyclists completed six trials at three workloads (2, 2.5 and 3 W/kg) and three cadences (75, 85, 95 rpm). Forces were recorded from the force pedal mounted to the left side. Absolute and normalized (to the peak total force) FML were compared across conditions and cross-correlation with Q-angle was calculated. Absolute FML was significantly different across cadences and workloads (p < 0.05) with higher absolute FML at higher cadence. There was no significant difference in normalized FML across the three cadences. There was a significant decrease in normalized FML (~10 N) at higher workloads. Statistically significant correlations were found between the FML and Q-angle (R = 0.70–0.77). The results demonstrate the link between the FML and Q-angle in healthy pain-free cyclists during stationary cycling. It has also been observed that smaller normalized magnitude of the FML is present when the force effectiveness is increased.

Postoperative Ultrasound as a Predictor of Newborn Function and Ambulation after Open Fetal Myelomeningocele Repair

<b><i>Objective:</i></b> Function of the lower extremities after prenatal myelomeningocele (MMC) repair is best assessed with ambulatory function at 30–36 months of age, but parents often ask about function before this milestone. Lower extremity movement can be assessed by ultrasound (US) and at the newborn exam (NE), but correlation between US, NE, and ambulation is not firmly established. <b><i>Methods:</i></b> This was a retrospective correlation study of fetuses that underwent open prenatal MMC repair at SSM Cardinal Glennon Fetal Care Institute, St. Louis, MO, between January 2011 and June 2017. Movement at the ankles, knees, and hips was assessed by US after open repair on postoperative days (PODs) 0–5 and at 32 weeks gestation. NE was performed by physical therapy or neurosurgery within the first month of life, and pediatric follow-up between 30 and 36 months of age was obtained to document ambulation. <b><i>Results:</i></b> Forty-two fetuses were included. Joint movement seen on US varied by POD: it was present on POD 1 in 7% of fetuses and 62% by POD 5. Degree of ventriculomegaly, lesion level, and lesion length did not have a significant effect on US, NE, or ambulation. Knee movement on POD 3 correlated with knee movement at NE (<i>k</i> = 0.58, <i>p</i> &#x3c; 0.01), but only later knee movement correlated with ambulation (<i>k</i> = 0.28–0.46, <i>p</i> = 0.01). Hip movement at 32 weeks was the only single joint assessment that correlated with NE and ambulation (<i>k</i> = 0.45 and 0.46, <i>p</i> = 0.03 and 0.01, respectively). <b><i>Conclusion:</i></b> Lower extremity movement increases between POD 1 and POD 5 in fetuses after open fetal MMC repair. Knee and hip movement on US at 32 weeks correlates with ambulation at 30–36 months. These data may inform counseling, and direct therapy and spark prospective investigations.

Evaluating measurement accuracy and repeatability with a new device that records spatial knee movement

Purpose: A novel portable system has been used to evaluate spatial knee movement, but its accuracy and repeatability is not known. The aim of this study was to investigate the accuracy and repeatability of the measurement. Methods: Ten healthy participants were included, and the knee motion trajectory during walking were assessed. Six evaluations were conducted (three days by two raters) for each participant. The motion parameters at the key points and the range of motion were statistically analyzed. Intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and the Bland–Altman method were used. Results: For intra-rater repeatability, 1) the ICC values range from 0.75 to 0.9 for rotations; and 0.64 to 0.96 for translations. Among the ICC values, 100% of rotations and 90% of translations were not less than 0.70; 2) among the SEM values, 100% of rotations were not more than 5°, while 73.3% of translations were less than 3 mm. For inter-rater repeatability, 1) the ICC values range from 0.68 to 0.99 for rotations; and 0.57 to 0.93 for translations. Among the ICC values, 95.6% of rotations and 82.2% of translations were not less than 0.70; 2) among the SEM values, 100% of rotations were not more than 5°, and 48.9% of translations were less than 3 mm. The Bland–Altman plots showed good agreement for intra- and inter- repeatability. Conclusions: The results indicated that the accuracy and repeatability of the measurement were acceptable, except for the inter-rater repeatability for translation. This may help researchers and physicians better interpret the measurement data.

Estimation of Knee Movement from Surface EMG Using Random Forest with Principal Component Analysis

To study the relationship between surface electromyography (sEMG) and joint movement, and to provide reliable reference information for the exoskeleton control, the sEMG and the corresponding movement of the knee during the normal walking of adults have been measured. After processing the experimental data, the estimation model for knee movement from sEMG was established using the novel method of random forest with principal component analysis (RFPCA). The influence of the sample size and the previous sEMG data on the prediction efficiency was analyzed. The estimation model was not sensitive to the sample size when samples increased to a certain value, and the results of different previous sEMG showed that the prediction accuracy of the estimation models did not always improve with the increasing features of input. By comparing the estimation model of back propagation neural network with principal component analysis (BPPCA), it was found that RFPCA was suitable for all participants in the experiment with less execution time, and the root mean square error was around 5° which was lower than BPPCA with errors varying from 7° to 25°. Therefore, it was concluded that the RFPCA method for the estimation of knee movement from sEMG is feasible and could be used for motion analysis and the control of exoskeleton.