Factors of radial bone strength after marginal defect formation

Purpose To determine the effect of biometrical parameters of the radial bone and due to edge defect formed on the radius strength properties using calculation methods. Materials and methods The study of bone strength affecting factors was conducted with the aid of experimental and calculation methods. Biometrical parameters were studied in 10 pairs of the human cadaveric radius as an intact bone initially and after the formation of rectangular or triangle-shaped edge cuts. To determine the stress-strain behaviour, mathematical calculations were performed based on the beam flexural theory for isotropic materials. Computation study were conducted using the finite element method with the NX Siemens software package. Based on assumed mathematical models, the actual areas of safe loads in the presence of cuts and values of destructive loads depending on the depth and shape of a cut taking into account the initial curvature of the bone as well as the criteria of a required residual strength in variation of influencing parameters were identified by means of calculations. Results It was established that an increase in bone curvature results in the reduction of longitudinal destructive loads and in increasing values of the normal strength. The 0.05 bone curvature combined with the 0.5 cut causes a decrease in the ultimate load by 20 times (up to 4.8 % for a rectangular cut and to 5.4 % for a triangular cut). A 0.5-deep cut in the bone which curvature is 0.05 enhances the normal stress by 6.9 times for a triangular cut and by 7.8 times for a rectangular one as compared to a bone without curvature. The critical values for the curvature and depth of the cut were established which permit to avoid additional bone reinforcement. Conclusion The strength of the radius with a maginal defect depends not only on the depth of a cut but on its location, shape and on the radius curvature.

Dynamics of Quality of Life of Elderly People with Frailty and Parkinsonism under the Influence of Physical Therapy in the Postimmobilization Period after Radial Bone Fracture in a Typical Place

In old age, due to the spread of age-related diseases, there are changes in the functioning of many organs and systems due to and against the background of polymorbidity, which affects the quality of life and requires correction. The purpose of the study was to determine the dynamics of the quality of life of elderly people with frailty and parkinsonism under the influence of physical therapy in the post-immobilization period after fracture of the radial bone in a typical place. Material and methods. We examined 27 elderly people with frailty and Parkinson's disease in the early postimmobilization period after fracture of the distal metaepiphysis of the radial bone (in a typical place). Group 1 engaged in the principles of outpatient rehabilitation with a predominance of preformed physical factors and group 2 engaged in a developed program of physical therapy, created in terms of patient-centric model of rehabilitation taking into account the specifics of each polymorbid condition using functional body training, massage, nutrition correction, expansion of social activity. The effectiveness of the program was evaluated in the dynamics before and after a month of implementation based on the results of the comparison of quality of life on the questionnaire "Medical outcomes study short form" (SF-36). 36 points were grouped into eight scales: Physical health: Physical Functioning, Role-Physical, Bodily Pain, General Health and Mental Health, Vitality, Social Functioning, Role-Emotional. Results and discussion. At the initial examination the examined people revealed a significant decrease in the results of all scales of physical and mental components of the quality of life of the questionnaire SF-36. The parameters of both groups did not differ statistically significantly (p> 0.05). At retesting, the difference between the results of the physical component of health in the primary and re-study on the physical functioning scale for individuals in group 1 was 18.9%, group 2 – 29.0%, role-physical – 19.8% and 35.5%, respectively, bodily pain – 12.3% and 33.1%, general health – 25.8% and 30.1%. The improvement of the mental component compared to the initial result on the vitality scales in patients of group 1 was 14,0%, group 2 – 27,4%, social functioning – 17,5% and 41,3%, respectively, role-emotional – 15,0% and 23,8%, mental health – 20,5% and 30,2%. The results of testing on all scales were statistically significantly better in individuals of group 1 compared with the result of group 2 (p <0,05). Conclusion. Elderly patients with polymorbid pathology and traumatic bone injuries require the development of pathogenetically based physical therapy programs taking into account and correcting the specifics of each disease, increases the overall effectiveness of rehabilitation and, consequently, quality of life

THE INFLUENCE OF THE PHYSICAL THERAPY PROGRAM ON THE UPPER LIMB FUNCTIONING INDICATORS IN ELDERLY ADULTS WITH SARCOPENIA AND EXTRAPYRAMIDAL DISORDERS IN THE POST-IMMOBILIZATION PERIOD AFTER THE DISTAL RADIUS METAPHYSEAL FRACTURE

Aim: to evaluate the impact of a comprehensive program of physical therapy on the functioning of the upper extremity in the elderly adults with sarcopenia and extrapyramidal disorders (due to Parkinson's disease) in the postimmobilization period after fracture of the distal metaphysis of the radial bone. Material and methods. Twenty seven elderly people with sarcopenia and extrapyramidal disorders in the early post-immobilization period after fracture of the distal metaphysis of the radial bone were examined. They were divided into two groups: 1 (practiced according to the principles of outpatient rehabilitation with a predominance of preformed physical factors) and 2 (engaged in the developed physical therapy program, which was created in terms of patient-centered model of rehabilitation taking into account the specifics of each polymorbid condition with functional training, massage, kinesio taping, nutrition correction). The effectiveness of the program was evaluated by comparing the condition of healthy and injured hands according to the results of goniometry, wrist dynamometry, standard tests and questionnaires Nine-hole peg test, Action Research Arm Test, French Arm Test, ABILIHAND, DASH. Results. Subjects found significant dysfunction of the upper extremity in all domains of the International Classification of Functioning, as determined by goniometry of the radial-carpal joint, wrist dynamometry, functional tests Nine-hole peg test, Action Research Arm Test, French Research Arm Test, questionnaires and DASH. The developed pathogenetically substantiated complex program of physical therapy showed a statistically significantly better effect on the indicators of functional capabilities of the forearm and wrist compared to the general outpatient rehabilitation program for all studied indicators (p <0.05). Conclusion. Elderly patients with complex pathology need to compile pathogenetically substantiated physical therapy programs taking into account and correcting the specifics of each disease, which increases the overall effectiveness of rehabilitation.

AIDS presenting as radial bone tuberculosis and pyogenic methicillin-sensitive Staphylococcus aureus osteomyelitis

Osteomyelitis is a rare initial presentation of HIV. We report a case of a 25-year-old, apparently well man presenting with a traumatic, pathological fracture of the right radius. He had a 2-week history of low-grade fever, swelling and purulent discharge of the radial aspect of his right forearm. Osteomyelitis, secondary bacteraemia and pneumonia were clues that led physicians to test for HIV. Multiple debridement, sequestrectomy and vacuum-assisted closure were done. Tissue cultures revealed Mycobacterium tuberculosis (TB) and methicillin-sensitive Staphylococcus aureus. He was treated successfully with 6 weeks of culture-guided intravenous oxacillin, staphylococcal decontamination and first-line anti-TB regimen (rifampicin, isoniazid, ethambutol, pyrazinamide). Antiretroviral agents were started thereafter. Successful infection control and preservation of limb functionality was achieved with a multidisciplinary team approach. To our knowledge this is the first reported case of an adult patient with HIV presenting with tuberculous and pyogenic osteomyelitis of the radial bone.

EARLY COMPLEX REHABILITATION TREATMENT OF PATIENTS WITH FRACTURE OF DISTAL METAEPIPHYSIS OF THE RADIUS

Relevance. Fractures of the distal metaepiphysis of the radial bone among all fractures range from 11% to 30%. Unsatisfactory results of treatment in patients over 70 years old are found in 44% of cases. Timely and adequate rehabilitation treatment is important for obtaining good results in the treatment of such patients. Objective: to improve the results of the treatment of patients with fractures of the distal metaepiphysis of the radial bone based on early comprehensive individual rehabilitation treatment. Materials and methods. 97 patients with displaced fractures of the distal metaepiphysis of the radius were observed. Among them, 67 are women (69.1%), over 50 years old – 64 (66%). Used conservative treatment with a sparing technique of one-stage reduction. Upon completion of the correction, according to the indications, measures were prescribed for the prevention of neurodystrophic syndrome, depending on the likelihood of its development (according to the temperature gradient of the fingers of the extremities) in the form of drug therapy. Massage, kinesiotherapy, and physiotherapy began on the second day. The pain intensity was determined using a visual analog scale. The nature of pain was determined by the DN4 questionnaire (questionnaire for the diagnosis of neuropathic pain). For subjective unified assessment of hand function in the long term after a hand injury, I used a specific questionnaire DASH (Disability of the Arm, Shoulder and Hand Outcome Measure) – a questionnaire of outcomes and disability of the hand and hand. Results. Rehabilitation treatment at admission and at the early outpatient stage was complex, individual, taking into account the periods of illness. The debris correction was painless, low-traumatic, rational fixing bandages were used. The volume of drug therapy was determined by the value of the temperature gradient of the fingers. Conclusion. The proposed method for the rehabilitation of patients with fractures of the distal metaepiphysis of the radius is highly effective: good and satisfactory (according to the DASH scale) results were obtained in 97.8% of cases, unsatisfactory – in 2.2%.

SAT0447 CORRELATES OF RADIAL BONE MICROARCHITECTURES IN OLDER ADULTS

Background:Weight, dietary patterns, vitamin D, physical activity and grip strength have been suggested to be associated with bone loss in older adults. However, studies have yet been performed to investigate the associations between these factors and radial bone microarchitecture.Objectives:This study aimed to describe the associations of weight, dietary patterns, serum 25-hydroxyvitamin D (25(OH)D) concentrations, physical activity and grip strength with bone measures in older adults.Methods:Cross-sectional data on 201 older adults (mean age 72 years, female 46%) from a population-based cohort study were analysed. Weight, dietary patterns, serum 25(OH)D concentrations, physical activity (steps per day), grip strength were collected and analysed from baseline to 10-year follow-up. Areal bone mineral density (aBMD) at spine, hip and whole body were measured by dual-energy X-ray absorptiometry (DXA). Radial cortical and trabecular bone microarchitectures were measured by high-resolution peripheral computed tomography (HRpQCT). Multivariable linear regression was used to analyse associations of study factors with bone measures.Results:Weight was positively associated with radial bone area (total: β=0.18, 95% CI: 0.07, 0.29; cortical: β=0.12, 95% CI: 0.03, 0.21; trabecular: β=0.18, 95% CI: 0.05, 0.32), and was inversely associated with compact cortical volumetric bone mineral density (vBMD) (β= -0.19, 95% CI: -0.37, -0.01) and trabecular thickness (β= -0.25, 95% CI: -0.43, -0.07). Ten-year changes in weight were not significantly associated with bone measures, apart from radial trabecular separation (β= 0.15, 95%CI: 0.009, 0.28). Western dietary pattern scores were inversely associated with radial vBMD (total: β= -0.17, 95% CI: -0.32, -0.01; cortical: β= -0.19, 95% CI: -0.34, -0.04; compact cortical: β= -0.19, 95% CI: -0.34, -0.04; outer transitional zone: β= -0.20, 95% CI: -0.35, -0.06), and were positively associated with cortical porosity (cortical: β= 0.18, 95% CI: 0.03, 0.33; compact cortical: β= 0.19, 95% CI: 0.04, 0.34; outer transitional zone: β= 0.20, 95% CI: 0.06, 0.35). Steps per day were not significantly associated with bone measures, apart from inner transitional zone area and thickness (β= 0.12, 95% CI: 0.003, 0.24; β= 0.19, 95% CI: 0.05, 0.33). Healthy food pattern scores, serum 25(OH)D and grip strength were not significantly associated with radial HRpQCT measures.Conclusion:Higher weight, but not weight change, was beneficial for radial cortical and trabecular bone area but also associated with worse compact cortical vBMD and trabecular thickness. Higher western dietary pattern scores had adverse effects on radial vBMD and cortical porosity while physical activity had inconsistent associations.Disclosure of Interests:None declared

THE SURGICAL TREATMENT OF HEAD RADIAL BONE FRACTURE IV TYPE BY MASON-HOTCHKISS FOR THE IMPLEMENTATION OF THE CEMENTLESS BIPOLAR MODULAR ENDOPROSTHESIS OF THE HEAD RADIAL BONE

Aim. The author of the article shows the features of the surgical technique of implantation of the developed cementless modular bipolar endoprosthesis of the head of the radial bone with a pair of metal-metal friction. Materials and methods. The developed cementless modular bipolar endoprosthesis of the radial head with a pair of metal-metal friction. Indications for endoprosthetic of the head of the radial were the fracture of the head IV, according to Mason-Hotchkiss. The result of the treatment was assessed by the Mayo Elbow Performance Score evaluation system. Results and discussion. At fractures on Mason-Hotchkiss IV type, the endoprosthetic of the head of a radial bone is applied. The use of the developed modular endoprosthesis of the head of the radial made it possible to restore the stability of the elbow joint, to resume rotational movements of the head radial, while maintaining the functional volume of flexion-extensor movements, and also to restore the length of the radial bone. Conclusions. The use of the developed advanced cementless bipolar modular endoprosthesis of radial head fracture-dislocation type IV by Mason-Hotchkiss allowed obtaining a good result, according to the assessment of the MEPS clinic (88.5 scores) in 6 months after surgery.