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To analyze the amount of weight-bearing during tilt table increments, with a review of neutral and unilateral knee flexion postures.
There were 17 healthy participants enrolled in this study. The subjects were tilted from 10° to 90°, and their body weight was measured at each 10° increment. In the first test, both plantar pressures, with the subjects in neutral posture, were recorded. During the second and third tests, the angle of inclination was thus recorded and increased, with the subjects in unilateral knee flexion posture; flexion was maintained at 25° by attaching a cylindrical support to the tilt table at the level of the popliteal fossa.
The study was divided into two types of postures: neutral and unilateral knee flexion. The percentage of body weight (%BW) between each leg during neutral posture was noted as not being statistically significant. The %BW of one side during tilt table inclination was significantly different between the two postures at 10° to 80° (p<0.05). The weight during unilateral knee flexion posture was lower as analyzed, regardless of tilt table inclination compared with that in neutral posture. We note that fifty percent of the ratio of %BW was noted at 33.12° and 38.76° in neutral and flexion postures, respectively.
The unilateral knee flexion could induce the effect of decreased body weight compared with non-flexion side. The results of this study will help in setting a safe and quantitative percentage of weight-bearing on the lower extremity during tilt training.
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To investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on the vastus lateralis (VL) in the early stage after hip replacement surgery.
Twenty-two patients who underwent hip replacement after proximal femur fracture were included in this study. After hip surgery, the experimental group was applied with 15 sessions of 10 Hz rPMS over the VL 5 times per week for 3 weeks, while the control group took sham stimulation. All patients were also given conventional physical therapy. The VL strength was measured with the root mean square (RMS) value of the VL with surface electromyography technique. The ratio of RMS values between fractured and unfractured legs and tandem stand test were used to assess standing balance. Usual gait speed was measured to evaluate gait function. Pain in two groups was assessed with visual analog scale (VAS).
Both RMS value of the VL and the ratio of RMS values after rPMS were significantly improved (p<0.05). Also, tandem standing time and usual gait speed in rPMS group were dramatically increased (p<0.05). However, no significant difference in VAS was found between the two groups after 3 weeks.
rPMS on the VL improved muscle strength, standing balance and gait function in the early stage after hip surgery. Therefore, rPMS could be applied to patients who cannot take electrical stimulation due to pain and an unhealed wound.
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To identify the prevalence of malnutrition in elderly hip fracture and to investigate the relationship between hip fracture patients and malnutrition on functional recovery and mortality.
All hip fracture patients age >65 years admitted to a rehabilitation unit were recruited from July 2015 to June 2016. Nutritional status was assessed by Mini-Nutritional Assessment Short-Form (MNA-SF) within 72 hours of admission. Patients were reassessed at 6 months for functional status and place of residence. Length of hospital stay, in-patient mortality rate, and 6-month mortality rate were also recorded.
There were 218 patients recruited. The mean age was 83.5±7.5 years. According the MNA-SF, 46 (21.1%) were well nourished, 115 (52.6%) were at risk of malnutrition, and 57 (26.1%) were malnourished. Malnourished individuals were significantly older, had lower Mini-Mental State Examination score and albumin level, were functionally more dependent and were more likely to reside in elderly care facility. A higher proportion of elderly care residents were at-risk or were malnourished on admission, discharge and at 6 months. Functional recovery was slower in the malnourished group. In-patient mortality was higher in malnourished individuals compared to those at risk of malnourishment and well-nourished individuals.
The prevalence of malnutrition is high and is associated with poor functional recovery and elderly care placement. Residents of elderly care facilities are especially at risk due a higher prevalence of malnourishment. Health authorities are encouraged to evaluate the dietetic component in elderly care facilities and initiate nutrition supplementation in their planning of healthcare resources.
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To determine whether there was a difference in balance, proprioception, and skeletal muscle mass among patients who undergo hip fracture surgery relative to and elective total hip replacement (THR).
Thirty-one THR patients were enrolled. The patients were categorized into two groups: fracture group (n=15) and non-fracture group (n=16). Berg Balance Scale (BBS) was used to balance the proprioception of the hip joint while a joint position sense (JPS) test was used to evaluate it. Skeletal muscle mass was measured by bioelectrical impedance analysis and expressed as a skeletal muscle mass index (SMI). Quality of life (QOL) was also assessed using a 36-item short form health survey (SF-36). All tests were assessed at 3 months after the surgery. An independent t-test was used to compare the fracture group and non-fracture group. Spearman correlation was used to identify the correlation of each variable.
In an independent t-test, the BBS score of patients undergoing elective surgery was higher than the BBS score of patients undergoing hip fracture surgery. There was a significant correlation between the BBS and JPS score after a THR. SMI also correlated with the score of BBS.
It seems that THR patients undergoing surgery for a hip fracture might have more trouble balancing than elective THR patients. Therefore THR patients undergoing hip fracture surgery might need more care during rehabilitation.
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To predict ambulatory capacity, 1 month after physical therapy following hip fracture surgery.
A retrospective chart review was carried out. Patients more than 60 years old, who underwent hip fracture surgery and received physical therapies, were selected (n=548). Age, gender, presence of cognitive dysfunction, combined medical diseases, combined fractures, previous history of hip surgery, prefracture ambulatory capacity, days from the fracture to surgery, type of fracture, type of surgery, presence of postoperative complications, days from the surgery to physical therapy, and total admission period, were collected. Prefracture ambulatory capacity and postoperative ambulatory capacity were classified into non-ambulatory status (NA), ambulation with assistive device (AA), and independent-ambulation without any assistive device (IA). Multiple-logistic regression analysis was performed for the prediction of postoperative ambulatory capacity.
Age (odds ratio [OR]=0.94 for IA and 0.96 for IA or AA), gender (OR=1.64 for IA and 0.98 for IA or AA), prefracture ambulatory capacity (OR of IA=19.17 for IA; OR of IA=16.72 for IA or AA; OR of AA=1.26 for IA, OR of AA=9.46 for IA or AA), and combined medical disease (OR=2.02) were found to be the factors related to postoperative ambulatory capacity and the prediction model was set up using these four factors.
Using this model, we can predict the ambulatory capacity following hip fracture surgery. Further prospective studies should be constructed to improve postoperative ambulatory capacity.
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We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.
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To evaluate the usefulness of various magnetic resonance imaging (MRI) findings in the prognosis of neurological recovery in paraplegics with thoracolumbar fracture using association analysis with clinical outcomes and electrodiagnostic features.
This retrospective study involved 30 patients treated for paraplegia following thoracolumbar fracture. On axial and sagittal T2-weighted MRI scans, nerve root sedimentation sign, root aggregation sign, and signal intensity changes in the conus medullaris were independently assessed by two raters. A positive sedimentation sign was defined as the absence of nerve root sedimentation. The root aggregation sign was defined as the presence of root aggregation in at least one axial MRI scan. Clinical outcomes including the American Spinal Injury Association impairment scale, ambulatory capacity, and electrodiagnostic features were used for association analysis.
Inter-rater reliability of the nerve root sedimentation sign and the root aggregation sign were κ=0.67 (p=0.001) and κ=0.78 (p<0.001), respectively. A positive sedimentation sign was significantly associated with recovery of ambulatory capacity after a rehabilitation program (χ2=4.854, p=0.028). The presence of the root aggregation sign was associated with reduced compound muscle action potential amplitude of common peroneal and tibial nerves in nerve conduction studies (χ2=5.026, p=0.025).
A positive sedimentation sign was significantly associated with recovery of ambulatory capacity and not indicative of persistent paralysis. The root aggregation sign suggested the existence of significant cauda equina injuries.
Avulsion fracture of the acromion is rare. It is difficult to diagnosis because there is little displacement and it occurs even without direct trauma. We experienced a case without direct trauma that was diagnosed with ultrasonography. A 55-year-old male patient visited our outpatient clinic with shoulder pain resulting from a significant stress at the trapezius muscle during lifting of a steel reinforcement. Simple radiography revealed a calcific deposit over the acromion rather than a fracture. Avulsion fracture was identified with ultrasonography. This is the first report demonstrating that ultrasonography has an advantage over radiographs in the diagnosis of an avulsion fracture of the acromion of the scapula.
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To investigate the prognostic factors predicting the recovery of pre-fracture functional mobility, we evaluated this by the use of ambulatory assistive devices in short-term follow-up.
Five hundred and fifty-three elderly patients who had undergone hip fracture operations from January 2006 to June 2013 were enrolled in this retrospective study. Clinical characteristics and predicted factors affecting functional recovery, such as the delay of rehabilitation after the operation, were reviewed. The functional status of the gait was classified as either a bedridden state, wheelchair-bound state, walker gait, single cane gait, and self-gait without any ambulatory assistance device. When this functional grade in patients who recovered after the surgery was compared to before the surgery, this state was considered 'functional recovery'.
One hundred and ninety-two patients (34.7%) showed recovery of preoperative mobility in the first month after their operation. Multiple logistic regression analysis identified that the following four factors were significantly associated with a deterioration of functional recovery: old age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.97), delays in rehabilitation after operation (OR, 0.94; 95% CI, 0.89-0.98), the presence of cognitive dysfunction (OR, 0.36; 95% CI, 0.18-0.71), and trochanteric fracturing (OR, 0.58; 95% CI, 0.36-0.94).
We found that old age, cognitive dysfunction, trochanteric fracture type, and delay of rehabilitation were associated with the deterioration of functional recovery after a hip fracture operation in the short-term. Therefore, early rehabilitation was required to acquire functional recovery after a hip fracture operation in the short-term.
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Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.
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Postpartum sacral fracture is relatively rare, and its diagnosis is often delayed. We herein report such a case of a 28-year-old patient who presented with an insidious-onset lower back pain, left buttock pain, and radicular symptoms mimicking lumbar radiculopathy. Laboratory tests showed a decreased 25-hydroxy vitamin D level, and the bone mineral densitometry of both femurs was below the expected range. Plain radiographs of the lumbar spine and pelvis showed no definite abnormality, but lumbosacral spinal magnetic resonance imaging identified a left sacral fracture. Symptoms were alleviated with rest and oral analgesic treatment.
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Bisphosphonates are potent inhibitors of bone resorption and considered as a gold standard and are generally recommended as first-line therapy in patients with osteoporosis. Though bisphosphonates are shown to significantly reduce the risk of vertebral, non-vertebral and hip fractures, recent reports suggest a possible correlation between long-term bisphosphonate therapy and the occurrence of insufficiency fractures owing to prolonged bone turnover suppression. We report a patient with non-traumatic stress fractures of bilateral femoral shafts related to long-term bisphosphonate therapy indicating the need for a critical evaluation of patients with long-term bisphosphonate therapy.
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To evaluate the outcomes of medial branch block in facet joint pain for osteoporotic compression fracture and utilize multiple regression, the relationship between their impact on treatment outcome and other factor, such as the radiologic finding, clinical parameters was analyze.
Fifty-three patients with axial back pain from osteoporotic compression fracture were enrolled. The clinical outcomes were measured by Verbal Numeric Rating Scale (VNS) and Oswestry Disability Index (ODI) before treatment, 2 weeks, 3 months, and 12 months after the medial branch block. Radiographic analysis included measurement of overall sagittal alignment, collapsed vertebral height, and vertebral kyphotic angle. After 12 months, patients' satisfaction was classified to five categories: excellent, good, fair, poor or fail. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two.
VNS and ODI was improved 2 weeks after the injection and continued to improve until 12 months. Significant improvement with significant pain relief (>40%), functional improvement (>20%), and the patients rated their satisfaction level as "excellent" or "good" at 12 months after the first injection were observed in 78.9%. The radiographic and clinical parameters were not significantly correlated with treatment outcome.
Our retrospective study demonstrated that the medial branch block provided significant pain relief and functional recovery to the patients with osteoporotic spinal compression fractures complaining of continuous facet joint pain after vertebroplasty or conservative treatment. A placebo-controlled prospective randomized double-blind study should be conducted in the future to evaluate the treatment effects.
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Thyroid carcinoma is the commonest endocrinological malignancy. After papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) is the second most common histological subtype. Common presentations of FTC include a solitary thyroid nodule and cervical lymphadenopathy. The incidence of individuals diagnosed with thyroid cancer showing initially distant metastatic disease ranges from 1 to 9%. Also, the incidence of solitary bone metastasis from thyroid is only 2 to 3%. We report a case of a patient with FTC whose initial presentation was low back pain and right buttock pain due to vertebral metastasis rather than the usual neck lumps or symptoms of thyroid disease.
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Collet-Sicard syndrome is a rare condition characterized by the unilateral paralysis of the 9th through 12th cranial nerves. We describe a case of a 46-year-old man who presented with dysphagia after a falling down injury. Computed tomography demonstrated burst fracture of the atlas. Physical examination revealed decreased gag reflex on the left side, decreased laryngeal elevation, tongue deviation to the left side, and atrophy of the left trapezius muscle. Videofluoroscopic swallowing study (VFSS) revealed frequent aspirations of a massive amount of thick liquid and incomplete opening of the upper esophageal sphincter during the pharyngeal phase. We report a rare case of Collet-Sicard syndrome caused by Jefferson fracture.
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To identify risk factors for developing a vertebral refracture after percutaneous vertebroplasty.
A retrospective analysis of 60 patients who had undergone percutaneous vertebroplasty between January 2008 and April 2010 was conducted. All patients were observed for a 1 year follow-up period, and fracture was defined when it was both clinically reported and radiographically confirmed. Twenty-seven patients with a refractured vertebra and 33 patients without a refracture were included. Of the 60 patients, 20 presented with a refracture from a cemented vertebra, whereas the remaining 40 patients did not. Clinical, imaging and procedure-related factors for each group were analyzed by the Fisher's exact, chi-square, and the Mann-Whitney
Local kyphotic angle and sagittal index were significant as a result of researching various risk factors related to vertebral refracture (p<0.001, p<0.001, respectively) and refracture from a cemented vertebra itself (p=0.004, p<0.001, respectively). Other factors were not significant.
Patients who had a high preoperative local kyphotic angle and a high sagittal index required a close follow-up and attention.
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To investigate the injury mechanism in patients who had peroneal neuropathy after a tibio-fibular fracture and the correlation between tibio-fibular fracture location and the severity of the peroneal neuropathy by using electrodiagnosis.
Thirty-four patients with peroneal neuropathy after a tibio-fibular fracture were recruited for this study. Their medical records, radiologic and electrodiagnostic findings were investigated retrospectively. They were divided into 2 groups according to the existence of a fibular head fracture. The group of patients without the fibular head fracture was further classified according to the criteria of Orthopedic Trauma Association (OTA) classification. The differences between the two groups in the severity of the neuropathy and electrodiagnostic findings were evaluated.
Nine cases (26.5%) had tibio-fibular fractures with a coexisting fibular-head fracture and 25 cases (73.5%) had tibio-fibular fractures without fractures in the fibular-head area. There was no statistical significance in the correlation between the existence of the fibular head fracture and the severity of the electrodiagnostic findings. Neither was there any statistically significant relationship between the site of the tibio-fibular fracture and the severity of the peroneal neuropathy (p>0.05).
This study showed there were numerous cases with common peroneal neuropathy after tibiofibular fracture without a coexisting fibular-head fracture, which shows the importance of indirect nerve injury mechanisms as well as that of direct nerve injury as a cause of peroneal neuropathy. In addition, this study showed that there was no statistically significant correlation between the site of tibio-fibular fracture and the severity of peroneal neuropathy.
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