3450 E. Rezanof Dr.
Kodiak AK 99615
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Prognostic value of computed tomography classification systems for intra-articular calcaneus fractures. - Foot & ankle international
There are several published computed tomography (CT) classification systems for calcaneus fractures, each validated by a different standard. The goal of this study was to measure which system would best predict clinical outcomes as measured by a widely used and validated musculoskeletal health status questionnaire.Forty-nine patients with isolated intra-articular joint depression calcaneus fractures more than 2 years after treatment were identified. All had preoperative CT studies and were treated with open reduction and plate fixation using a lateral extensile approach. Four different blinded reviewers classified injuries according to the CT classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders. Functional outcomes evaluated with a Musculoskeletal Functional Assessment (MFA). The mean follow-up was 4.3 years.The mean MFA score was 15.7 (SD = 11.6), which is not significantly different from published values for midfoot injuries, hindfoot injuries, or both, 1 year after injury (mean = 22.1, SD = 18.4). The classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders, the number of fragments of the posterior facet, and payer status were not significantly associated with outcome as determined by the MFA. The Sanders classification trended toward significance. Anterior process comminution and surgeon's overall impression of severity were significantly associated with functional outcome.The amount of anterior process comminution was an important determinant of functional outcome with increasing anterior process comminution significantly associated with worsened functional outcome (P = .04). In addition, the surgeon's overall impression of severity of injury was predictive of functional outcome (P = .02), as determined by MFA.Level III, comparative series.Â© The Author(s) 2014.
A comparison of forearm supination and elbow flexion strength in patients with long head of the biceps tenotomy or tenodesis. - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
The purpose of this study was to compare the forearm supination and elbow flexion strength of the upper extremity in patients who have had an arthroscopic long head of the biceps tendon (LHBT) release with patients who have had an LHBT tenodesis.Cybex isokinetic strength testing (Cybex Division of Lumex, Ronkonkoma, NY) was performed on 17 patients who underwent arthroscopic LHBT tenotomy, 19 patients who underwent arthroscopic LHBT tenodesis, and 31 age-, gender-, and body mass index-matched control subjects. Subjects were considered fully recovered from shoulder surgery, were released for unrestricted activities, and were at least 6 months after surgery before testing. Subjects were tested for forearm supination and elbow flexion strength of both arms by use of a Cybex II NORM isokinetic dynamometer at 60Â°/s and 120Â°/s. Testing was performed on injured and uninjured arms as well as dominant and nondominant arms in control subjects. Both forearm supination and elbow flexion strength values were recorded.Comparison between the involved and uninvolved upper extremities within each group by use of a paired t test showed a 7% increase in elbow flexion strength when the dominant and nondominant arms were compared at 60Â°/s. Neither the tenotomy nor tenodesis groups exhibited elbow flexion strength differences at 120Â°/s (all P â‰¥ .147). Comparison between groups by use of 2 Ã— 3 analysis of variance (speed Ã— group) showed no statistical difference in either forearm supination or elbow flexion strength when we compared the tenotomy, tenodesis, and control groups.In asymptomatic patients who have had biceps tenotomy or tenodesis, no statistically significant forearm supination or elbow flexion strength differences existed in the involved extremity between the 2 study groups.Level III, case-control study.Copyright Â© 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Leisure as a context for active living, recovery, health and life quality for persons with mental illness in a global context. - Health promotion international
Globally, the mental health system is being transformed into a strengths-based, recovery-oriented system of care, to which the concept of active living is central. Based on an integrative review of the literature, this paper presents a heuristic conceptual framework of the potential contribution that enjoyable and meaningful leisure experiences can have in active living, recovery, health and life quality among persons with mental illness. This framework is holistic and reflects the humanistic approach to mental illness endorsed by the United Nations and the World Health Organization. It also includes ecological factors such as health care systems and environmental factors as well as cultural influences that can facilitate and/or hamper recovery, active living and health/life quality. Unique to this framework is our conceptualization of active living from a broad-based and meaning-oriented perspective rather than the traditional, narrower conceptualization which focuses on physical activity and exercise. Conceptualizing active living in this manner suggests a unique and culturally sensitive potential for leisure experiences to contribute to recovery, health and life quality. In particular, this paper highlights the potential of leisure engagements as a positive, strengths-based and potentially cost-effective means for helping people better deal with the challenges of living with mental illness.
In praise of sport: promoting sport participation as a mechanism of health among persons with a disability. - Disability and health journal
Achieving and maintaining health are no less important to people with a disability than they are to anyone else; it is just typically more challenging. This report explores sport as a mechanism of health for people with a disability. The International Classification of Functioning, Disability and Health (ICF) is used to frame the analysis and discussion of the narratives of 12 women and men with a disability who participate in sport.The goal was to describe how participating in sport, broadly defined, helps persons with a disability achieve and maintain health and health-related components of well-being. The ICF was used to frame a secondary analysis and discussion of participant narratives.Participants with physical or sensory disabilities responded to a request for participation in in-depth interviews to explore their sport participation; snowball sampling was used to ensure maximum variation in demographic characteristics. Interviews were transcribed verbatim and analyzed using a grounded theory approach. A secondary analysis was conducted that focused on the relationship of the data categories to the ICF.Sport benefits included enhanced functional capacity, health promotion, relationship development, increased optimism, and inclusion in meaningful life activities and roles. Health professionals were vital in introducing and encouraging people with disabilities to participate in sport.Sport is a valuable and promising mechanism for fostering physical and emotional health and building valuable social connections. Health professionals, in concert with individual, family, and community members, may use the framework of the ICF to guide their clinical and educational reasoning for enhancing sport participation among persons with a disability.
Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal. - Foot & ankle international
Great variability exists in methods of stabilization for syndesmotic disruptions of the ankle. We hypothesized that syndesmotic screw fixation with 3.5-mm fully threaded cortical screws through either three or four cortices would have similar strength and rate of mechanical failure and that retention of screws after fracture healing would not result in adverse clinical symptoms.In a prospective, surgeon-randomized study at a Level-one trauma center, 127 patients with syndesmotic disruptions were treated surgically. Seven patients were lost to followup, leaving 120 for review. Syndesmotic disruptions were stabilized with 3.5-mm fully threaded cortical screws placed through three or four cortices. Screws were removed only if symptomatic. Outcome criteria were screw failure, loss of reduction, and need for hardware removal.Fifty-nine patients received fixation through three cortices and 61 patients received fixation through four cortices. Mean follow-up was 150 days. In the group with stabilization through three cortices, hardware failure occurred in five patients (8%) and three had a loss of reduction. In the group with stabilization through four cortices, hardware failure occurred in four patients (7%); all were asymptomatic and did not require screw removal. There was no loss of reduction in that group. Comparing the two groups using binary logistic analysis, there was no difference in loss of reduction (p = 0.871), screw breakage (p = 0.689), or need for hardware removal (p = 0.731).The data suggest that either three or four cortices of fixation can be used when stabilizing syndesmotic injuries of the ankle. There was a trend towards higher loss of reduction in the group with tricortical fixation when weightbearing restrictions were not followed. Retention of the syndesmotic screws, even with mechanical failure, does not pose a clinical problem. Weightbearing can be allowed at 6 to 10 weeks without routine removal of screws.
Bilateral peroneal nerve palsy following emergent stabilization of a pelvic ring injury. - Journal of orthopaedic trauma
External noninvasive compressive devices are becoming popular for emergent stabilization of pelvic ring disruptions. The ease of application utilizing available materials such as sheets, the noninvasive nature of such measures, and perceived absence of complications has made this a popular stabilization modality. The authors report a case of bilateral peroneal nerve palsy related to the use of external compressive wraps in a patient with pelvic ring injury.
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3450 E. Rezanof Dr. Kodiak, AK 99615