Nisanci, Mustafa; Sahin, Ismail; Eski, Muhitdin; Alhan, Dogan
Management of long-term bedridden patients experiencing pressure sores still represents a surgical challenge due to limited flap alternatives and high recurrence rates after the treatment. Fasciocutaneous, musculocutaneous, local perforator-based flaps, and free flaps have all been used for treatment of trochanteric pressure sores. This study presents a new use of distal gluteus maximus (GM) muscle as an advancement musculocutaneous flap for coverage of trochanteric pressure sores in 7 patients. The technique involves design of a long V-shaped skin island over the distal fibers of the GM muscle, beginning from the inferoposterior wound edge and extending inferomedially, almost parallel to the gluteal crease. After its harvest as an island flap on the distal fibers of the GM muscle, the skin paddle can be advanced onto the trochanteric defect, whereas the muscle itself is rotated after severing its insertion to femur. If a second triangular skin island is designed on the proximal fibers of GM muscle to cover an associated sacral defect, 2 coexisting pressure sores can be reconstructed concomitantly with 2 skin paddles on a single muscle belly at 1 surgical setting. Of the 7 patients, 3 had 3 (bilateral trochanteric and sacral), 2 had 2 (sacral and trochanteric), and 2 had 1 (only trochanteric) pressure sores. All ulcers were closed successfully and all of the flaps survived totally without any complication except the one in which we experienced minimal wound dehiscence in the early postoperative period. Conclusively, our current surgical method provided a reliable coverage for trochanteric pressure sores although it was technically straightforward and fast. Additionally, it offers simultaneous closure of 2 pressure ulcers with 2 skin islands on a single muscle flap.
Pressure sores are areas of damaged skin caused by staying in one position for too long. They ... wheelchair, or are unable to change your position. Pressure sores can cause serious infections, some of which ...
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Full Text Available ... Injury Medical Expert Videos Topics menu Topics Preventing Pressure Sores Adult Injuries Spinal Cord Injury 101 David Chen, MD Preventing Pressure Sores Mary Zeigler, MS Transition from Hospital to ...
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Full Text Available ... OTR/L Sarah Harrison, OT Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury Patti Rogers, ... do to prevent pressure sores? play_arrow What role does diet and hydration play in ... play_arrow What are the six stages of a pressure sore and how ...
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Full Text Available Background: The treatment of pressure sores represents a significant challenge to health care professionals. Although, pressure wound management demands a multidisciplinary approach, soft tissue defects requiring reconstruction are often considered for surgical management. Myocutaneous and fasciocutaneous flaps can provide stable coverage of pressure sores. Purpose: Here, we describe our experience using a recent fasciocutaneous flap, which is named ′reading man′ flap, in sacral, ischial, and trochanteric pressure sores. Materials and Methods: During a period of 1 year the authors operated 16 patients, 11 men, and 5 women, using the reading man flap. The ages of the patients ranged from 24 to 78 years. The location of pressure sores was 8 sacral, 5 ischial, and 3 trochanteric pressure sores. The mean size of pressure sores was 8 cm × 9 cm. Results: All pressure sores covered bt the Reading Man flap healed asymptomatically. After follow-up of 2-8 months, no recurrences were encountered and no further surgical intervention was required. Conclusion: The reading man flap was found to be a useful technique for the closure of pressure sore in different anatomic locations. The advantage of tension-free closure and the minimal additional healthy skin excision made this flap a useful tool in pressure sore reconstructions.
... Tract Infections: Indwelling (Foley) Catheter Taking Care of Pressure Sores [Download this pamphlet: "Taking Care of Pressure ... may not show up right away. Stages of pressure sores and how to care for them: STAGE ...
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Summary. Pressure sores are a predictable consequence of poorly managed spinal cord-injured patients. Not only do pressure sores contribute to the morbidity, but also add significantly to the medical/nursing management, cost and admission stay, limiting optimal bed utilisation. This intervention study assesses the impact ...
Malament, I R; Dunn, M E; Davis, R
A training system for the prevention of pressure sores has been designed to teach the paralytic person to relieve pressure intermittently from his ischium while sitting in a wheelchair. The system automates the training of wheelchair pushups, and conditions the person into exercising, based upon modified avoidance learning procedures. Results indicate that the paralytic person can be trained to pushup intermittently and efficiently using this system, thus reducing the incidence of pressure sore formation. Further long-term study is needed to assess the effectiveness of the training system as a preventative program for pressure sores.
Chen, X; Jiang, Z; Chen, Z; Wang, D
Retrospective clinical study. To assess the method of primary surgical closure of pressure sores developed by the Ruixin Hospital for burns. Nanjing, China. The study included 235 grade IV pressure sores of 160 patients, M:F = 119:41. Their age ranged from 19 to 93 years (mean = 47.4, s.d. ± 15.7). The primary disease was spinal cord injury in 141 patients (88.1%). The location of sore spread over ischial, sacrococcygeal and trochanteric regions. The largest pressure sore measured 15 × 25 cm(2). The time from onset of sore to admission ranged from 3 months to 22 years (mean = 35.5 months, s.d. ± 55.8). Local preoperative preparation included external skin traction using adhesive tapes, wound cleaning and change of dressing. General condition was checked and improved by supportive measures. Operation procedures included thorough debridement, excision of hidden minor scars, mobilizing opposing skin flaps and meticulous haemostasis before closure. Skin traction continued after the operation until the wound was healed. All but 10 sores healed primarily. These 10 sores healed after a revision. The length of stay in hospital ranged from 20 to 140 days (mean = 45.1 days, s.d. ± 21.1). Follow-up period was 2-51 months (mean = 22 months, s.d. ± 12.5). Two ischial sores recurred owing to long sitting. They were cured with the same method. Three illustrative cases are presented. The method is simple and enjoys a high success rate with a short stay in hospital and hence is cost effective. The recurrence is rare.
Results. All flaps survived completely with no complications in 9 patients. One patient had a haematoma below the flap that was easily drained. No recurrence of the bedsore occurred during follow-up. Conclusion. We suggest that the pedicled SGAP fasciocutaneous flap is a reliable surgical option for sacral pressure sore ...
Jul 22, 2008 ... interrogated for all cervical spine injuries. Patients were identified retrospectively for the period April 2003 to May 2006 and divided into 4 groups according to the level of intervention they received to prevent pressure sores. Group A. These were the first 100 patients with cervical injuries managed in the unit ...
Bates-Jensen, B M; Vredevoe, D L; Brecht, M L
There is not yet a universal system for describing the status of pressure sores. The purpose of this study was to assess the validity and reliability of an instrument developed by the researchers for evaluation of pressure sores, the Pressure Sore Status Tool (PSST). This study was part of a larger study, which included development of a theoretical model for creation of items for the PSST. A nine-member expert judge panel established content validity of items on the instrument. Data were analyzed using a content of validity index (average index for tool = .91) and judges' comments were used to modify two items on the PSST. Two Enterostomal Therapy (ET) nurses independently used the revised tool to rate 20 pressure sores on ten adult medical-surgical patients, at two observation times. Interrater reliability was established at r = .91 for first observation and r = .92 for the second observation (p < .001). Intrarater reliability was r = .99 for rater one and r = .96 for rater two (p < .001). Future research will focus on refinement and further reliability testing of the instrument.
Andersen, Klaus Ejner; Jensen, O; Kvorning, S A
The risk of pressure sores developing in patients admitted with acute conditions was assessed by a simple risk score system based on age, reduced mobility, incontinence, pronounced emaciation, redness over bony prominences, unconsciousness, dehydration, and paralysis in a prospective clinical study....... During seven months in 1977, 600 of 3571 patients were classified as at risk. Of these 35 (5.8%) developed sores compared with five (0.2%) of those not at risk. The results of this study compared with those over the same period in 1976 show that close observation of at-risk patients and early detection...
Doménech-García, V; Palsson, T S; Herrero, P; Graven-Nielsen, T
Several chronic pain conditions are accompanied with enlarged referred pain areas. This study investigated a novel method for assessing referred pain. In 20 healthy subjects, pressure pain thresholds (PPTs) were recorded and pressure stimuli (120% PPT) were applied bilaterally for 5 and 60 seconds at the infraspinatus muscle to induce local and referred pain. Moreover, PPTs were measured bilaterally at the shoulder, neck, and leg before, during, and after hypertonic saline-induced referred pain in the dominant infraspinatus muscle. The pressure and saline-induced pain areas were assessed on drawings. Subsequently, delayed onset muscle soreness was induced using eccentric exercise of the dominant infraspinatus muscle. The day-1 assessments were repeated the following day (day 2). Suprathreshold pressure stimulations and saline injections into the infraspinatus muscle caused referred pain to the frontal aspect of the shoulder/arm in all subjects. The 60-second pressure stimulation caused larger referred pain areas compared with the 5-second stimulation (P soreness side (P soreness, indicating that the referred pain area may be a sensitive biomarker for sensitization of the pain system.
Velaei, Kobra; Bayat, Mohammad; Torkman, Giti; Rezaie, Fatemealsadat; Amini, Abdollah; Noruzian, Mohsen; Tavassol, Azaedh; Bayat, Mehernoush
This study used a biomechanical test to evaluate the effects of pentoxifylline administration on the wound healing process of an experimental pressure sore induced in rats. Under general anesthesia and sterile conditions, experimental pressure sores generated by no. 25 Halsted mosquito forceps were inflicted on 12 adult male rats. Pentoxifylline was injected intraperitoneally at a dose of 50 mg/kg daily from the day the pressure sore was generated, for a period of 20 days. At the end of 20 da...
Theunissen, C.C.W.; Zeilstra, J.T.; van Voorst Vader, P.C.; Kardaun, S.H.; Leeman, F.W.J.
Even with intact skin the possibility of pressure sores should not be dismissed. Early recognition of a pressure sore is important for adequate treatment and prevention of progression. Multidisciplinary intervention is essential. A wheelchair patient with spinal cord injury is described, who
Pressure sores have plagued the nursing profession for many years as a major health care problem in terms of a patient's suffering and financial cost. Pressure sores are increasingly common in hospitalized patients in the United States with a 63% increase from 1993 to 2003. The nurse leader is accountable for the occurrence of pressure sores, a nurse-sensitive indicator, by a scorecard which is benchmarked against other facilities. The nurse leader must take a systematic approach in the prevention of pressure sores, with the strategy being consistent and motivating to the staff in order to improve patient outcome. The chief nursing officer, the unit manager, and the bedside nurse must all collaborate to prevent tissue injury in patients at risk for developing pressure sores and to promote wound healing in patients with existing breakdown.
Full Text Available Abstract Background Myelomeningocele (MMC is a part of a complex neural tube defect and a disorder of the cerebrospinal fluid system. Pressure sores are a frequent complication for patients with MMC. Little is known about the risk factors for pressure sores in adults with MMC. The aim of this study was to investigate an association between the presence of pressure sores and other patient characteristics, in order to develop an improved strategy for the management of sores. Methods A structured questionnaire regarding sores, medical condition, function and living factors was designed and sent to the 193 patients with MMC registered in the year 2003 at TRS, a National Centre for Rare Disorders in Norway. Results Out of 193 total, 87 patients participated and 71 patients (82% reported sores; 26 (30% at the time of the interview and 45 (52% during the last 5 years. Sores were mostly localized on toes and feet and occurred exclusively in regions with reduced or missing sensibility. A significant association was found between sores and memory deficit (p = 0.02, Arnold Chiari malformation (p = 0.02 and a record of previous sores (p = 0.004. Sores were not significantly associated with hydrocephalus, syringomyelia, nutrition, body mass index, smoking, physical activity, employment or living together with other persons. Some patients (18, 21% reported skin inspection by others and the remainder relied on self-inspection. Conclusion Patients with sensory deficit, memory problems, and Arnold Chiari malformation had a higher risk of having pressure sores. This patient group needs improved skin inspection routines and sore treatment.
Background: Before 2006, all our spinal injured patients were nursed on conventional form mattress without pressure redistributing support surface. Pressure sore was a common complication and was a major contributing factor to prolonged hospitalization. Aim: The aim of this study is to determine the pattern of pressure ...
Full Text Available Introduction: Pressure sores are the most common complication post spinal cord injury that requires patients to be on bed rest. Patient bed rest delay rehabilitation and may lead to other complications associated with immobility. This study sought to establish the treatment interventions physiotherapists provide to patients with sacral pressure sores and the factors that they consider when deciding whether the patient should receive physiotherapy in the ward or gym. Methods: This was a questionnaire based survey of physiotherapists working in spinal cord injury rehabilitation units in South Africa. The self-designed questionnaire was sent to all the main spinal rehabilitation units in the country (14 located in Gauteng, Kwa-Zulu Natal, Western Cape, Eastern Cape and Free State provinces. Results: Thirty-nine physiotherapists from a total of 51 completed the questionnaires (76% response rate. The most common treatment practice for patients with sacral pressure sores was bed rest (98%. The most common physio-therapy practices (70% included were upper limb muscle strengthening, upper and lower limb passive movements, positioning into prone and side lying and passive stretching. The choice of treatment environment was influenced by doctors’ orders and the size, grade and duration of the pressure sores. Conclusion: Direct involvement in pressure sore management in South Africa seem to be less than in other parts of the world. If we are to minimise the pressure sore impact, it appears like we need more focus on gait re-education and standardised ADL programmes and patient treatment in the gym to possibly maximise healing and rehabilitation.
Knudsen, M.A.; Biering-Sørensen, Fin
of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies...
Lakhe, Gajal; Sharma, Surendra Mohan
The use of nitrous oxide and carboperitoneum in laparoscopic cholecystectomy lead to increase in endotracheal tube cuff pressure. It may impair tracheal mucosal perfusion with subsequent tracheal damage. The purpose of this study was to evaluate cuff pressure and incidence of post-operative sore throat in patients undergoing laparoscopic cholecystectomy. In this prospective observational study, 128 patients aged 18-65 years of American Society of Anesthesiologist physical status I and II undergoing laparoscopic cholecystectomy were enrolled and allocated alternately into two groups, Study Group (Maintenance of anesthesia with sevoflurane 1-2%, oxygen/nitrous oxide mixture; 40/60), Control Group (Maintenance of anesthesia with sevoflurane 1-2%, oxygen/air mixture; 40/60) were analysed and comapared. Each group contained 64 patients. Aneroid manometer was used to monitor cuff pressure. Volume of air used to inflate the cuff, baseline cuff pressure, comparison of intraoperative cuff pressure and incidence of post-operative sore throat were measured. The study results demonstrated higher cuff pressure in study group at all times after the creation of carboperitoneum (p=0.00) with increased incidence of sore throat(p=0.004). Increase in endotracheal tube cuff pressure was noted with the use of nitrous oxide in laparoscopic cholecystectomy with subsequent post-operative airway complication. Monitoring of cuff pressure is simple, noninvasive and efficient way of achieving therapeutic cuff pressure of 20-30 cm of H2O and thus recommends its use.
Niu, Junzhi; Han, Lin; Gong, Fen
BACKGROUND This study aimed to explore the therapeutic effect of external application of ligustrazine combined with holistic nursing on pressure sores, as well as the underlying mechanism. MATERIAL AND METHODS From February 2014 to March 2015, a total of 32 patients with Phase II and Phase III pressure sores were enrolled and randomly assigned to an experimental group or a control group. The clinical data were comparable between the 2 groups. In addition to holistic nursing, the patients in the experimental group received 4 weeks of continuous external application of ligustrazine, whereas patients in the control group received compound clotrimazole cream. Therapeutic effect and healing time were recorded. HaCaT cells were used as an in vitro model for mechanism analysis of the effect of ligustrazine in treating pressure sores. After culturing with different concentrations of ligustrazine or the inhibitor of AKT (LY294002) for 72 h, cell viability, clone formation numbers, and levels of phosphatidyl inositol 3-kinase (PI3K), p-AKT, and p-mammalian target of rapamycin (mTOR) were determined. RESULTS Compared to the control group, the total effective rate in the experimental group was significantly higher, and the healing time was significantly reduced. Cell viability and clone formation numbers were significantly upregulated by ligustrazine in a dose-dependent manner. Both the cell viability and clone formation numbers were significantly inhibited by application of LY294002. CONCLUSIONS Our results suggest that ligustrazine combined with holistic nursing is an effective treatment of pressure sores. The protective effect may be associated with the promotion of cell growth by activation of the PI3K/AKT pathway.
Full Text Available Objective: Pressure sores are an important source of complications in patients who are immobilized and bedridden. We aimed to investigate the efficiency of magnetic field treatment in pressure sores. Material and Methods: This was a randomized, double blind controlled design study. 20 patients in the study group received magneto-therapy, once a day for 30 minutes and with 150G, keeping to the BTL09 magnetotherapy device’s program. In the control group, 20 patients received the dressing only once a day. The surface areas of the pressure sores were evaluated at the onset of the treatment (1st day, and on the 7th and 15th days.Results: When within group comparisons were conducted, a significant difference was observed between the 1st and 7th day, 7th and 15th day, and 1st and 15th day measures in both the groups in terms of the scar area. The average healing time for the treatment group was 10.80±4.06 (6-20 days, and the average healing time for the control group was 18.85±9.75 (5-32 days. There was a statistically significant difference between the two groups (z=-2.114, p=0.034. Also, there was a significant difference in the scar area between the two groups in the 15th day measure (z=-3.818, p=0.000.Conclusion: The healing process of the tissue can be accelerated.with the use of magnetotherapy in the treatment of pressure sores of stage II and III,
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Hsiao, Yen-Chang; Chuang, Shiow-Shuh
The sacral region is one of the most vulnerable sites for the development of pressure sores. Even when surgical reconstruction is performed, there is a high chance of recurrence. Therefore, the concept of dual-dermal-barrier fashion flaps for sacral pressure sore reconstruction was proposed. From September 2007 to June 2010, nine patients with grade IV sacral pressures were enrolled. Four patients received bilateral myocutaneous V-Y flaps, four patients received bilateral fasciocutaneous V-Y flaps, and one patient received bilateral rotation-advanced flaps for sacral pressure reconstruction. The flaps were designed based on the perforators of the superior gluteal artery in one patient's reconstructive procedure. All flaps' designs were based on dual-dermal-barrier fashion. The mean follow-up time was 16 months (range = 12-25). No recurrence was noted. Only one patient had a complication of mild dehiscence at the middle suture line, occurring 2 weeks after the reconstructive surgery. The dual-dermal fashion flaps are easily duplicated and versatile. The study has shown minimal morbidity and a reasonable outcome.
Herrlin, K.; Stroemberg, T.; Lidgren, L.; Walloee, A.; Pettersson, H.; Lund Univ.
Four hundred and thirty trochanteric factures operated upon with McLaughlin, Ender or Richard's osteosynthesis were divided into 6 different types based on their radiographic appearance before and immediately after reposition with special reference to the medial cortical support. A significant correlation was found between the fracture type and subsequent mechanical complications where types 1 and 2 gave less, and types 4 and 5 more complications. A comparison of the various osteosyntheses showed that Richard's had significantly fewer complications than either the Ender or McLaughlin types. For Richard's osteosynthesis alone no correlation to fracture type could be made because of the small number of complications in this group. (orig.)
Chen, J-H; Wu, S-C; Chen, H-J; Kao, C-H; Tseng, C-H; Tsai, C-H
Prior investigations with few cases have disclosed lack of pressure sore (PrS) formation was characteristic in amyotrophic lateral sclerosis (ALS) patients. However, studies with larger samples are lacking to ascertain this concept. To investigate whether patients with ALS have higher risk of PrS. Utilizing a Taiwan National Insurance claims dataset with 23 million participants, we extracted 514 ALS patients and 2,056 controls from January 1, 2000, to December 31, 2008. Both groups were followed up until PrS occurrence during study period (2000-2011). The PrS risk was calculated with Cox proportional regression model. The ALS patients had a greater PrS risk (adjusted hazard ratio [aHR] = 8.82, 95% confidence interval [CI] = 4.90-15.9, P ALS women (aHR = 26.6, 95% CI = 9.05-78.2, P ALS men (aHR = 4.38, 95% CI = 1.99-9.68, P ALS was linked with a much greater PrS risk (aHR = 27.7, 95% CI = 5.79-132, P ALS is discovered to be correlated with an enhanced PrS risk. For PrS prevention, it is needed to pay more attention to the management of the ALS patients, particularly in women and those with relatively younger age. Further investigations are needed to confirm the findings in this study. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Prebio, Michael; Katz-Papatheophilou, Elfriede; Heindl, Werner; Gelbmann, Herbert; Burghuber, Otto C
Prone positioning in patients with adult respiratory distress syndrome is a well-known method to improve oxygenation. The aim of our study was to evaluate a new device for prone positioning, the prone-head support system (PHS system), with regard to reduction of cutaneous pressure sores. In a pilot study we randomized 8 patients with ARDS in two groups: 180 degrees standard prone positioning (group without mask) and prone positioning with the PHS system (group with mask). The PHS system consists of a facemask support, which is connected to an adapted air suspension bed. The patients of both groups were intermittently proned for several days. We evaluated the pressure sores on head and neck before turning the patients prone for the first time and after each period of prone positioning. We documented the quantity, the size, the type and the localization of the pressure sores. There was no significant difference in the mean duration of prone positioning (27.1+/-14.7 hours in the group with mask versus 24.5+/-18.7 h in the group without mask). In the group with mask there were 1.5+/-0.8 new pressure sores by each proning, whereas in the group without mask there were 2.37+/-1.6 new pressure sores, which was lower, but not significantly. The overall area of pressure sores (798 mm2 versus 3184 mm2, p=0.004), the area of pressure sores per patient (199.5+/-104.7 mm2 versus 796+/-478 mm2, p=0.03) and the increase of the area of pressure sores per proning (79.8+/-52.0 mm2 versus 398.0+/-214.3 mm2, p=0.004) were significantly lower in the group with mask in comparison to the group without mask. The lips were the most effected localization in both groups. The pressure sores in the group with mask were less severe and showed a homogenous distribution in comparison to the group without mask. Blisters dominated in the group with mask in comparison to erosions, necrosis and ulcers in the group without mask. The PHS system with its face mask is able to reduce the extent and the
... disorders Cancer of the mouth Infections such as hand-foot-mouth disease Weakened immune system -- for example, if you have ... Names Aphthous stomatitis; Herpes simplex; Cold sores Images Hand-foot-mouth disease Mouth sores Fever blister References Daniels TE, Jordan ...
... may be a connection between canker sores and stress . If you get canker sores around exam time or some other big event in your life, it may be a sign of how much stress you're under. Mouth injuries (like biting the ...
... pain Headache Cold sore Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...
... health basics Canker sore Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...
... may suggest allergy testing. Q: Is there a cure for canker sores? A: Not yet. However, therapies are available to decrease pain, shorten the time of the ulcers, and even reduce how often they occur. These ...
... may reduce how often they return. Symptoms A cold sore usually passes through several stages: Tingling and itching. Many people feel an itching, burning or tingling sensation around their lips for a day or so ...
... swab. Follow by dabbing a small amount of Milk of Magnesia on the canker sore afterward. Repeat these steps ... Rinse your mouth with a mixture of half Milk of Magnesia and half Benadryl liquid allergy medicine. Swish mixture ...
Crenshaw, A. G.; Friden, J.; Hargens, A. R.; Lang, G. H.; Thornell, L. E.
A scintigraphic technique employing technetium pyrophosphate uptake was used to identify the area of skeletal muscle damage in the lower leg of four runners 24 h after an ultramarathon footrace (160 km). Most of the race had been run downhill which incorporated an extensive amount of eccentric work. Soreness was diffuse throughout the posterior region of the lower leg. In order to interpret what increased technetium uptake reflects and to express extreme endurance related damages, a biopsy was taken from the 3-D position of abnormal uptake. In addition, intramuscular pressures were determined in the deep posterior compartment. Scintigraphs revealed increased technetium pyrophosphate uptake in the medial portion of the gastrocnemius muscle. For 3698 fibres analysed, 33 fibres (1%) were necrotic, while a few other fibres were either atrophic or irregular shaped. A cluster of necrotic fibres occurred at the fascicular periphery for one subject and fibre type grouping occurred for another. Ultrastructural analysis revealed Z-line streaming near many capillaries and variously altered subsarcolemmal mitochondria including some with paracrystalline inclusions. The majority of the capillaries included thickened and irregular shaped endothelial cells. Intramuscular pressures of the deep posterior compartment were slightly elevated (12-15 mmHg) for three of the four subjects. Increased technetium uptake following extreme endurance running does not just reflect muscle necrosis but also subtle fibre abnormalities. Collectively, these pathological findings are attributed to relative ischaemia occurring during the race and during pre-race training, whereas, intramuscular pressure elevations associated with muscle soreness are attributed to mechanical stress caused by extensive eccentric work during the race.
for you, too, now. Furthermore I write in the beginning: “The characteristics of digital images and the use Orlan makes of them, as well as the crisis in representation that she and the media mark, are linked with the notion of 'sore society’. Why is there a displacement from representation towards...
Burm, Jin Sik; Hwang, Jungil; Lee, Yung Ki
Owing to the high recurrence rates of ischial pressure sores, surgeons should consider the possibility of future secondary flap surgery during flap selection. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores using a simple hamstring-adductor magnus advancement flap and direct closure. After horizontal fusiform skin excision, complete bursa excision and ischiectomy were performed. The tenomuscular origin of the adductor magnus and the conjoined tenomuscular origin of the biceps femoris long head and semitendinosus were isolated and completely detached from the inferior border of the ischial tuberosity. They were then advanced in a cephalad direction without detachment of the distal tendon or muscle and securely affixed to the sacrotuberous ligament. The wound was directly closed without further incision or dissection. Twelve ischial pressure sores (6 primary and 6 recurrent; 12 patients) were surgically corrected. The follow-up period was 12 to 65 months. All patients healed successfully without early postoperative complications, such as hematoma, seroma, infection, wound dehiscence, or partial necrosis. Late complications included wound disruption 5 weeks after surgery that spontaneously healed in 1 case and recurrence 3 years later in another case. The new surgical option presented herein, which involves hamstring-adductor magnus advancement flap and direct closure, is a simple and reliable method for providing sufficient muscle bulk to fill the dead space and proper padding to the bone stump while preserving the main vascular perforators and pedicles as well as future surgical options.
Molano Alvarez, Esteban; Murillo Pérez, María del Ara; Salobral Villegas, María Teresa; Domínguez Caballero, Mireia; Cuenca Solanas, Manuela; García Fuentes, Carlos
Cervical collars are essential in the treatment of patients with suspicion or verification of acute cervical spine injury (ACSI). One of the complications of these devices is the development of pressure scores (PS). This study aims to determine its incidence in our unit, the characteristics of patients with ACSI who suffer PS due to the collar and to describe aspects related with these injuries. We include 92 patients with ACSI hospitalized more than 24 hours from January 2002 to December 2003. We analyze demographic variables, incidence, risk factors and characteristics of the PS that develop. The incidence of these lesions was 23.9%. Patients with PS presented: a higher injury severity score (ISS) (37.5 9.8 vs. 31.3 14.9), a greater percentage of catheter carriers of intracraneal pressure (ICP) (55.6% vs. 16.2%), longer time of mechanical ventilation (15.4 8.2 vs. 6.1 9) and longer stays (24.6 10.9 vs. 10 10.3), all statistically significant (pACSI, elevated ISS, monitoring of ICP, mechanical ventilation and prolonged stays is required. The occipital zone requires special attention due to the seriousness of the injuries recorded. We suggest a specific multidisciplinary protocol for this problem.
Singh, Sudhir; Shrivastava, Chetan; Kumar, Sanjiv
Unstable inter-trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut-out of the lag screw, are the common problems of attempts to fix these fractures. Present study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty in unstable inter-trochanteric fractures in elderly patients. This prospective study included 25 cases with unstable inter-trochanteric fracture of femur between 60 -75 y of age in whom primary Cemented Bipolar hemi - arthroplasty was performed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS), Lower Extremity Functional Scale (LEFS), Visual analogue scale (VAS) for evaluation of outcome. The mean HHS score was 78.86+8.13 by the end of one year. Similarly mean LEFS score was 34.36+7.01 by the end of one year, whereas the mean pain score on VAS Scale by the year end was 1.04+1.02. The changes in HHS, LEFS and VAS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. We compared our results with those reported by other authors and our study gave quite comparable results. We also used lower extremity function status score (LEFS) for assessment of functional ability. The purpose of its use was that while Harris Hip Score (HHS) provides information on a multitude of factors, LEFS is more patient oriented and provides the correct information about the level of activities a patient can resume post-operatively and can be offered as a self assessment tool. No significant complication except for grade I pressure sores in four patients were seen in postoperative period but they all resolved with proper nursing care by six week follow up. No patient required revision surgery. The authors believe that primary cemented bipolar hemiarthroplasty for
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Revilla, T.Y.; Manjon, P.; Lozaono, C.
To describe the radiological findings associated with trochanteric bursitis. Six patients studied by means of plain radiography (n=6), CT(n=4) and MR(n=2). The conventional radiography study was normal in two patients and disclosed bone abnormalities in four. US showed a hypoechoic or anechoic collection in all the patients. Two patients presented areas suggestive of calcification, and septa were observed in one. CT disclosed the presence of well defined, low-attenuation, unenhanced collections. MR images identified collections with a signal intensity similar to that of water. Trochanteric bursitis is a relatively common cause of hip pain, and can involve any one of a number of etiologies. US is a good imaging technique for diagnosing this pathology. (Author) 10 refs
Govaert, L. H. M.; van der Vis, H. M.; Marti, R. K.; Albers, G. H. R.
We describe a new operative procedure for patients with chronic trochanteric bursitis. Between March 1994 and May 2000, a trochanteric reduction osteotomy was performed on ten patients (12 hips). All had received conservative treatment for at least one year. Previous surgical treatment with a
K Ramaprathap Reddy
Full Text Available Background: Trochanteric fractures of femur like intertrochanteric and subtrochanteric fractures are a leading cause of hospital admissions in elderly people. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilizations such as bed sores, deep vein thrombosis, and respiratory infections. This study is done to analyze the surgical management of trochanteric fractures of the femur using a proximal femoral nail (PFN. Methodology: This is a prospective study of 40 cases of trochanteric and subtrochanteric fractures admitted to Government General Hospital, Vijayawada, Andhra Pradesh. Cases were taken according to inclusion and exclusion criteria, i.e., patients with trochanteric fractures femur above the age of 20 years. Medically unsuitable, open fractures and patients not willing for surgery were excluded from the study. Results: Forty percentage of cases were admitted due to slip and fall and with a slight predominance of the right side. Out of 40 cases, 26 were trochanteric, and 14 were subtrochanteric. In trochanteric class, 37.5% were body and griffin Type 2, in subtrochanteric class 12.5% were sinsheimer Type 3a and 10% were 2b. Out of 30 remaining cases, 25 were trochanteric, and 05 were subtrochanteric. Good to excellent results are seen in 100% cases of trochanteric fractures and 90% cases in subtrochanteric fractures. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of pertrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier, and exactly performed osteosynthesis.
... sign of an immune system problem. Even emotional stress could be a factor. One study of college students showed that they had more canker sores during stressful periods, such as around exam time. Who Gets Canker Sores? About 1 in ...
Daniel Ferreira da Cunha
Full Text Available Pressure sores are common among bedridden, elderly, or malnourished patients, and may occur in terminal ill patients because of impaired mobility, fecal or urinary incontinence, and decreased healing capacity. The aim of this study was to compare frequency of pressure sores between malnourished and non-malnourished necropsied adults. METHOD: All (n = 201 adults (age ³ 18 years autopsied between 1986 and 1996 at the Teaching Hospital of Triangulo Mineiro Medical School (Uberaba were eligible for the study. Gender, race, weight, height and main diagnoses were recorded. Ninety-six cases were excluded because of probable body water retention (congestive heart failure, hepatic insufficiency, nephrotic syndrome or pressure sores secondary to peripheral vascular ischemia. Body mass index (BMI was used to define malnourished (BMI 18.5kg/m² groups. RESULTS: Except for weight (42.5kg; range: 28-57 vs. 60; 36-134.5kg and BMI (16.9; range: 12.4-18.5 vs. 22.7; range: 18.5-54.6kg/m², respectively, there were no statistical differences among 43 malnourished and 62 non-malnourished cases in relation to age (54.9 ± 20.4 vs. 52.9 ± 17.9 years, percentage of white persons (74.4 vs. 64.5%, male gender (76.7 vs. 69.3% and main diagnoses. Five malnourished (11.6% and 7 (11.5% non-malnourished cases had pressure sores (p=0.89. CONCLUSION: Pressure sores were equally common findings in necropsied persons with protein-energy malnutrition, as assessed by body mass index.Escaras de decúbito são comuns em pacientes acamados, idosos e subnutridos e podem ocorrer em pacientes terminais devido à imobilidade, incontinência fecal e urinária e imunodepressão. Além disso, a contaminação das Escaras de decúbito aumentam o risco de sepsis e podem piorar o estado nutricional. O objetivo deste estudo foi comparar a freqüência de Escaras de decúbito entre adultos necropsiados com ou sem subnutrição. MÉTODO: Adultos (n=201 necropsiados no Hospital Escola da FMTM
Douša, P; Čech, O; Weissinger, M; Džupa, V
At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1
Márcio Paulino Costa
crompression due to sitting, lying or wearing brace in a heathy person results in discomfort and pain due to local isquemia. The normal protective pahtways are interrupted, however, in paraplegics, quadriplegic or the signals are ignored in severely de hibilitade, eldery or chronic ill patients. The pressure sore develops in these patients. Few papers have been done in Brazil abour pressure sores, despite economic problem envolved with. The purpose of this paper is to evaluate the epidemiology, treatment and complications of pressure sores in the Hospital das Clínicas (University of São Paulo from February 1997 to March 1999 in the Orthopedics Institute. A prospective study has been done. Data were evaluated as to the sex, age, sites, classification, type of treatment employed, length of stay and complications. The treatment was evaluated by the success rate and recurrence rate . The average follow-up period was 1 year and a half, ranging from 6 month to 2 years. 77 pressure sores in 45 patients were apraised. 36 men and 9 women, age range 17-64, mean 34,78 years. Of the patients, 100% had severe spinal cord injuries, and most of them victims of gun shot (60%. 93,3% of the wound were chronic (present longer than 3 months. 77,92% were treated by surgical procedures, and most of them with myocutaneous flaps (45%. The success rate changed with the site of the lesion: 80% trochanter, 84% sacrum and 66,6% ischium. The recurrence rate was 25%. The complication rate also changed with the site of the lesion: 84% trocanter, 64% sacrum and 50% isquium.
Colin, D; Rochet, J-M; Ribinik, P; Barrois, B; Passadori, Y; Michel, J-M
The use of support surfaces in the prevention and treatment of pressure ulcers prevention is an important part of care for a patient at risk and/or suffering from sore(s). Define which support surfaces to use in prevention and treatment of at-risk and/or pressure sore patients. A systematic review of the literature querying the several Pascal Biomed, PubMed and Cochrane Library databases from 2000 through 2010. RESULTS (GRADE A): In prevention, a structured foam mattress is more efficient than a standard hospital mattress. An alternating pressure mattress is more effective than a visco-elastic mattress limiting the occurrence heel pressure ulcers, but those that do occur are more serious. A low-air-loss bed is more efficient than a mixed pulsating air mattress in prevention of heel pressure ulcers. Some types of sheepskin can reduce sacral pressure ulcer incidence in orthopedic patients. Use of an overlay on an operating table limits the occurrence of peroperative and postoperative pressure ulcers. An air-fluidized bed improves pressure ulcer healing. The data in the literature are not always relevant and do not suffice to dictate a clinician's choices. We are compelled to recognize the methodological limitations of many studies, the lack of corporate interest in conducting such studies and the relatively small number of available trials. However, the effectiveness of some support surfaces reaches a sufficient level of evidence, especially when they are associated with postural, hydration and nutritional measures. Support surfaces are recommended in prevention and treatment of patients at risk and/or already suffering from pressure ulcer, and their use should constitute part of an overall preventive or curative strategy. Copyright © 2012. Published by Elsevier Masson SAS.
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... in some cases: Strep throat is caused by group A streptococcus. Less commonly, bacterial diseases such as gonorrhea and chlamydia can cause sore throat. Most cases of pharyngitis occur ... illness often spreads among family members and close contacts.
Mallow, Michael; Nazarian, Levon N
Lateral hip pain, or greater trochanteric pain syndrome, is a commonly seen condition; in this article, the relevant anatomy, epidemiology, and evaluation strategies of greater trochanteric pain syndrome are reviewed. Specific attention is focused on imaging of this syndrome and treatment techniques, including ultrasound-guided interventions. Copyright © 2014 Elsevier Inc. All rights reserved.
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Rothenberger, Jens; Krauss, Sabrina; Held, Manuel; Bender, Dominik; Schaller, Hans-Eberhard; Rahmanian-Schwarz, Afshin; Constantinescu, Mihai Adrian; Jaminet, Patrick
Pressure ulcers are associated with severe impairment for the patients and high economic load. With this study we wanted to gain more insight to the skin perfusion dynamics due to external loading. Furthermore, we evaluated the effect of different types of pressure relief mattresses. A total of 25 healthy volunteers were enrolled in the study. Perfusion dynamics of the sacral and the heel area were assessed using the O2C-device, which combines a laser light, to determine blood flow, and white light to determine the relative amount of hemoglobin. Three mattresses were evaluated compared to a hard surface: a standard hospital foam mattress bed, a visco-elastic foam mattress, and an air-fluidized bed. In the heel area, only the air-fluidized bed was able to maintain the blood circulation (mean blood flow of 13.6 ± 6 versus 3.9 ± 3 AU and mean relative amount of hemoglobin of 44.0 ± 14 versus 32.7 ± 12 AU.) In the sacral area, all used mattresses revealed an improvement of blood circulation compared to the hard surface. The results of this study form a more precise pattern of perfusion changes due to external loading on various pressure relief mattresses. This knowledge may reduce the incidence of pressure ulcers and may be an influencing factor in pressure relief mattress selection. Copyright © 2014 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.
San Roman, R.; Manjon, P.; Revilla, Y.; Rodriguez, P.
To analyze the radiological signs and clinical presentation of tuberculous bursitis arising in the ischial and trochanteric territories, given the limited available knowledge on these entities and in view of the growing prominence of extra pulmonary tuberculosis (TB) in the field of infectious diseases. We present seven cases dealt with in our hospital from the first medical consultation to the definitive diagnosis and treatment. Five of the patients presented greater trochanter involvement, while ischium was the site in the remaining two, in one of whom the bursitis extended toward pubis. The radiographic images revealed demineralization and/or erosion of the bone surface in six cases, soft tissue calcification in four, soft tissue mass in two, coccygeal involvement in one and avulsion of a bone fragment one. An ultrasound study was carried out in a of case soft tissue abscess and fistulography in a case of peri-ischial abscess reaching the cutaneous level. Images of the ischial and trochanteric tuberosities such as those described in the present report should lead to a suspicion of bursitis accompanied by local osteitis. One of the etiologies that should be considered, probably the most common one, is tuberculosis, given the serious consequences that poor initial management would have (if is often treated as pyogenic) and its growing incidence. (Author) 10 refs
Makki, Daoud; Watson, Alex James
Trochanteric bursitis, whether septic or inflammatory in origin, is a condition that affects middle-aged patients. Here we report the rare case of an adolescent with septic trochanteric bursitis (treated successfully with intravenous antibiotics), review the available literature on septic bursitis, illustrate the importance of prompt recognition and treatment of this condition in any age group, and describe the clinical presentation and the radiologic findings.
Board, Tim N; Hughes, Simon J; Freemont, Anthony J
Trochanteric bursitis has been used as a general term to describe pain around the greater trochanteric region of the hip. We hypothesised that trochanteric bursitis may not however have an inflammatory component and that accordingly, bursal inflammation has no role in lateral hip pain. This study was designed to test this hypothesis. Patients undergoing primary total hip replacement were enrolled in this prospective, case-controlled, blinded study. Twenty-five patients who met the criteria for diagnosis of trochanteric bursitis (group A) were matched with a control group of 25 patients (group B). Trochanteric bursal samples were harvested from all patients intraoperatively and sent for histological analysis for the presence of inflammation. The intraoperative appearance of the abductor tendon insertion was also noted. None of the samples showed any evidence of acute or chronic inflammatory changes. Intraoperatively, five patients (20%) in group A were noted to have thinning of the gluteus medius tendon but no macroscopic tendon tears were detected in any bursal samples. This study suggests that there is no inflammatory component to so-called trochanteric bursitis, which accordingly casts doubt on both the terminology and the existence of this condition as a separate clinical entity. Clinicians should search for an alternative cause of symptoms in such cases.
Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won
We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nai...
Mahmoud, I; Gafsi, L; Saidane, O; Souayah, A; Tekaya, R; Sahli, H; Abdelmoula, L
Trochanteric tuberculosis is a very rare localization of musculo-skeletal tuberculosis. The diagnosis is difficult and is often made in a late stage. The authors describe five cases of trochanteric tuberculosis. The mean age of patients was 46.6 years. Time to diagnosis was long (7.6 months on average). The tuberculosis was plurifocal in all cases. Diagnosis was based on positive Lowenstein culture in one case, on the presence of caseum granuloma in one case and through a pathognommonic manifestation in one case. For the remaining two cases, diagnosis was established on clinical and paraclinical arguments. The patients recovered after medical treatment alone.
Reiter, Michael; O'Brien, Seth D; Bui-Mansfield, Liem T; Alderete, Joseph
Proximal femoral fractures are frequently encountered in the emergency department (ED). Prompt diagnosis is paramount as delay will exacerbate the already poor outcomes associated with these injuries. In cases where radiography is negative but clinical suspicion remains high, magnetic resonance imaging (MRI) is the study of choice as it has the capability to depict fractures which are occult on other imaging modalities. Awareness of a particular subset of proximal femoral fractures, namely greater trochanteric fractures, is vital for both radiologists and clinicians since it has been well documented that they invariably have an intertrochanteric component which may require surgical management. The detection of intertrochanteric or cervical extension of greater trochanteric fractures has been described utilizing MRI but is underestimated with both computed tomography (CT) and bone scan. Therefore, if MRI is unavailable or contraindicated, the diagnosis of an isolated greater trochanteric fracture should be met with caution. The importance of avoiding this potential pitfall is demonstrated in the following case of an elderly woman with hip pain and CT demonstrating an isolated greater trochanteric fracture who subsequently returned to the ED with a displaced intertrochanteric fracture.
Lewis, Paul B; Ruby, Deana; Bush-Joseph, Charles A
Immediate and delayed-onset muscle soreness differ mainly in chronology of presentation. Both conditions share the same quality of pain, eliciting and relieving activities and a varying degree of functional deficits. There is no single mechanism for muscle soreness; instead, it is a culmination of 6 different mechanisms. The developing pathway of DOMS begins with microtrauma to muscles and then surrounding connective tissues. Microtrauma is then followed by an inflammatory process and subsequent shifts of fluid and electrolytes. Throughout the progression of these events, muscle spasms may be present, exacerbating the overall condition. There are a multitude of modalities to manage the associated symptoms of immediate soreness and DOMS. Outcomes of each modality seem to be as diverse as the modalities themselves. The judicious use of NSAIDs and continued exercise are suggested to be the most reliable methods and recommended. This review article and each study cited, however, represent just one part of the clinician's decisionmaking process. Careful affirmation of temporary deficits from muscle soreness is not to be taken lightly, nor is the advisement and medical management of muscle soreness prescribed by the clinician.
Biber, Roland; Berger, Johanna; Bail, Hermann Josef
The name of Ender is primarily associated with the Ender nails, which were popular for trochanteric fracture fixation more than thirty years ago. However, Ender's concepts were not limited to the implant. Ender developed a unique classification system for trochanteric and subtrochanteric fractures, which provided the theory for closed reduction maneuvers that made the method so successful in his hands. While Ender's nails have become history in the meantime, his principles of fracture reduction can be readily applied on surgery with modern implants such as proximal femoral nails. This article reflects the classification and the principles published by Hans Georg Ender in some print work hardly available nowadays. Copyright © 2016 Elsevier Ltd. All rights reserved.
Redmond, John M; Cregar, William M; Gupta, Asheesh; Hammarstedt, Jon E; Martin, Timothy J; Domb, Benjamin G
Lateral hip pain along with tenderness of the greater trochanter has been associated with greater trochanteric pain syndrome. Radiographically, this has been associated with gluteus medius pathology on magnetic resonance imaging. This has led some surgeons to conclude that abductor pathology is a primary cause of lateral hip pain. Failure of conservative treatment in the setting of gluteus medius pathology may lead to surgical intervention. In some patients a focal tear of the gluteus medius cannot be visualized and likely represents more diffuse tendinopathy. In these patients we propose micropuncture of the greater trochanter. Similar procedures have shown effectiveness in the elbow and shoulder by eliciting a healing response. Our experience suggests that trochanteric micropuncture at the insertion of the gluteus medius tendon can be effectively performed endoscopically for gluteus medius tendinopathy.
Ramos-Pascua, Luis R; Carro-Fernández, José A; Santos-Sánchez, José A; Casas Ramos, Paula; Díez-Romero, Luis J; Izquierdo-García, Francisco M
We presented three patients with trochanteric tuberculosis and described the clinical and imaging findings of the infection. Histology revealed a necrotizing granulomatous bursitis and microbiology confirmed tuberculosis. All cases were successfully treated with bursectomy and curettage of the trochanteric lesion and antituberculous chemotherapy including isoniazid, pyrazinamide, rifampicin, and ethambutol.
Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won
We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.
Recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Treatment is surgical, of various sorts. Open reduction internal fixation (ORIF) with intra- or extra-medullary implants is the most frequent attitude in these fractures, which usually heal easily. In elderly patients, arthroplasty is an alternative of choice for some authors. These different treatment modalities are presented, focusing on technical details. Possible technical difficulties and the means of dealing with them are considered. Published results help in choosing the treatment most suitable for a particular type of fracture in a particular patient. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
... blood flow, including diabetes or vascular disease Have Alzheimer disease or another condition that affects your mental state Have fragile skin Cannot control your bladder or bowels Do not get enough nutrition
Santos, Leandro Em?lio Nascimento; Pires, Robinson Esteves Santos; Figueiredo, Leonardo Brand?o; Soares, Eduardo Augusto Marques
Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed.
Lee, Bong-Jin; Song, Jyewon
Stress fractures may occur at various sites in the femur including the head, neck, shaft, supracondylar and condylar regions. To the best of our knowledge, stress fracture occurring in the trochanteric region has not been previously reported. We report here a case of trochanteric stress fracture in a 53-year-old female window cleaner treated with hip nailing without adverse consequences. Careful consideration of this entity is needed when evaluating patients who have repetitive jumping up and...
Schipper, I. B.; Marti, R. K.; van der Werken, Chr
For operative treatment of unstable trochanteric fractures two options exist: extramedullary or intramedullary stabilisation. A review of 18 international papers that compared two different treatment methods for trochanteric fractures, in prospective randomised clinical trials, is presented. In view
Myburgh, Kathryn H.; And Others
To identify factors which cause shin soreness in athletes, 25 injured exercisers and a control group of 25 uninjured exercisers were studied. Methodology and results are presented and analyzed. Differences in calcium intake between the two groups is cited as a key factor in causing shin soreness. (JL)
Díaz, A R; Navas, P Z
The differences between the two main types of fracture of proximal end of the femur, trochanteric and cervical fractures, are still a subject of study, and could be the key to a better understanding of its pathophysiology and prevention. The aim of this study is to determine whether epidemiological differences in the distribution of risk factors associated with hip fracture exist between these two entities. A descriptive cross-sectional study of 428 patients over the age of 65 admitted for trochanteric or cervical fractures in 2015, in which gender, age, previous diagnosis, external causes associated with fracture and place of the event were recorded. There were 220 patients with a cervical fracture (51.4%) and 208 patients with a trochanteric fracture (48.6%). The average age was higher in the trochanteric fracture, observing a constant increase with age only in women with trochanteric fractures. Cervical fracture showed a significant association with cerebrovascular disease (p=0.039) and trochanteric fracture with accidental falls (p=0.047) and presence of 5-9 previous diseases (p=0.014). A regression analysis maintained this association in the case of a cerebrovascular disease (OR 2.6, 95%CI 1.1-6.4) and the presence of 5-9 diseases (OR 1.5, 95%CI 1.1-2.3). Trochanteric fractures are associated with women patients of more advanced ages, 5-9 previous diseases and accidental falls. Cerebrovascular disease shows a higher prevalence in cervical fractures. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.
Dubina, Andrew G; Wickramaratne, Niluka; O'Toole, Robert V; Manson, Theodore T
Trochanteric osteotomies are performed in conjunction with standard approaches to improve surgical exposure during open reduction and internal fixation (ORIF) of acetabular fractures. The literature on total hip arthroplasty reports nonunion rates as high as 30% associated with trochanteric osteotomies; however, few data exist regarding the outcomes of trochanteric osteotomies for acetabular fracture surgery. Our hypotheses were 1) patients receiving trochanteric osteotomies during ORIF of acetabular fractures have a low rate of nonunion of the osteotomy fragment, and 2) hip abduction precautions are not necessary with digastric type osteotomies. A retrospective review was conducted to identify patients with acetabular fractures between July 2002 and June 2010 (n=734 fractures) who required trochanteric osteotomies (n=64, 9% of fractures). Forty-seven met inclusion criteria of adequate follow-up (>56days). No excluded patient experienced a complication. Fractures were classified using the Letournel-Judet classification system. Only seven (20%) of 35 patients who received digastric osteotomies had hip abduction precautions applied during the postoperative period. All study patients were shown to have radiographic union at the trochanteric osteotomy site (100% union rate, n=47). Hip abduction precautions intended to protect the osteotomy site and reduce the risk of nonunion and fixation failure were infrequently applied to patients with digastric osteotomies (20%) in this cohort. Multiple protective factors against nonunion were present in this study population compared with previous arthroplasty studies from other institutions. Trochanteric osteotomies are not associated with a significant nonunion rate, and digastric osteotomies might be safely managed without hip abduction precautions. Copyright © 2016. Published by Elsevier Ltd.
Mandell, B F
Five patients are described with avascular necrosis of the femoral head who presented with ipsilateral trochanteric bursitis, in the absence of clearcut hip joint disease. Avascular necrosis was indicated by magnetic resonance imaging. It is suggested that clinical trochanteric bursitis, especially when refractory to local corticosteroid treatment, may be the initial sign of hip disease. In the patient with risk factor(s) for avascular necrosis that diagnosis should be considered and evaluated with appropriate studies, such as magnetic resonance imaging, to prevent weight bearing at an early stage and permit possible surgical decompression in the hope of postponing or obviating the need for total hip replacement. PMID:2241294
Soro Marín, Sandra; Sánchez Trenado, María Asunción; Mínguez Sánchez, María Dolores; Paulino Huertas, Marcos; García Morales, Paula Virginia; Salas Manzanedo, Verónica
Soft tissue infection due to Mycobacterium tuberculosis can affect muscle, tendons, fascia, bursa and synovial tissue. Tuberculous trochanteric bursitis is a rare entity that usually affects immunocompromised patients. Manifestations usually occur insidiously, which delays diagnosis and treatment. We present the case of an immunocompetent young woman who came to our department for chronic left hip pain. The study confirms the diagnosis of tuberculous trochanteric bursitis. This case demonstrates the importance of considering a possible infectious origin of bursitis in immunocompetent patients. Copyright © 2010 Elsevier España, S.L. All rights reserved.
Whitelock, R.G.; Dyce, J.; Houlton, J.E.F.
The records and radiographs of 24 dogs that underwent femoral trochanteric osteotomy repair were reviewed. Osteotomy repair was performed with either a pin and tension band wire or a lag screw technique. Significant clinical complications associated with the osteotomy were identified in one dog (4 per cent) six weeks after surgery, although abnormal radiographic changes were evident in 15 dogs (62 per cent). The method of repair did not influence healing and there were comparable radiographic complication rates. It is concluded that femoral trochanteric osteotomy is not associated with significant clinical problems, despite a high incidence of abnormal radiographic findings
Baruah, Ranjit Kumar; Borah, Pranab Jyoti; Haque, Russel
To evaluate perioperative blood loss and blood transfusion requirement in patients who underwent dynamic hip screw plate fixation for a stable trochanteric fracture with or without preoperative intravenous tranexamic acid (TXA). 49 men and 11 women (mean age, 56.5 years) who underwent open reduction and internal fixation with a dynamic hip screw plate for a stable trochanteric fracture by a single surgeon were equally randomised to receive either a single dose of intravenous TXA (15 mg/kg) 15 minutes prior to surgery or an equal volume of normal saline by slow infusion. Intra- and post-operative blood loss and the need for blood transfusion were assessed, as was any thromboembolic adverse event. The TXA and control groups were comparable in terms of age, gender, body mass index, blood pressure, pulse rate, time from injury to surgery, operating time, and preoperative haematological data. Blood loss was lower in the TXA than control group intraoperatively (320.3 vs. 403.33 ml, ptrochanteric fractures.
Nielson, Carrie M.; Bouxsein, Mary L.; Freitas, Sinara S.; Ensrud, Kristine E.; Orwoll, Eric S.
Background: Greater thickness of the tissue extending laterally from the greater trochanter has been associated with a lower risk of hip fracture in women. The effect of trochanteric soft tissue thickness on the risk of incident hip fracture has not been evaluated in men.
Surgical implants used were the Judet screw plate and Küntscher nail. Results: Postoperative death occurred in three cases. Fracture ... These injuries could be managed surgically with simple methods that are readily available with immediate satisfactory outcome. Keywords: trochanteric fractures, surgical care Judet screw ...
Bonnaire, F; Lein, T; Bula, P
The objective of any surgical care of a trochanteric femoral fracture should be the achievement of a stable osteosynthesis that allows early full weight-bearing mobilisation of the patient, because long-term immobilisation soon becomes a vital threat to the affected patients who are usually elderly with correlating comorbidities. The anatomical references of the proximal femur and the structure of the hip joint contain some specifics that play an essential role in the incurrence of a trochanteric femoral fracture and the planning of the osteosynthesis as well. With reposition and fracture stabilisation particular importance must be attached to the collo-diaphyseal and the antetorsion angle so that they do not interfere with the functional interaction of the hip and knee joint. Uncomplex trochanteric fractures ordinarily stabilise sufficiently after reposition so that even an extramedullary implant can ensure full weight-bearing stability. With evermore distal fracture course and intertrochanteric comminution zone, rotational instability and pivot transfer of the fracture area to lateral and caudal are followed by an increase of the dislocating forces. These kinds of fractures (A2 and A3 according to the AO/ASIF classification) profit from an intramedullary and rotationally stable osteosynthesis. Basically primary total hip arthroplasty is a potential option for surgical care of a trochanteric fracture in elderly patients with relevant coxarthrosis. However this procedure can only be recommended in cases of a stable uncomplex fracture. The more the medial interlocking of the proximal femur is destroyed the more difficult it will be to primarily implant a total hip prosthesis with good offset and without a varus and rotational failure in the fracture zone.The current studies in the main show disadvantages due to increased complications in these patients, so that in cases of an unstable trochanteric fracture a primary osteosynthesis should be performed followed by
Nielson, Carrie M.; Bouxsein, Mary L.; Freitas, Sinara S.; Ensrud, Kristine E.; Orwoll, Eric S.
Background: Greater thickness of the tissue extending laterally from the greater trochanter has been associated with a lower risk of hip fracture in women. The effect of trochanteric soft tissue thickness on the risk of incident hip fracture has not been evaluated in men. Methods: We measured trochanteric soft tissue thickness by dual-energy x-ray absorptiometry for all incident hip fracture cases (n = 70) and 222 randomly selected noncases in older men (≥65 yr) enrolled in the Osteoporotic Fractures in Men (MrOS) Study. Differences in tissue thickness between cases and controls were examined. Changes in fall force and factor-of-risk (the ratio of force from a sideways fall to femoral bone strength) associated with tissue thickness were determined. The relative risk for incident hip fracture per sd decrease in tissue thickness was calculated. Results: Mean trochanteric soft tissue thickness did not differ significantly between cases and noncases (29.1 ± 11.9 vs 31.0 ± 11.5 mm; P = 0.2). Although increased tissue thickness reduced both the estimates of fall force and the factor-of-risk, tissue thickness was not associated with the risk of hip fracture (age- and bone mineral density-adjusted relative risk per sd decrease in tissue thickness = 0.90; 95% confidence interval, 0.70–1.16). Conclusions: In this study of elderly community-dwelling men, we found no significant association between trochanteric soft tissue thickness and incident hip fracture. Trochanteric soft tissue thickness in these men was less than previously reported in older women and may explain the difference between these results and those reported in women. PMID:19017753
Burnett, D; Smith, K; Smeltzer, C; Young, K; Burns, S
The purpose of this study was to determine if rating of perceived exertion correlated with perceived muscle soreness during delayed onset muscle soreness (DOMS) in female runners. This study examined the pre and post running economy measures and perceived muscle soreness before and after a 30-min downhill run (DHR) at -15% grade and 70% of the subjects predetermined maximum oxygen uptake (VO2 peak). Six female recreational runners (mean age = 24.5) performed level running at 65%, 75%, and 85% of their VO2 peak prior to DHR (baseline economy runs), as well as, immediately following and 4 successive days after the DHR. Subjective response related to perceived muscle soreness increased significantly from a mean of 2 (pre DHR) to 62 (2 days post DHR) on a scale of 1-100. Creatine kinase levels and oxygen consumption increased post DHR compared to pre DHR. Rating of perceived exertion did not change between the economy runs performed prior to or at any point after the DHR. Perceived muscle soreness is a better tool than the RPE scale to monitor exercise intensity for recreational female runners during periods of DOMS and running economy is adversely affected by DOMS.
Jay, Kenneth; Sundstrup, Emil; Søndergaard, Stine D; Behm, David; Brandt, Mikkel; Særvoll, Charlotte A; Jakobsen, Markus D; Andersen, Lars L
Muscle soreness can negatively interfere with the activities of daily living as well as sports performance. In the working environment, a common problem is muscle tenderness, soreness and pain, especially for workers frequently exposed to unilateral high repetitive movements tasks. The aim of the study is therefore to investigate the acute effect of massage applied using a simple device Thera-band roller Massager on laboratory induced hamstring muscle soreness, and the potential cross over effect to the non-massaged limb. 22 healthy untrained men (Mean age 34 +/- 7 years; mean height 181.7 +/- 6.9 cm; mean weight 80.6 +/- 6.4 kg; BMI: 24.5 +/- 1.3) with no prior history of knee, low back or neck injury or other adverse health issues were recruited. Participants visited the researchers on two separate occasions, separated by 48 hours, each time providing a soreness rating (modified visual analog scale 0-10), and being tested for pressure pain threshold (PPT) and active range of motion (ROM) of the hamstring muscles. During the first visit, delayed onset muscular soreness of the hamstring muscles was induced by 10 x 10 repetitions of the stiff-legged dead-lift. On the second visit participants received either 1) 10 minutes of roller massage on one leg, while the contralateral leg served as a cross over control, or 2) Resting for 10 minutes with no massage at all. Measurement of soreness, PPT and ROM were taken immediately before and at 0, 10, 30 and 60 min. after treatment. There was a significant group by time interaction for soreness (p soreness and increasing PPT compared with the control group. There was no group by time interaction for ROM (p = 0.18). At 10 min. post massage there was a significant reduction in soreness of the non-massaged limb in the cross over control group compared to controls but this effect was lost 30 minutes post massage. Massage with a roller device reduces muscle soreness and is accompanied by a higher PPT of the affected muscle. 2c
Derman, Peter B; Horneff, John G; Kamath, Atul F; Garino, Jonathan
Post-operative trochanteric bursitis is a known complication secondary to the surgical approach in total hip arthroplasty. This phenomenon may be partially attributable to repetitive microtrauma generated when soft tissues rub against implanted hardware. Significant rates of post-operative trochanteric bursitis have been observed following procedures in which a trochanteric fixation device, such as a bolt-washer mechanism or a cable-grip/claw system, is used to secure the trochanteric fragment after trochanteric osteotomy. We present a simple technique for use with a bolt-washer system or grip plate in which trochanteric components are covered in bone wax followed by a layer of cement to decrease friction and to diminish the risk of post-operative bursitis.
Veqar, Zubia; Imtiyaz, Shagufta
Both athletic and nonathletic population when subjected to any unaccustomed or unfamiliar exercise will experience pain 24-72 hours postexercise. This exercise especially eccentric in nature caused primarily by muscle damage is known as delayed-onset muscle soreness (DOMS). This damage is characterized by muscular pain, decreased muscle force production, reduce range of motion and discomfort experienced. DOMS is due to microscopic muscle fiber tears. The presence of DOMS increases risk of injury. A reduced range of motion may lead to the incapability to efficiently absorb the shock that affect physical activity. Alterations to mechanical motion may increase strain placed on soft tissue structures. Reduced force output may signal compensatory recruitment of muscles, thus leading to unaccustomed stress on musculature. Differences in strength ratios may also cause excessive strain on unaccustomed musculature. A range of interventions aimed at decreasing symptoms of DOMS have been proposed. Although voluminous research has been done in this regard, there is little consensus among the practitioners regarding the most effective way of treating DOMS. Mechanical oscillatory motion provided by vibration therapy. Vibration could represent an effective exercise intervention for enhancing neuromuscular performance in athletes. Vibration has shown effectiveness in flexibility and explosive power. Vibration can apply either local area or whole body vibration. Vibration therapy improves muscular strength, power development, kinesthetic awareness, decreased muscle sore, increased range of motion, and increased blood flow under the skin. VT was effective for reduction of DOMS and regaining full ROM. Application of whole body vibration therapy in postexercise demonstrates less pressure pain threshold, muscle soreness along with less reduction maximal isometric and isokinetic voluntary strength and lower creatine kinase levels in the blood.
Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L
This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty.
Full Text Available “Bed sores” owe their name to the observation that patients who were bedridden and not properly repositioned would often develop ulcerations or sores on their skin, typically over bony prominences. These bed sores, which result from prolonged pressure, are also called “decubitus ulcers,” “pressure sores,” “skin breakdown,” and “pressure ulcers.” They are associated with adverse health outcomes and high treatment costs. This study focuses on developing herbal finish to prevent bed sores. For this purpose, functional finishing was utilized to produce a bedsore preventing fabric. Plain weave cotton fabric was dyed by using herbal extracts, dried, and then cured. Two samples in different ratios (1 : 2 and 2 : 1 of two herbal extracts (Mangifera indica and Triphala dried fruits were prepared with and without binder (chitosan. Air permeability, wicking ability, Drop Test for absorbency, and antibacterial properties were examined for those samples. Based on the results, fabric dyed with Mangifera indica and Triphala dried fruits in the ratio of 2 : 1 with chitosan is determined as the most promising combination for the final product.
Mathur, Sunita; Sheel, A William; Road, Jeremy D; Reid, W Darlene
Skeletal muscle damage occurs following high-intensity or unaccustomed exercise; however, it is difficult to monitor damage to the respiratory muscles, particularly in humans. The aim of this study was to use clinical measures to investigate the presence of skeletal muscle damage in the inspiratory muscles. Ten healthy subjects underwent 60 minutes of voluntary inspiratory threshold loading (ITL) at 70% of maximal inspiratory pressure. Maximal inspiratory and expiratory mouth pressures, delayed onset muscle soreness on a visual analogue scale and plasma creatine kinase were measured prior to ITL, and at repeated time points after ITL (4, 24 and 48 hours post-ITL). Delayed onset muscle soreness was present in all subjects 24 hours following ITL (intensity = 22 +/- 6 mm; significantly higher than baseline p = 0.02). Muscle soreness was reported primarily in the anterior neck region, and was correlated to the amount of work done by the inspiratory muscles during ITL (r = 0.72, p = 0.02). However, no significant change was observed in maximal inspiratory or expiratory pressures or creatine kinase. These findings suggest that an intense bout of ITL results in muscle soreness primarily in the accessory muscles of inspiration, however, may be insufficient to cause significant muscle damage in healthy adults.
Andersen, Lars L; Jay, Kenneth; Andersen, Christoffer H; Jakobsen, Markus D; Sundstrup, Emil; Topp, Robert; Behm, David G
Massage is commonly believed to be the best modality for relieving muscle soreness. However, actively warming up the muscles with exercise may be an effective alternative. The purpose of this study was to compare the acute effect of massage with active exercise for relieving muscle soreness. Twenty healthy female volunteers (mean age 32 years) participated in this examiner-blind randomized controlled trial (ClinicalTrials.gov NCT01478451). The participants performed eccentric contractions for the upper trapezius muscle on a Biodex dynamometer. Delayed onset muscle soreness (DOMS) presented 48 hours later, at which the participants (a) received 10 minutes of massage of the trapezius muscle or (b) performed 10 minutes of active exercise (shoulder shrugs 10 × 10 reps) with increasing elastic resistance (Thera-Band). First, 1 treatment was randomly applied to 1 shoulder while the contralateral shoulder served as a passive control. Two hours later, the contralateral resting shoulder received the other treatment. The participants rated the intensity of soreness (scale 0-10), and a blinded examiner took measures of pressure pain threshold (PPT) of the upper trapezius immediately before treatment and 0, 10, 20, and 60 minutes after treatment 48 hours posteccentric exercise. Immediately before treatment, the intensity of soreness was 5.0 (SD 2.2) and PPT was 138 (SD 78) kPa. In response to treatment, a significant treatment by time interaction was found for the intensity of soreness (p soreness and increased PPT (i.e., reduced pain sensitivity). For both types of treatment, the greatest effect on perceived soreness occurred immediately after treatment, whereas the effect on PPT peaked 20 minutes after treatment. In conclusion, active exercise using elastic resistance provides similar acute relief of muscle soreness as compared with that using massage. Coaches, therapists, and athletes can use either active warm-up or massage to reduce DOMS acutely, for example, to prepare
J. Gómez; J. Albareda; L. Ezquerra
Introduction: Trochanteric hip fractures in elderly patients with osteoporosis are commonly caused by low energy trauma. The cardioversion therapy is an extremely rare cause of this type of fracture. Presentation of case: We report the case of a woman with hip fracture after cardioversion. Discussion: We discuss the production mechanism of this injury and the importance of the care of the osteoporotic bone under these therapies. Conclusion: The propofol sedation should be complemente...
Kim, Tae Young; Lee, Yong Beom; Chang, Jun Dong; Lee, Sang Soo; Yoo, Jae Hyun; Chung, Kook Jin; Hwang, Ji Hyo
The rotational alignment is definitely important in the long bones such as tibias and femurs. We also predict the importance of rotational alignment in the trochanteric fractures. So we measured torsional malalignment in trochanteric fracture and anlaysed their risk factors and their clinical significance. A total of 109 inpatients who had undergone internal fixation following trochanteric fracture and a postoperative pelvic CT scan between 2008 and 2013, with at least one year follow-up, were selected. Factors that affect torsional malalignment, such as age, gender, fracture stability, injured area, operative time, time of surgery after admission, and ASA status, were investigated. Factors that affect the patients' clinical results in malrotation, including ambulation time after surgery, postoperative complication rates, pain assessment of VAS one year postoperatively and Koval score, were also investigated. Of the 109 subjects, torsional malalignment was observed in 28 (25.7%) subjects with a mean torsional malalignment angle of 20.7° (range: -31.2° to 27.1°). Torsional malalignment risk factors were fracture stability (p=0.021) and operative time (p=0.043). In terms of the time to ambulation after surgery, the postoperative complication rates, and the VAS and Koval scores at one year postoperatively, no statistically significant difference was observed between the torsional malalignment patients and the non-deformity patients. In this study, 25.7% of the patients who had undergone internal fixation following trochanteric fracture experienced torsional malalignment. Major factors of the torsional malalignment were an unstable fracture and the consequent delay in the operative time. But the torsional malalignment was deemed to have no effect on clinical results. Copyright © 2015 Elsevier Ltd. All rights reserved.
Gadegone Wasudeo M.
Full Text Available Introduction: Biomechanically proximal femoral nail (PFN is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3 and 37 cases of AO 31 A3 (3.1, 3.2, 3.3. Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5, Z effect (n = 1, infection (n = 2, and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40 in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.
Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko
[Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, presence of lesser trochanteric displacement, discharge destination, and walking ability were investigated. The relationship between these factors and the period from surgery to discharge was analyzed with logistic regression analysis. [Results] Age and lesser trochanteric displacement were significantly higher in the over-85-day group, and walking ability before fracture and at discharge were significantly lower in the over-85-day group. Logistic regression analysis showed that lesser trochanteric displacement and age were predictors of the length from surgery to discharge. Lesser trochanteric displacement were observed in 87.5% of these. Immediate displacement after surgery occurred in 57.8% of lesser trochanteric fractures, while 26.3% displaced 1 to 3 weeks after surgery. [Conclusion] This study revealed that lesser trochanteric displacement, higher age, and lower walking ability before fracture and at discharge were associated with longer hospitalizations in patients with femoral trochanteric fractures. Lesser trochanteric displacement were observed in 87.5% of lesser trochanteric fractures. These displacements occurred within 3 weeks after surgery in 84.1% of cases. PMID:29200639
Full Text Available Objective Unstable intertrochanteric fractures continue to be a challenge for orthopedic surgeons due to the functional limitations it results in the postoperative period. Anatomical reconstruction of the posteromedial fragment becomes difficult through conventional lateral approach, leading to excessive fracture collapse and limping. Materials and Methods: prospective, nonrandomized study was done with 40 patients. They were operated in prone position through posterior approach. Cancellous screws or SS-wires were used to fix the greater or lesser trochanteric fragments and dynamic hip screw (DHS or dynamic condylar screw (DCS for the main two fragments. Bone grafts were used to pack cavities at the posterior trochanteric regions. Results: Fracture healing occurred earlier compared to conventional lateral approach without excessive fracture collapse in majority of cases (average time to achieve union was 13.8 weeks; range: 10–18 weeks. Good functional recovery was noted with 75% 'Good' or 'Excellent' Harris Hip Scores at 24 weeks. Conclusion: Anatomical reconstruction of unstable trochanteric fractures becomes easier through posterior approach with earlier and better functional recovery.
Martín-Pintado-Zugasti, Aitor; Rodríguez-Fernández, Ángel Luis; Fernandez-Carnero, Josue
Postneedling soreness is considered the most frequent secondary effect associated to dry needling. A detailed description of postneedling soreness characteristics has not been previously reported. (1) to assess the intensity and duration of postneedling soreness and tenderness after deep dry needling of a trapezius latent myofascial trigger point (MTrP), (2) to evaluate the possible differences in postneedling soreness between sexes and (3) to analyze the influence on postneedling soreness of factors involved in the dry needling process. Sixty healthy subjects (30 men, 30 women) with latent MTrPs in the upper trapezius muscle received a dry needling intervention in the MTrP. Pain and pressure pain threshold (PPT) were assessed during a 72 hours follow-up period. Repeated measures analysis of covariance showed a significant effect for time in pain and in PPT. An interaction between sex and time in pain was obtained: women exhibited higher intensity in postneedling pain than men. The pain during needling and the number of needle insertions significantly correlated with postneedling soreness. Soreness and hyperalgesia are present in all subjects after dry needling of a latent MTrP in the upper trapezius muscle. Women exhibited higher intensity of postneedling soreness than men.
van Biezen Frans C
Full Text Available Abstract Background Although no prospective studies have compared functional results of trochanteric osteotomy and a non-trochanteric approach, most surgeons feel that trochanteric osteotomy is outdated in simple hip arthroplasty. Reasons not to perform an osteotomy include the fear of longer rehabilitation and worse (final functional outcome. Method This prospective study examines differences in rehabilitation between posterolateral and trochanteric approach one year post-surgery using questionnaires (WOMAC, SF-36, HHS and functional tests (walking, climbing stairs, rising from sitting, and strength tests. Of the 109 patients 24 had a trochanteric osteotomy: the selected approach was based on the surgeon's preference. The trochanteric osteotomy group included more patients with developmental dysplasia of the hip. Before the start of the study no power analysis was performed. Results Data from the questionnaires showed no significant differences between the two groups at 3, 6 and 12-months follow-up. At 3-months follow-up patients in the trochanteric osteotomy group scored lower on the functional tests. This difference had disappeared at 6 and 12-months follow-up, except for abduction force which remained lower in the trochanteric osteotomy group in patients with a non union of the TO. Conclusion For simple hip arthroplasty an approach without osteotomy seems a logical choice. Although the power of this study is low, in experienced hands trochanteric osteotomy seems to give good functional results at 6-12 months post surgery if trochanteric union is obtained. Therefore, one should not hesitate to perform an osteotomy in difficult cases.
Despite the widespread occurrence of delayed onset muscle soreness (DOMS), there is little consensus as to the exact cause or which treatments may be most effective at alleviating symptoms. Greater understanding of DOMS can give sports medicine and fitness professionals an opportunity to help prevent or speed recovery of this performance limiting condition. This article will review the DOMS literature, including the potential role of psychosocial factors and explore studies which involve massage therapy as a treatment modality. Articles from PubMed, MEDLINE, Google Scholar, and references from articles are included in this review. Search words and phrases included delayed onset muscle soreness, repeated bout effect, massage effectiveness, exercise induced muscle damage, and eccentric exercise. Copyright © 2013 Elsevier Ltd. All rights reserved.
Brandner, Christopher R; Warmington, Stuart A
Brandner, CR, and Warmington, SA. Delayed onset muscle soreness and perceived exertion after blood flow restriction exercise. J Strength Cond Res 31(11): 3101-3108, 2017-The purpose of this study was to determine the perceptual responses to resistance exercise with heavy loads (80% 1 repetition maximum [1RM]), light loads (20% 1RM), or light loads in combination with blood flow restriction (BFR). Despite the use of light loads, it has been suggested that the adoption of BFR resistance exercise may be limited because of increases in delayed onset muscle soreness (DOMS) and perceived exertion. Seventeen healthy untrained males participated in this balanced, randomized cross-over study. After 4 sets of elbow-flexion exercise, participants reported ratings of perceived exertion (RPE), with DOMS also recorded for 7 days after each trial. Delayed onset muscle soreness was significantly greater for low-pressure continuous BFR (until 48 hours postexercise) and high-pressure intermittent BFR (until 72 hours postexercise) than for traditional heavy-load resistance exercise and light-load resistance exercise. In addition, RPE was higher for heavy-load resistance exercise and high-pressure intermittent BFR than for low-pressure continuous BFR, with all trials greater than light-load resistance exercise. For practitioners working with untrained participants, this study provides evidence to suggest that to minimize the perception of effort and postexercise muscle soreness associated with BFR resistance exercise, continuous low-pressure application may be more preferential than intermittent high-pressure application. Importantly, these perceptual responses are relatively short-lived (∼2 days) and have previously been shown to subside after a few exercise sessions. Combined with smaller initial training volumes (set × repetitions), this may limit RPE and DOMS to strengthen uptake and adherence and assist in program progression for muscle hypertrophy and gains in strength.
Blankenbaker, Donna G.; Ullrick, Steven R.; Davis, Kirkland W.; De Smet, Arthur A. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); Haaland, Ben; Fine, Jason P. [University of Wisconsin School of Medicine and Public Health, Departments of Biostatistics and Medical Informatics and Statistics, Madison, WI (United States)
Greater trochanter pain syndrome due to tendinopathy or bursitis is a common cause of hip pain. The previously reported magnetic resonance (MR) findings of trochanteric tendinopathy and bursitis are peritrochanteric fluid and abductor tendon abnormality. We have often noted peritrochanteric high T2 signal in patients without trochanteric symptoms. The purpose of this study was to determine whether the MR findings of peritrochanteric fluid or hip abductor tendon pathology correlate with trochanteric pain. We retrospectively reviewed 131 consecutive MR examinations of the pelvis (256 hips) for T2 peritrochanteric signal and abductor tendon abnormalities without knowledge of the clinical symptoms. Any T2 peritrochanteric abnormality was characterized by size as tiny, small, medium, or large; by morphology as feathery, crescentic, or round; and by location as bursal or intratendinous. The clinical symptoms of hip pain and trochanteric pain were compared to the MR findings on coronal, sagittal, and axial T2 sequences using chi-square or Fisher's exact test with significance assigned as p<0.05. Clinical symptoms of trochanteric pain syndrome were present in only 16 of the 256 hips. All 16 hips with trochanteric pain and 212 (88%) of 240 without trochanteric pain had peritrochanteric abnormalities (p=0.15). Eighty-eight percent of hips with trochanteric symptoms had gluteus tendinopathy while 50% of those without symptoms had such findings (p=0.004). Other than tendinopathy, there was no statistically significant difference between hips with or without trochanteric symptoms and the presence of peritrochanteric T2 abnormality, its size or shape, and the presence of gluteus medius or minimus partial thickness tears. Patients with trochanteric pain syndrome always have peritrochanteric T2 abnormalities and are significantly more likely to have abductor tendinopathy on magnetic resonance imaging (MRI). However, although the absence of peritrochanteric T2 MR abnormalities
Blankenbaker, Donna G.; Ullrick, Steven R.; Davis, Kirkland W.; De Smet, Arthur A.; Haaland, Ben; Fine, Jason P.
Greater trochanter pain syndrome due to tendinopathy or bursitis is a common cause of hip pain. The previously reported magnetic resonance (MR) findings of trochanteric tendinopathy and bursitis are peritrochanteric fluid and abductor tendon abnormality. We have often noted peritrochanteric high T2 signal in patients without trochanteric symptoms. The purpose of this study was to determine whether the MR findings of peritrochanteric fluid or hip abductor tendon pathology correlate with trochanteric pain. We retrospectively reviewed 131 consecutive MR examinations of the pelvis (256 hips) for T2 peritrochanteric signal and abductor tendon abnormalities without knowledge of the clinical symptoms. Any T2 peritrochanteric abnormality was characterized by size as tiny, small, medium, or large; by morphology as feathery, crescentic, or round; and by location as bursal or intratendinous. The clinical symptoms of hip pain and trochanteric pain were compared to the MR findings on coronal, sagittal, and axial T2 sequences using chi-square or Fisher's exact test with significance assigned as p<0.05. Clinical symptoms of trochanteric pain syndrome were present in only 16 of the 256 hips. All 16 hips with trochanteric pain and 212 (88%) of 240 without trochanteric pain had peritrochanteric abnormalities (p=0.15). Eighty-eight percent of hips with trochanteric symptoms had gluteus tendinopathy while 50% of those without symptoms had such findings (p=0.004). Other than tendinopathy, there was no statistically significant difference between hips with or without trochanteric symptoms and the presence of peritrochanteric T2 abnormality, its size or shape, and the presence of gluteus medius or minimus partial thickness tears. Patients with trochanteric pain syndrome always have peritrochanteric T2 abnormalities and are significantly more likely to have abductor tendinopathy on magnetic resonance imaging (MRI). However, although the absence of peritrochanteric T2 MR abnormalities
Niu, Yunfei; An, Xiaofei; Xu, Shuogui; Wu, Dajiang; Zhang, Chuncai; Li, Ming
The aim of this study is to explore the method and clinical outcome of posterior trochanteric osteotomy in acetabular fractures. From January 2000 to January 2008, 32 cases of acetabular fractures involving the dome of acetabulum underwent posterior trochanteric osteotomy for a better exposure and internal fixation with acetabular tridimensional memory fixation system. 28 cases (16 men and 12 women, mean age 39.9 years, range 16-73 years) were followed up with an average of 48.9 months (range of 19-95 months) and four were lost during follow up. Of 28 cases, 19 were fresh fractures and 9 were old fractures. The reduction was evaluated with Matta criteria. Clinical evaluation was based on modified Merle d'Aubigne and Postel scoring. Motor strength of the abductors was evaluated according to the Medical Research Council grading system. Ectopic ossification was classified according to Brooker criteria. Anatomical reduction was achieved in 17 cases and satisfied reduction in 10 patients. Poor reduction happened in an old fracture. All acetabular fractures got a direct bone union and no displacement and deep infection occurred. All osteotomies healed within 3.5 months without any nonunion, proximal migration of the greater trochanter, loosing or broken of instrumentation, and deep infection. Two superficial infections were healed with a regular dressing. Two patients underwent removal of implants from greater trochanter because of irritation. The strength of the abductors was of Grade 3/5 in two patients, Grade 4/5 in five patients, and normal in the rest. Clinical scoring was excellent to good in 84 %. Ectopic ossification occurred in five patients, grade 1 in two patients, grade 2 in two, and grade 3 in one. But function of hip joint was not seriously affected. Posterior trochanteric osteotomy can provide an adequate exposure of the dome of acetabulum without the associated complications like nonunion, proximal replacement, and weak of the abductors which often occur
Full Text Available Fractures of the greater trochanter rank amongst severe injuries of bone tissue. They occur most frequently in patients over 65 years of age, nearly all of whom are diagnosed with osteoporosis. Non-surgical treatment does not prove to be satisfactory and results in high mortality rate. Surgical treatment is a method of fracture treatment of the trochanteric region, which enables early activation and thus prevents numerous complications in bedridden patients. Gamma3 nails are one of the most state-of-the-art implants for trochanteric fracture fixation. The implant is easy to embed, which does not require a large surgical team. This implant embedding requires the least invasive surgery and complications are rare.This paper describes 47 patients who received surgical treatment and is focused on the first nine months of 2009. The patients were treated at the Orthopaedics Ward of Health Centre Valjevo. They were in their seventies, average age: 72.21 years, with female sex prevailing (63.82%. The outcome was as follows: excellent in 65.96%, good in 17.02% and satisfactory in 4.25% of patients. Surface infections occurred in 6.38% of patients. One implant broke.We had one death outcome in the early post-surgical treatment.Surgical treatment of trochanteric fractures by Gamma3 implants proved very effective as it resulted in few complications and numerous excellent functional and anatomic outcomes. Thus we recommend it as an option when decision on treatment of this type of fractures is made.
Lustenberger, David P; Ng, Vincent Y; Best, Thomas M; Ellis, Thomas J
Objective Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of nonoperative treatment or surgical intervention may be necessary in refractory cases. The purpose of this systematic review was to evaluate the efficacy of the treatment of TB. Data Sources A literature search in the PubMed, MEDLINE, CINAHL, and ISI Web of Knowledge databases was performed for all English language studies up to April 2010. Terms combined in a Boolean search were greater trochanteric pain syndrome, trochanteric bursitis, trochanteric, bursitis, surgery, therapy, drug therapy, physical therapy, rehabilitation, injection, Z-plasty, Z-lengthening, aspiration, bursectomy, bursoscopy, osteotomy, and tendon repair. Study Selection All studies directly involving the treatment of TB were reviewed by 2 authors and selected for further analysis. Expert opinion and review articles were excluded, as well as case series with fewer than 5 patients. Twenty-four articles were identified. According to the system described by Wright et al, 2 studies, each with multiple arms, qualified as level I evidence, 1 as level II, 1 as level III, and the rest as level IV. More than 950 cases were included. Data Extraction The authors extracted data regarding the type of intervention, level of evidence, mean age of patients, patient gender, number of hips in the study, symptom duration before the study, mean number of injections before the study, prior hip surgeries, patient satisfaction, length of follow-up, baseline scores, and follow-up scores for the visual analog scale (VAS) and Harris Hip Scores (HHS). Data Synthesis Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be
Full Text Available Objective: The aim of this study was to investigate the prevalence of greater trochanteric bursitis and gluteus medius tendinopathy using ultrasound in patients with greater trochanteric pain and assess the value of the pain on resisted hip abduction and pain on resisted hip internal rotation in predicting the presence of gluteus medius tendinopathy. Methods: The study was a retrospective analysis of 75 patients with greater trochanteric pain. The physical examination records were identified as pain on resisted hip abduction and hip internal rotation. After observing physical examination records, presence of greater trochanteric bursitis or gluteus medius tendinopathy were assessed in documented ultrasound findings. Results: Of the 75 patients with greater trochanteric pain, trochanteric bursitis was found in 41.4% of patients, gluteus medius tendinopathy was found in 20% of patients. A significant difference was found in both presence of pain on resisted hip abduction and internal rotation between patients with gluteus medius tendinopathy and patients with other abnormalities in favor of gluteus medius tendinopathy. Conclusion: In order to determine the etiology of greater trochanteric pain, physical examination and ultrasound imaging is important, especially examination of pain on resisted hip abduction and hip internal rotation is essential to detect gluteus medius tendinopathy.
Long, Suzanne S; Surrey, David E; Nazarian, Levon N
Greater trochanteric pain syndrome is a common condition with clinical features of pain and tenderness at the lateral aspect of the hip. Diagnosing the origin of greater trochanteric pain is important because the treatment varies depending on the cause. We hypothesized that sonographic evaluation of sources for greater trochanteric pain syndrome would show that bursitis was not the most commonly encountered abnormality. We performed a retrospective review of musculoskeletal sonographic examinations performed at our institution over a 6-year period for greater trochanteric pain syndrome; completed a tabulation of the sonographic findings; and assessed the prevalence of trochanteric bursitis, gluteal tendon abnormalities, iliotibial band abnormalities, or a combination of findings. Prevalence of abnormal findings, associations of bursitis, gluteal tendinosis, gluteal tendon tears, and iliotibial band abnormalities were calculated. The final study population consisted of 877 unique patients: 602 women, 275 men; average age, 54 years; and age range, 15-87 years). Of the 877 patients with greater trochanteric pain, 700 (79.8%) did not have bursitis on ultrasound. A minority of patients (177, 20.2%) had trochanteric bursitis. Of the 877 patients with greater trochanteric pain, 438 (49.9%) had gluteal tendinosis, four (0.5%) had gluteal tendon tears, and 250 (28.5%) had a thickened iliotibial band. The cause of greater trochanteric pain syndrome is usually some combination of pathology involving the gluteus medius and gluteus minimus tendons as well as the iliotibial band. Bursitis is present in only the minority of patients. These findings have implications for treatment of this common condition.
Effects of intravenous diclofenac on postoperative sore throat in patients undergoing laparoscopic surgery at Aga Khan University Hospital, Nairobi: A prospective, randomized, double blind controlled trial.
Hyldahl, Robert D; Keadle, Justin; Rouzier, Pierre A; Pearl, Dennis; Clarkson, Priscilla M
Muscle soreness is a common symptom after novel exercise and may influence exercise adherence. This study examined the effect of an ibuprofen topical gel and the effect of age and sex on muscle soreness after a gym exercise. One hundred and six participants completed six sets of 10 repetitions of the elbow and knee flexor muscles. Thirty-six hours after exercise, participants were randomized to apply an ibuprofen topical gel or placebo treatment to the affected muscle groups. Soreness evaluations were taken each hour for the first 6 h (36-42 h), then at 48, 60, 66, 72, 84, 90, 96, and 108 h after exercise. Subjects then returned to the laboratory after 3 wk and repeated the same study protocol with the opposite arm/leg and treatment. We found no significant differences in soreness between the active ibuprofen gel and the placebo treatment and no difference in effectiveness between men and women or between older and younger subjects. For the placebo groups, there was no sex differences in muscle soreness; however, when the data were analyzed by dividing participants into young (18-29 yr) and old (40-65 yr) cohort, the old cohort reported significantly less soreness in response to the elbow flexion exercise than the young cohort (P soreness after an unaccustomed gym exercise. Furthermore, our results show that there is no sex difference in the soreness response and that older subjects have less soreness in response to a similar exercise stimulus as young subjects.
Forni, Cristiana; Loro, Loretta; Tremosini, Morena; Mini, Sandra; Pignotti, Elettra; Bigoni, Ombretta; Guzzo, Giuseppe; Bellini, Laura; Trofa, Carmela; Di Cataldo, Anna M; Guzzi, Marilena
The aim of this study was to test the effectiveness of polyurethane foam in contact with the heel inside a plaster cast to decrease the rate of pressure sores in the population at most risk. The rate of pressure sores caused by the plaster cast is reported to be 14-15% in the paediatric population, 33.3% in patients having undergone chemotherapy for bone tumours and 43% in orthopaedic patients who already have sore skin when the cast is applied (grade 1 lesion) to the heel. Controlled clinical trial. From November 2007-January 2009, all consecutive subjects requiring lower limb casts having undergone chemotherapy and/or presenting heel soreness received polyurethane foam in contact with the skin of the heel before applying the cast. The results were compared with those of patients with the same risk factors but were not administered the foam and were enrolled from May 2005-August 2006. In total, 156 patients were enrolled, 85 in the control group and 71 in the experimental group. In the experimental group, 2 of the 56 patients (3.6%) with sore skin developed a pressure sore compared with 21 of 49 (42.9%) in the control group without polyurethane foam (p polyurethane foam in contact with the skin of the heel inside a plaster cast prevents the formation of pressure sores. This study provides evidence that using polyurethane foam to prevent sores even inside plaster casts in populations at most risk is a simple and cost-effective strategy and decreases the discomfort, pain and risks in these patients. © 2011 Blackwell Publishing Ltd.
Guo, Xiaoze; Zhang, Ying; Xiao, Jin; Xie, Huibin; Yu, Jiefeng
To design and produce a lesser trochanteric reduction fixation system and verify its value and effectiveness. A lesser trochanteric reduction fixation system was designed and produced according to the anatomical features of the lesser trochanteric fractures. Sixty-six patients with intertrochanteric fractures of Evans type III were included between January 2010 and July 2012. Of 66 patients, 32 were treated with dynamic hip screw (DHS) assisted with the lesser trochanteric reduction fixation system (study group), and 34 cases were treated with DHS only (control group). The 2 groups were comparable with no significant difference in gender, age, the reasons, and the types of the fractures (P > 0.05). The operation time, intraoperative blood loss, neck-shaft angle, bone healing time, ratio of successful fixations, and the functional evaluation of the hip joint after operation were compared between 2 groups. The study group had shorter operation time [(58.4 ± 5.3) minutes] and less intraoperative blood loss [(186.3 ± 6.6) mL than the control group [(78.5 ± 6.2)minutes and (246.2 ± 8.7) mL], showing significant differences (t = -14.040, P = 0.000; t = -31.145, P = 0.000). There was no significant difference in neck-shaft angle between study group [(138.6 ± 3.0)] and control group [(139.4 ± 2.9) degrees] (t = -1.044, P = 0.301). The wounds healed by first intention in both groups. The 30 and 31 patients were followed up 12 to 24 months (mean, 15 months) in the study group, and 13 to 25 months (mean, 16 months) in the control group, respectively. All fractures healed well in 2 groups. The study group had significantly shorter healing time [(8.8 ± 2.0) weeks] than the control group [(10.7 ± 3.4) weeks] (t = -2.871, P = 0.006). At 12 months after operation, coxa vara happened in 2 cases of the study group with a successful fixation ratio of 93.3% and in 10 cases of the control group with a successful fixation ratio of 67.7%, showing significant difference (Χ2 = 6
Park, Ki Deok; Lee, Woo Yong; Lee, Jihae; Park, Min-Ho; Ahn, Jae Ki; Park, Yongbum
Trochanteric bursa injections of corticosteroids and local anesthetics have been shown to provide pain relief for the treatment of greater trochanteric pain syndrome (GTPS). However, symptom recurrence and incomplete symptom relief are common. The reason for the variation in response is unclear but may be related to disease-, treatment-, or patient-related factors. To determine whether there are factors related to patient, treatment, or disease that can predict either the magnitude or duration of response to ultrasound-guided trochanteric bursa injections for GTPS. Retrospective evaluation. A university hospital outpatient center. Potential study participants were patients who underwent ultrasound-guided trochanteric bursa injection at an outpatient rehabilitation department. Follow-up interviews were performed in a hospital visit at 1, 3, and 6 months after injection. The Harris Hip Score and the Verbal Numeric Pain Scale were used to evaluate clinical effectiveness of pain reduction and functional improvement at baseline, 1, 3, and 6 months after treatment. Clinical data and ultrasound findings were obtained to assess the possible predictive factors for a good and durable response to ultrasound-guided trochanteric bursa injection. Patients receiving ultrasound-guided trochanteric bursa injections had a statistically significant improvement in pain and hip function at 1, 3, and 6 months after the last injections. Of the 137 patients, 110 (80.3%), 95 (64.9%), and 77 (56.2%) patients achieved successful outcomes according to their 1, 3, and 6-month follow-up evaluations, respectively. Univariate analysis showed that patients with knee osteoarthritis and lumbar facet joint or sacroiliac joint pain experienced less therapeutic effect than those without the conditions at 6 months post-injection. Logistic regression analysis showed that the significant outcome predictors at the 6-month follow-up were facet joint or S-I joint pain (odds ratio = 0.304, P = .014) and knee
Little, P; Williamson, I
This paper discusses primary care management of sore throat in the context of recent national 'consensus' guidelines from the Drugs and Therapeutics Bulletin. The guidelines advise taking a throat swab, using typical clinical features where swabs are not available, and suggest that antibiotics shorten the duration of symptoms and prevent complications. Systematic reviews and individual studies indicate that the evidence for prescribing antibiotics for most presentations of sore throat in general practice is marginal, and the benefits are probably outweighed by the likely costs of antibiotics. Using clinical scorecards or symptom clusters to identify individuals who would benefit from treatment is insensitive with low predictive value, although inexpensive. Using throat swabs as a gold standard for diagnosis is inappropriate since they are neither very specific nor sensitive, and will greatly increase costs of management. The relative lack of evidence for the efficacy of antibiotics and for the use of throat swabs from primary care research, and also an unbalanced perspective of dangers and complications related predominantly to a secondary care setting, underlines the problem of achieving valid consensus guidelines. Guidelines not firmly based on evidence appropriate to the intended setting are more likely to be received sceptically and hinder getting research into practice.
Liu, T C Y; Fu, D R; Liu, X G; Tian, Z X
Delayed onset muscle soreness (DOMS) and its photobiomodulation were reviewed from the viewpoint of function-specific homeostasis (FSH) in this paper. FSH is a negative-feedback response of a biosystem to maintain the function-specific fluctuations inside the biosystem so that the function is perfectly performed. A stressor may destroy a FSH. A stress is a response of a biosystem to a stressor and may also be in stress-specific homeostasis (StSH). A low level light (LLL) is so defined that it has no effects on a function in its FSH or a stress in its StSH, but it modulate a function far from its FSH or a stress far from its StSH. For DOMS recovery, protein metabolism in the Z-line streaming muscular cell is the essential process, but the inflammation, pain and soreness are non-essential processes. For many DOMS phenomena, protein metabolism in the Z-line streaming muscular cell is in protein metabolism-specific homeostasis (PmSH) so that there are no effects of LLL although the inflammation can be inhibited and the pain can be relieved. An athlete or animal in the dysfunctional conditions such as blood flow restriction and exercise exhaustion is far from PmSH and the protein metabolism can be improved with LLL.
De Maeseneer, Michel [Department of Radiology, Wake Forest University Hospital, Medical Center Boulevard, Winston Salem, NC 27157 (United States)], E-mail: firstname.lastname@example.org; Gosselin, Robert [Department of Radiology, Universiteit Gent, Ghent (Belgium); De Ridder, Fillip; Shahabpour, Maryam; Vanderdood, Kurt [Department of Radiology, Vrije Universiteit Brussel, Brussels (Belgium)
Objective: To investigate the MR imaging appearance of the trochanteric region in a group of patients referred for non-musculoskeletal conditions. Materials and methods: Forty-five patients (n = 90 hips) referred for non-musculoskeletal conditions were imaged with a coronal T1 weighted fat saturated sequence after intravenous administration of contrast medium. Findings were interpreted by consensus of two experienced radiologists. Results: In 54 of 90 hips (60%) no signal changes were seen at the level of the greater trochanter. A linear area of contrast enhancement with a craniocaudal dimension of less than 3 cm, and thickness less than 0.3 cm was seen in 32 of 90 hips (35.6%). A fusiform area of contrast enhancement with a craniocaudal dimension of more than 3 cm, and thickness more than 0.3 cm was seen in 4 hips (4.4%). Conclusion: An area of signal abnormality may be seen on contrast enhanced studies in asymptomatic persons, located in between the gluteus medius tendon and iliotibial band, and this should not be considered as a cause of pain in the trochanteric region.
Farmer, Kevin W; Jones, Lynne C; Brownson, Kirstyn E; Khanuja, Harpal S; Hungerford, Marc W
We examined the efficacy of corticosteroid injection as treatment for postarthroplasty trochanteric bursitis and the risk factors for failure of nonoperative treatment. There were 32 (4.6%) cases of postsurgical trochanteric bursitis in 689 primary total hip arthroplasties. Of the 25 hips with follow-up, 11 (45%) required multiple injections. Symptoms resolved in 20 (80%) but persisted in 5. We found no statistically significant differences between patients who did and did not develop trochanteric bursitis, or between those who did and did not respond to treatment. There was a trend toward younger age and greater limb-length discrepancy in nonresponders. In conclusion, (1) corticosteroid injection(s) for postoperative trochanteric bursitis is effective; and (2) nonoperative management may be more likely to fail in young patients and those with leg-length discrepancy. 2010 Elsevier Inc. All rights reserved.
Conclusion: Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.
Ban, Ilija; Birkelund, Lasse; Palm, Henrik
Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply...
Pharyngitis is a sore throat caused by inflammation of the back of the throat. It is one of the most common reasons for visits to family physicians. Throat may be scratchy and swallowing can be painful. Usually, a sore throat is the sign of another illness, such as a cold or the flu. In this review article, epidemiology, national ...
Apr 23, 1983 ... group with sore throat was 23,0 years and that of the control group 22,2 years. The agreement between the clinical prediction and the labora- tory findings of the presence of streptococcus for the 62 patients with sore throat is depicted in Table I, which shows that the clinical predictions were correct in 26 ...
Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat. Methods: ... Conclusion: Intravenous diclofenac sodium does not reduce the occurrence or severity of postoperative sore throat. .... 8.4% sodium bicarbonate-also a colourless liquid- was added to ...
Buroker, Katherine C.; Schwane, James A.
Because many experts recommend stretching after exercise to relieve muscle soreness, 23 subjects performed a 30-minute step test to induce delayed muscle soreness. There was neither temporary relief of pain immediately after stretching nor a reduction in pain during the 3-day postexercise period. (Author/SM)
Bobbert, M F; Hollander, A P; Huijing, P A
In this study 11 subjects performed exercise resulting in delayed onset muscular soreness in m. gastrocnemius with one leg, the experimental leg. The other leg served as control. Pre-exercise and 24, 48 and 72 h postexercise, soreness perception, resting EMG level of m. gastrocnemius, and volume and
Raman, D; Haslock, I
One hundred consecutive patients with rheumatoid arthritis (RA) were examined for the presence of trochanteric bursitis. This condition was found in 15. Ten patients responded to a single local injection of corticosteroid and the remaining 5 to a second injection. Trochanteric bursitis is an underdiagnosed, easily remediable cause of pain in RA. Specific examination for in presence should be a routine in all patients with RA, especially those with hip pain. PMID:7149797
Tal, Sari; Gurevich, Alexander; Sagiv, Shaul; Guller, Vladimir
To investigate the potential distinct risk factors associated with trochanteric and cervical hip fractures. Elderly patients aged 65 years and older (n = 1161) were admitted to the orthopedic department with hip fractures during the years 2006-2011. Demographic and clinical data, as well as routine blood tests, were retrieved from the patient electronic medical records. Approximately 58% of patients had trochanteric fractures and 42% had cervical fractures. Women were more likely to have trochanteric fractures than men (P = 0.002). Female sex, frailty, falls, diabetes and subnormal calcium, as well as subnormal hemoglobin levels, were significant risk factors for trochanteric fractures (OR 1.39, P = 0.0202, OR 1.36, P = 0.0166, OR 1.49, P = 0.0015, OR 1.33, P = 0.0343, OR 0.68, P = 0.0054, OR 0.70, P = 0.0036, respectively). Patients with Parkinson's disease were at a lower risk for trochanteric fractures (OR 0.6, P = 0.007). As there are some differences between risk factors for trochanteric and cervical hip fractures, there is a need for further studies in order to understand the etiology of fractures and to be able to carry out effective preventive efforts. © 2014 Japan Geriatrics Society.
Ovesen, Ole; Andersen, Mikkel; Poulsen, Thomas
In a prospective, randomized trial we compared the trochanteric gamma nail (TGN) and the dynamic hip screw (DHS) in the treatment of 146 intertrochanteric fractures. Follow-up was after four and 12 months. The operation time was significantly shorter in the DHS group. At discharge the need...... for walking aids was less in the DHS group. There were no differences in intraoperative blood loss, medical complications, mortality or length of hospital stay. Major fracture complications occurred twiceas often in the TGN group compared with the DHS group, however they were not statistically significant....... Any potential for the TGN leading to a less invasive procedure and a more rapid postoperative mobilisation could not be demonstrated. Compared with the TGN we prefer the DHS for most intertrochanteric fractures in a setting where the majority of these fractures are treated by younger doctors...
Baril, Yannick; Bourgeois, Yan; Brailovski, Vladimir; Duke, Kajsa; Laflamme, G Yves; Petit, Yvan
Cable-grip systems are commonly used for greater trochanteric reattachment because they have provided the best fixation performance to date, even though they have a rather high complication rate. A novel reattachment system is proposed with the aim of improving fixation stability. It consists of a Y-shaped fixation plate combined with locking screws and superelastic cables to reduce cable loosening and limit greater trochanter movement. The novel system is compared with a commercially available reattachment system in terms of greater trochanter movement and cable tensions under different greater trochanteric abductor application angles. A factorial design of experiments was used including four independent variables: plate system, cable type, abductor application angle, and femur model. The test procedure included 50 cycles of simultaneous application of an abductor force on the greater trochanter and a hip force on the femoral head. The novel plate reduces the movements of a greater trochanter fragment within a single loading cycle up to 26%. Permanent degradation of the fixation (accumulated movement based on 50-cycle testing) is reduced up to 46%. The use of superelastic cables reduces tension loosening up to 24%. However this last improvement did not result in a significant reduction of the grater trochanter movement. The novel plate and cables present advantages over the commercially available greater trochanter reattachment system. The plate reduces movements generated by the hip abductor. The superelastic cables reduce cable loosening during cycling. Both of these positive effects could decrease the risks related to grater trochanter non-union. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.
Vickers, Andrew J
Background Post-exercise muscle soreness is a dull, aching sensation that follows unaccustomed muscular exertion. Primarily on the basis of previous laboratory-based research on eccentric exercise, soreness is usually said to follow an inverted U-shaped curve over time, peaking 24 – 48 hours after exercise. As such, it is often described as "delayed-onset" muscle soreness. In a study of long-distance runners, soreness seemed to peak immediately and then reduce gradually over time. The study is a secondary analysis of clinical trial data that aims to determine whether the time course of soreness following a natural exercise, long-distance running, is different from that following a laboratory-based exercise, bench-stepping. Methods This is a reanalysis of data from three previous clinical trials. The trials included 400 runners taking part in long-distance races and 82 untrained volunteers performing a bench-stepping test. Subjects completed a Likert scale of muscle soreness every morning and evening for the five days following their exercise. Results Interaction between trial and time is highly significant, suggesting a different time course of soreness following running and bench-stepping. 45% of subjects in the bench-stepping trial experienced peak soreness at the third or fourth follow-up (approximately 36 – 48 hours after exercise) compared to only 14% of those in the running trial. The difference between groups is robust to multivariate analysis incorporating possible confounding variables. Conclusion Soreness in runners following long-distance running follows a different time course to that in untrained individuals undertaking bench-stepping. Research on exercise taking place in the laboratory context does not necessarily generalize to exercise undertaken by trained athletes when engaged in their chosen sport. PMID:11701094
... Subscribe August 2016 Print this issue Spotlight on Psoriasis Preventing Patches of Itchy, Sore Skin En español ... Sun Damage Sun and Skin Wise Choices Avoid Psoriasis Triggers Factors that may trigger psoriasis or make ...
Full Text Available Background: Osteoporosis is pathophysiologically related to trochanteric fractures, and this condition is more preventable by lifestyle modifications than cervical fractures. We investigated whether older physicians, who are health-conscious people, are at a lower risk of hip fractures because of fewer trochanteric fractures. Methods: Data regarding older (≥65 years physicians (n = 4303 and matched non-medical persons (control were retrieved from Taiwan’s National Health Insurance claims. All of the subjects were obtained from NHIRD with index dates from 1 January 2000 to 31 December 2008. Cox proportional hazard and competing risk regression models were established to estimate the hazard ratio (HR of hip fracture associated with older physicians. Results: The incidence rates of trochanteric fractures were lower in older physicians than in controls (1.73 and 3.07 per 1000 person-years, respectively, whereas the rates of cervical fractures were similar between the two groups (2.45 and 2.12 per 1000 person-years, respectively. Older physicians yielded 46% lower hazard of trochanteric fractures than controls (adjusted HR 0.54, 95% confidence interval 0.37–0.79; by contrast, hazards of cervical fractures were comparable between the two groups. The HRs estimated from the competing risk models remained unchanged. Conclusions: Our findings indicated that health risk awareness may pose a significant preventive effect on trochanteric hip fractures.
Shen, Hsiu-Nien; Lin, Wei-Ting; Lu, Chin-Li; Li, Chung-Yi
Background: Osteoporosis is pathophysiologically related to trochanteric fractures, and this condition is more preventable by lifestyle modifications than cervical fractures. We investigated whether older physicians, who are health-conscious people, are at a lower risk of hip fractures because of fewer trochanteric fractures. Methods: Data regarding older (≥65 years) physicians (n = 4303) and matched non-medical persons (control) were retrieved from Taiwan’s National Health Insurance claims. All of the subjects were obtained from NHIRD with index dates from 1 January 2000 to 31 December 2008. Cox proportional hazard and competing risk regression models were established to estimate the hazard ratio (HR) of hip fracture associated with older physicians. Results: The incidence rates of trochanteric fractures were lower in older physicians than in controls (1.73 and 3.07 per 1000 person-years, respectively), whereas the rates of cervical fractures were similar between the two groups (2.45 and 2.12 per 1000 person-years, respectively). Older physicians yielded 46% lower hazard of trochanteric fractures than controls (adjusted HR 0.54, 95% confidence interval 0.37–0.79); by contrast, hazards of cervical fractures were comparable between the two groups. The HRs estimated from the competing risk models remained unchanged. Conclusions: Our findings indicated that health risk awareness may pose a significant preventive effect on trochanteric hip fractures. PMID:25689999
Thompson, D; Nicholas, C W; Williams, C
The aim of this study was to examine the impact of prolonged intermittent high-intensity shuttle running on soreness and markers of muscle damage. Sixteen males took part in the study, half of whom were assigned to a running group and half to a resting control group. The exercise protocol involved 90 min of intermittent shuttle running and walking (Loughborough Intermittent Shuttle Test: LIST), reflecting the activity pattern found in multiple-sprint sports such as soccer. Immediately after exercise, there was a significant increase (P < 0.05) in serum activities of creatine kinase and aspartate aminotransferase, and values remained above baseline for 48 h (P < 0.05). Median peak activities of creatine kinase and aspartate aminotransferase occurred 24 h post-exercise and were 774 and 43 U x l(-1), respectively. The intensity of general muscle soreness, and in the specific muscles investigated, was greater than baseline for 72 h after the shuttle test (P < 0.05), peaking 24-48 h post-exercise (P < 0.05). Muscle soreness was not correlated with either creatine kinase or aspartate aminotransferase activity. Soreness was most frequently reported in the hamstrings. Neither soreness nor serum enzyme activity changed in the controls over the 4 day observation period. It appears that unaccustomed performance of prolonged intermittent shuttle running produces a significant increase in both soreness and markers of muscle damage.
Tinsley, Grant M; Gann, Joshua J; Huber, Stefan R; Andre, Thomas L; La Bounty, Paul M; Bowden, Rodney G; Gordon, Paul M; Grandjean, Peter W
The aim of this study was to examine the effects of fish oil supplementation on the magnitude and time-course of postresistance exercise muscle soreness. This study was a randomized, placebo-controlled, double-blind trial. Nonresistance trained females were randomized into one of two groups: fish oil supplementation (6 g/day; 5:1 eicosapentaenoic acid to docosahexaenoic acid (EPA:DHA)) or placebo (6 g/day corn/soy oil). After consuming the supplements for one week, participants underwent a single bout of resistance exercise consisting of 10 sets to failure of elbow flexion and leg extension machines. Muscle soreness was measured daily over the next week via grounded visual analog scale while participants continued to consume their assigned supplement. At 48 hours and one week postexercise, soreness during functional movements and limb circumferences were measured. The fish oil group perceived less static and functional muscle soreness than placebo, although the differences were not statistically significant. Effect sizes for resistance exercise-induced static and functional soreness responses were 33 to 42% lower in fish oil versus placebo without changes in upper arm and thigh circumferences. Supplementing the diet with 6 g per day of fish oil may alleviate muscle soreness experienced after resistance training in young untrained females.
Mavrogenis, Andreas F.; Igoumenou, Vasilios G.; Megaloikonomos, Panayiotis D.; Panagopoulos, George N.; Galanopoulos, Ioannis P.; Vottis, Christos Th.; Karamanis, Eirinaios; Koulouvaris, Panayiotis; Papagelopoulos, Panayiotis J.
Introduction: There are limited information and inconclusive results for dual head screw intramedullary hip nails for trochanteric fractures. Therefore, we performed a prospective study to evaluate the healing of fractures, and survival, function, and complications of patients operated with this implant. Methods: We prospectively studied 79 patients (61 women and 18 men; mean age: 84.7 years; range: 65–96 years) with a low-energy trochanteric fracture, treated with a dual head screw intramedullary hip nail from 2013 to 2016. The mean follow-up was 2.1 years (range: 1–3 years); seven patients were lost to follow up. This left 72 patients for further analysis. We evaluated the healing of fractures, and survival, function, and complications of patients. Results: Fracture healing was evident in 70 patients (97.2%) at 2–3 months postoperatively. One patient experienced cut-out and z-effect phenomenon of the head screws. Another patient experienced a periprosthetic femoral diaphysis fracture at the distal tip of the nail. A third patient experienced an acute postoperative superficial skin infection that was treated successfully with wound dressing changes and a course of antibiotics. Sixteen patients (22.2%) deceased within 12 months postoperatively. In the remaining patients, the Harris Hip Score (HHS) at 12 months postoperatively was excellent in 16 (28.6%), good in 23 (41.1%), fair in 10 (17.8%), and poor in 7 patients (12.5%). The function declined after the patients’ fracture. Fair and poor results were related to age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types. Conclusion: The dual head screw intramedullary hip nail is associated with high healing and low complication rates for intertrochanteric fractures. The function of the patients is good or excellent in most cases; however, it declines, especially for those patients with age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types
Mavrogenis Andreas F.
Full Text Available Introduction: There are limited information and inconclusive results for dual head screw intramedullary hip nails for trochanteric fractures. Therefore, we performed a prospective study to evaluate the healing of fractures, and survival, function, and complications of patients operated with this implant. Methods: We prospectively studied 79 patients (61 women and 18 men; mean age: 84.7 years; range: 65–96 years with a low-energy trochanteric fracture, treated with a dual head screw intramedullary hip nail from 2013 to 2016. The mean follow-up was 2.1 years (range: 1–3 years; seven patients were lost to follow up. This left 72 patients for further analysis. We evaluated the healing of fractures, and survival, function, and complications of patients. Results: Fracture healing was evident in 70 patients (97.2% at 2–3 months postoperatively. One patient experienced cut-out and z-effect phenomenon of the head screws. Another patient experienced a periprosthetic femoral diaphysis fracture at the distal tip of the nail. A third patient experienced an acute postoperative superficial skin infection that was treated successfully with wound dressing changes and a course of antibiotics. Sixteen patients (22.2% deceased within 12 months postoperatively. In the remaining patients, the Harris Hip Score (HHS at 12 months postoperatively was excellent in 16 (28.6%, good in 23 (41.1%, fair in 10 (17.8%, and poor in 7 patients (12.5%. The function declined after the patients’ fracture. Fair and poor results were related to age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types. Conclusion: The dual head screw intramedullary hip nail is associated with high healing and low complication rates for intertrochanteric fractures. The function of the patients is good or excellent in most cases; however, it declines, especially for those patients with age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3
Full Text Available Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy, using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC, greater trochanter (GT reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci
Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro
An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. 2014 BMJ Publishing Group Ltd.
Full Text Available Arterial injury following impalement due to a trochanteric hip fracture-fragment per se has been documented rarely. We report a case of pseudoaneurysm of profunda femoris artery at the first perforator branch in a 48-year-old male, with trochanteric hip fracture following a fall during an epileptic episode. Persistent recalcitrant pain, globular swelling in the groin, unexplained drop in the haemoglobin level, and color doppler ultrasonography findings were salient features to the diagnosis. Additionally, we collected all reported cases of pseudoaneurysm associated with hip fractures. We reviewed the literature regarding the incidence, treatment, and prognosis for the same. Acute vascular injury was probably caused by the spikes of fractured lesser trochanter which was found to be displaced superomedially. All trochanteric fractures especially those with displaced lesser trochanter fragment should be closely watched for the possibility of vascular injury. Early diagnosis and treatment in a staged manner can prevent the catastrophic vascular event and hence the limb.
Full Text Available A retrospective study on 2 years and 4 months (April 2012 - August 2014 on 430 patients admitted with trochanteric fractures in our Clinic. The surgical indications depended on the patients age, degree of osteoporosis, level activity, associated pathologies and the anatomo-clinical particularity of the fractures. The fractures were operated with gamma nail. The surgery was done in the first 24-72 hours, patients were followed clinically and radiographically at 2, 4, 6 months postoperative. The age of the patients were between 28-95 years, female sex was predominant in 65% of case. It was reported a case of a fracture produced intraoperatory during progression of the nail, 11 bronhopulmonary complications, 5 phlebitis, 7 cases of hematoma after surgery, a case of pseudarthrosis with loosening of implant and 4 dead. There were no septic complications. Fractures consolidate within 12- 14 weeks. The results were appreciated according to fracture reduction, stability of implant, consolidation time and possibility of walking and weight bearing on operated limb.
Hurley, Caitlin F; Hatfield, Disa L; Riebe, Deborah A
The beneficial effects of caffeine on aerobic activity and resistance training performance are well documented. However, less is known concerning caffeine's potential role in reducing perception of pain and soreness during exercise. In addition, there is no information regarding the effects of caffeine on delayed onset muscle soreness (DOMS). The primary purpose of this study was to examine the effect of caffeine ingestion on muscle soreness, blood enzyme activity, and performance after a bout of elbow flexion/extension exercise. Nine low-caffeine-consuming males (body mass: 76.68 ± 8.13 kg; height: 179.18 ± 9.35 cm; age: 20 ± 1 year) were randomly assigned to ingest either caffeine or placebo 1 hour before completing 4 sets of 10 bicep curls on a preacher bench, followed by a fifth set in which subjects completed as many repetitions as possible. Soreness and soreness on palpation intensity were measured using three 0-10 visual analog scales before exercise, and 24, 48, 72, 96, and 120 hours after exercise. After a washout period, subjects crossed over to the other treatment group. Caffeine ingestion resulted in significantly (p ≤ 0.05) lower levels of soreness on day 2 and day 3 compared with placebo. Total repetitions in the final set of exercise increased with caffeine ingestion compared with placebo. This study demonstrates that caffeine ingestion immediately before an upper-body resistance training out enhances performance. A further beneficial effect of sustained caffeine ingestion in the days after the exercise bout is an attenuation of DOMS. This decreased perception of soreness in the days after a strenuous resistance training workout may allow individuals to increase the number of training sessions in a given time period.
Kong, Andrew; Van der Vliet, Andrew [Regional Imaging Border, Albury, NSW (Australia); Zadow, Steven [Dr Jones and Partners Medical Imaging, Adelaide, SA (Australia)
Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis. Gluteal tendinopathy most frequently occurs in late-middle aged females. In this pictorial review the pertinent MRI and US anatomy of the gluteal tendon insertions on the greater trochanter and the adjacent bursae are reviewed. The direct (peritendinitis, tendinosis, partial and complete tear) and indirect (bursal fluid, bony changes and fatty atrophy) MRI signs of gluteal tendon injury are illustrated. The key sonographic findings of gluteal tendinopathy are also discussed. (orig.)
Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko
[Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, pre...
I.B. Schipper (Inger)
textabstractTreatment of unstable trochanteric fractures poses a challenge to surgeons in many ways. Accepting this challenge requires understanding of those parameters that determine the outcome. In operative fracture care at least four elements influence the outcome of treatment: the patient, the
Langford, Joshua; Pillai, Gita; Ugliailoro, Anthony D; Yang, Edward
This study was performed to determine the incidence of perioperative lateral wall fractures with a standard sliding hip screw (SHS) versus a percutaneous compression plate (PCCP) using identical meticulous closed reduction techniques in both groups. Retrospective analysis of a prospective trauma registry. Urban Level I trauma center. Over a 7-year period, 337 patients with intertrochanteric hip fractures were treated with either a SHS or a PCCP at our institution. The PCCP group (Group 1) consisted of 200 patients, of which 141 (71%) had adequate images to be included in the study. The SHS group (Group 2) consisted of 137 patients, of which 100 (73%) had adequate images to be included in the study. Closed reduction and plate application with either a standard sliding hip screw or a percutaneous compression plate for an Orthopaedic Trauma Association 31A1 or 31A2 intertrochanteric hip fracture. : Radiographic evidence of lateral trochanteric wall fracture as measured by intraoperative and perioperative radiographs. There was an overall lateral wall fracture incidence of 20% in the SHS group versus 1.4% in the PCCP group (P fracture types, there was a lateral wall fracture incidence of 29.8% in the SHS group versus 1.9% in the PCCP group (P trochanteric wall fracture compared with the SHS group. This difference became greater when just unstable intertrochanteric fractures were analyzed. An anatomic reduction, combined with a device (PCCP) that uses small-diameter defects in the lateral trochanteric wall, essentially eliminates perioperative lateral trochanteric wall fractures.
Singh, Ashutosh Kumar; Narsaria, Nidi; G R, Arun; Srivastava, Vivek
Unstable trochanteric femur fractures are common fractures that are difficult to manage. We conducted a prospective study to compare functional outcomes and complications of 2 different implant designs, proximal femur nail (PFN) and proximal femur locking compression plate (PFLCP), used in internal fixation of unstable trochanteric femur fractures. On hospital admission, 48 patients with unstable trochanteric fractures were randomly assigned (using a sealed envelope method) to treatment with either PFN (24 patients) or PFLCP (24 patients). Perioperative data and complications were recorded. All cases were followed up for 2 years. The groups did not differ significantly (P > .05) in operative time, reduction quality, complications, hospital length of stay, union rate, or time to union. Compared with the PFLCP group, the PFN group had shorter incisions and less blood loss. Regarding functional outcomes, there was no significant difference in mean Harris Hip Score (P = .48) or Palmer and Parker mobility score (P = .58). Both PFN and PFLCP are effective in internal fixation of unstable trochanteric femur fractures.
Schipper, I.B.; Steyerberg, E.W.; Castelein, R.M.; Heijden, F.H. van der; Hoed, P.T. den; Kerver, A.J.; Vugt, A.B. van
The proximal femoral nail (PFN) is a recently introduced intramedullary system, designed to improve treatment of unstable trochanteric fractures of the hip. In a multicentre prospective clinical study, the intra-operative use, complications and outcome of treatment using the PFN (n = 211) were
Mnif, H; Koubaa, M; Zrig, M; Trabelsi, R; Abid, A
Trochanteric fractures are a major source of mortality, morbidity and functional impairment in the elderly. Morbidity is closely related to the degree of instability and comminution and is substantially influenced by the quality of reduction and internal fixation. Advanced age and associated co-morbidities are two decisive factors of mortality secondary to trochanteric fracture. This prospective study examined the epidemiological profile of trochanteric fractures and assessed mortality and morbidity with the aim of establishing management guidelines and improving prevention strategies. One hundred patients were included; 60% were male. Mean age was 76 years (range, 60-96 yrs). One, or more than one, co-morbidities were present in 68% of cases. The fractures were caused by a simple fall in 90% of cases. Fractures were classified according to the criteria of Ramadier and the ones of Ender. Sixty-five percent of these fractures were unstable. A dynamic hip screw was systematically used as the standard means of internal fixation. Anatomic and functional results were analyzed in 82 patients (18 had died within the first year following fracture occurrence). Mean follow-up period was 24 months (range, 12-36 months). Bone healing was achieved in 96% of cases. There were numerous postoperative complications (four cases of thromboembolism, fourteen immobility-related complications, two infections, six secondary displacement combined to loss of fixation, four non-unions, and nine malunions). At 2 years follow-up, 28 patients had died. Mortality was strongly correlated with older age (over 90 years), associated co-morbidity and fracture instability. Good functional outcomes (72%) correlated with younger age (60-74 years), fracture stability, adequate reduction and internal fixation. In stable trochanteric fractures, osteosynthesis by dynamic screw-plate is more effective than alternative techniques (blade-plate, nail-plate, Ender nail or even trochanteric nail). In unstable
Lee, Young-Kyun; Park, Chan Ho; Koo, Kyung-Hoi
Bipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture. We reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81.7 years. During the arthroplasty, trochanteric fracture fragments were fixed using 1 or 2 vertical wires and transverse wires. We evaluated the clinical outcomes such as abductor power, ambulatory ability and wire-related complications, and radiologic outcomes including the union of the trochanteric fragment and subsidence of stem. Sixty-two patients were followed for a minimum of 2 years (mean, 59 months) postoperatively. The mean abductor power and Koval category was 4.1 (range, 3 to 5) and 4.6 (range, 1 to 6). The wire was broken in 3 hips (4.8%) and the nonunion of the greater trochanter occurred in 1 hips (1.6%). Two stems subsided by 3 mm and 8 mm, respectively, during postoperative 6 weeks, after which the subsidence was not progressive. Cerclage wiring of the trochanter using monofilament wire leads to acceptable outcome in cementless HA for senile patients with unstable intertrochanteric fracture. Cerclage wiring using a monofilament wire is recommended for the fixation of trochanteric fragments.
Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos
The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.
Introduction: Antibiotics are often prescribed by physicians for sore throat in children because of the danger of post streptococcal complications. The role of the parents in over prescription of antibiotics is less well known. Objective: To evaluate the knowledge, attitudes and practice of parents to antibiotic prescription for ...
The article is based on a study that aimed at documenting the ethno-knowledge on the usage of plants healing wounds and sores at the rural areas around uNgoye forest as well as document the methods of preparation and dosage forms of medicinal plants used by people around Ungoye forest. The survey was conducted ...
Sore throat is a common presentation in paediatric emergency and sick bays in schools. It is associated with acute upper respiratory tract infection, and recurrent episodes of infection may result in recurrent tonsillitis which may be complicated by sleep disorders, rheumatic heart disease and acute glomerulonephritis.
Caravelli, Ashley; Bhatnagar, Rupal; Ashaye, Adelola
The patient complained of worsening vaginal pain and increased vaginal discharge, but reported resolution of her back and chest pain. She also said that a week earlier, she'd had a fever that reached 104° F and a sore throat. She denied urinary frequency/urgency, sexual activity, or sexual abuse.
A 20-year-old man presented with a severely sore throat and myalgia, which were unresponsive to antibiotics. He was admitted to a regional hospital with an ongoing painful throat, generalised myalgia, fever and a transient, recurring, salmon-pink rash on his hands and trunk. He did not respond to ceftriaxone and had a ...
Yoshida, E.; Lobbezoo, F.; Fueki, K.; Naeije, M.
The aim was to clarify the effects of experimentally provoked delayed-onset muscle soreness (DOMS) in the jaw-closing muscles on subjective and objective measures of masticatory function. Twenty-one dentate female subjects, without pain-related signs and symptoms of temporomandibular disorders,
Szymanski, David J.
Describes the possible causes of delayed-onset muscle soreness (DOMS), which include buildup of lactic acid in muscle, increased intracellular calcium concentration, increased intramuscular inflammation, and muscle fiber and connective tissue damage. Proposed methods to reduce DOMS include warming up before exercise and performing repeated bouts…
Han, Hyun Ho; Choi, Eun Jeong; Moon, Suk Ho; Lee, Yoon Jae; Oh, Deuk Young
The sacral area is the most common site of pressure sore in bed-ridden patients. Though many treatment methods have been proposed, a musculocutaneous flap using the gluteus muscles or a fasciocutaneous flap is the most popular surgical option. Here, we propose a new method that combines the benefits of these 2 methods: combined V-Y fasciocutaneous advancement and gluteus maximus muscle rotational flaps. A retrospective review was performed for 13 patients who underwent this new procedure from March 2011 to December 2013. Patients' age, sex, accompanying diseases, follow-up duration, surgical details, complications, and recurrence were documented. Computed tomography was performed postoperatively at 2 to 4 weeks and again at 4 to 6 months to identify the thickness and volume of the rotational muscle portion. After surgery, all patients healed within 1 month; 3 patients experienced minor complications. The average follow-up period was 13.6 months, during which time 1 patient had a recurrence (recurrence rate, 7.7%). Average thickness of the rotated muscle was 9.43 mm at 2 to 4 weeks postoperatively and 9.22 mm at 4 to 6 months postoperatively (p = 0.087). Muscle thickness had not decreased, and muscle volume was relatively maintained. This modified method is relatively simple and easy for reconstructing sacral sores, provides sufficient padding, and has little muscle donor-site morbidity.
Maier, K-J; Bücking, B; Horst, K; Andruszkow, H; Hildebrand, F; Knobe, M
In unstable trochanteric fractures, the extramedullary rotationally stable screw-anchor (RoSA) combines the benefits of the load and rotational stability of the blade with the advantages of the screw (pull-out resistance, compression capability) in a single load carrier, and was designed to prevent femoral neck shortening by using an additional locked trochanteric stabilizing plate (TSP). The aim of the current prospective cohort study was the clinical evaluation of the RoSA/TSP system regarding the mechanical re-operation rate and the amount of postoperative femoral neck shortening. From September 2011 to January 2014 80 patients with unstable trochanteric fractures underwent internal extramedullary fixation with the RoSA/TSP (Königsee Implantate GmbH, Allendorf, Germany). Due to fracture stability and after induction of compression, additional long locked antitelescoping screws (AT, n = 1-4) were placed reaching the femoral head. Radiological (femoral neck shortening) and clinical re-examination of patients (n = 61) was performed 6-10 weeks and 6-10 months later. In the 61 re-examined patients (76 %) femoral neck shortening was very low with 2 mm 6-10 months after operation. Re-operations occurred in 8 % (n = 6) and in 4 % (n = 3) as prophylactic surgical intervention. Whereas one-third (4 %) of re-operations occurred due to iatrogenic surgical problems from the first operation two-thirds of patients (8 %) had a re-operation due to delay of bone union (3× nonunion, 3 planned removals of AT-screws to improve healing). The in-hospital mortality was 3 % (n = 2). The fixation of unstable trochanteric femur fractures using the RoSA/TSP in a first clinical setting led to a great primary stability, with significant advantages with regard to limited femoral neck shortening. However, the rigidity of the construct with its consequences regarding bone healing can be challenging for the surgeon. Nevertheless, in some cases of revision it could be beneficial
Singh, Tarveen K R; Guelfi, Kym J; Landers, Grant; Dawson, Brian; Bishop, David
The aim was to compare the effect of a simulated team sport activity circuit (reflective of the activity demands of Australian football) either with or without body 'contact' on muscle soreness, damage, and performance when the circuit was repeated 48 h later. Eleven male, team-sport athletes completed a 'non-contact' (NCON) and a 'contact' (CON) version of the team sport activity circuit in a crossover design with at least 1 week between trials. The effect of CON and NCON on repeated 15m sprint and vertical jump performance was assessed by completing the same version of the circuit 48 h after the initial trial. The effect on perceived soreness and blood markers of muscle damage and inflammation was also determined. Subsequent performance was affected to a greater extent by CON, with both best and mean sprint times significantly slower 48h following CON (psoreness and pressure sensitivity were elevated following both NCON and CON (psoreness was greater with CON (p=0.012). Both CON and NCON resulted in elevated serum creatine kinase, myoglobin and lactate dehydrogenase, while c-reactive protein increased following CON but not NCON. In conclusion, Greater perceived soreness and decrements in performance of the simulated team sport activity circuit when repeated 48 h later were observed following CON. Copyright © 2011 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
Kim, In-Sung; Pansey, Nachiket; Kansay, Rajeev K; Yoo, Je-Hyun; Lee, Hwang-Yong; Chang, Jun-Dong
The purpose of the study is to evaluate the radiologic and functional results of greater trochanteric reattachment using the third-generation cable plate system in revision total hip arthroplasty (THA). A total of 47 trochanteric fixations (27 men and 18 women; mean age of 60.2 years) using the third-generation cable plate system in revision THA were retrospectively evaluated. The mean follow-up was 80.4 months (range 27-148 months). The osteotomized greater trochanter was reattached using the Cable-Ready system (Zimmer, Warsaw, IN) and the Dall-Miles cable system (Stryker, Mahwah, NJ). The clinical results with Harris hip score, visual analog scale, and radiologic outcomes were evaluated. The mean Harris hip score was improved from 55.7 (range 17-72) preoperatively to 90.8 (range 68-100; P = .001) postoperatively, and the mean pain score was improved from 6.6 (range 3-10) to 2.5 (range 0-6; P = .001), respectively. Nonunion was observed in 6 hips (12.7%). Migration of the osteotomized greater trochanteric fragment (>1 cm) was seen in 8 hips (17.0%). Cable breakage occurred in 13 cases (27.6%). Although 5 cable plate systems were removed, there was no need for reattachment of the greater trochanter in this study. This study showed a relatively high incidence of radiologic failure after greater trochanteric reattachment using the cable plate system in revision THA, although reattachments were not required and clinical outcome was relatively satisfactory. Periodic and close observation for the early detection of failure is necessary. Copyright © 2017 Elsevier Inc. All rights reserved.
Stewart, Andrew D; Abdelbary, Hesham; Beaulé, Paul E
Greater trochanteric fracture/nonunion can be a devastating complication with significant functional impact after total hip arthroplasty, and their fixation remains a challenge because of the significant forces being transmitted as well as the poor bone quality often associated with these fractures. The objective of this study is to investigate the rates of reoperation and trochanteric nonunion using a third-generation cable-plate system at one center. Thirty-five patients, mean age 72.9 years (range 46-98 years) with 24 women and 11 men, underwent fixation of their fractured greater trochanter using a third-generation cable-plate system. The indications were: periprosthetic fracture (n = 17), complex primary arthroplasty (n = 5), and complex revision arthroplasty (n = 13). Primary outcomes included rates of reoperation and radiographic union. At a mean follow-up of 2.5 years, trochanteric union rate was 62.9% with nonunion rate of 31.4%, and fibrous union in 5.7%. In regard to quality of initial apposition, only 40% achieved a perfect bone on bone reduction. Ten patients (28.6%) had evidence of wire breakage. Five patients (14.3%) required reoperation and removal of the internal fixation because of lateral hip pain. Fixation of the trochanteric fractures remains a challenge with a relatively high reoperation rate. Poor bone quality and capacity to maintain a stable reduction continue to make this complication after total hip arthroplasty a difficult problem to solve. Copyright © 2017. Published by Elsevier Inc.
Sandifer, Phillip A; Hulick, Robert M; Graves, Matthew L; Spitler, Clay A; Russell, George V; Hydrick, Josie M; Jones, LaRita C; Bergin, Patrick F
This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Patient demographics, operative findings, and radiographic findings were recorded. Medical records were reviewed to identify symptomatic hardware. Overall, 27 patients (19.1%) were symptomatic, and 3 (2.1%) required revision surgery for blade prominence. Of the patients, 42 (30%) had lateralization of greater than 1 cm, and 16 of these (38.1%) were symptomatic (Pfractures showing lateralization of greater than 1 cm. The quality of calcar reduction nearly reached statistical significance, and 44.8% of patients who had inadequate reduction had lateralization of greater than 1 cm compared with 26.4% of patients who had adequate reduction (P=.054). Lateralization of greater than 1 cm was directly associated with the presence of symptoms (Ptrochanteric pain (P=.007). Multivariate analysis showed that increasing tip-apex distance, inadequate calcar reduction, and greater fracture severity were predictive of excessive lateralization of greater than 1 cm. Nearly 20% of patients had lateral hip pain associated with cephalomedullary fixation. Final lateralization of the helical blade of greater than 1 cm was a very strong predictor of symptoms. During preoperative counseling, surgeons should caution patients about this relatively frequent and likely underreported complication. [Orthopedics. 2017; 40(5):e886-e891.]. Copyright 2017, SLACK Incorporated.
Herbert, Robert D; de Noronha, Marcos; Kamper, Steven J
Many people stretch before or after engaging in athletic activity. Usually the purpose is to reduce risk of injury, reduce soreness after exercise, or enhance athletic performance. This is an update of a Cochrane review first published in 2007. The aim of this review was to determine effects of stretching before or after exercise on the development of delayed-onset muscle soreness. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to 10 August 2009), the Cochrane Central Register of Controlled Trials (2010, Issue 1), MEDLINE (1966 to 8th February 2010), EMBASE (1988 to 8th February 2010), CINAHL (1982 to 23rd February 2010), SPORTDiscus (1949 to 8th February 2010), PEDro (to 15th February 2010) and reference lists of articles. Eligible studies were randomised or quasi-randomised studies of any pre-exercise or post-exercise stretching technique designed to prevent or treat delayed-onset muscle soreness (DOMS). For the studies to be included, the stretching had to be conducted soon before or soon after exercise and muscle soreness had to be assessed. Risk of bias was assessed using The Cochrane Collaboration's 'Risk of bias' tool and quality of evidence was assessed using GRADE. Estimates of effects of stretching were converted to a common 100-point scale. Outcomes were pooled in fixed-effect meta-analyses. Twelve studies were included in the review. This update incorporated two new studies. One of the new trials was a large field-based trial that included 2377 participants, 1220 of whom were allocated stretching. All other 11 studies were small, with between 10 and 30 participants receiving the stretch condition. Ten studies were laboratory-based and other two were field-based. All studies were exposed to either a moderate or high risk of bias. The quality of evidence was low to moderate.There was a high degree of consistency of results across studies. The pooled estimate showed that pre-exercise stretching reduced soreness at one
Thakkar, Chandrashekar J; Thakkar, Savyasachi; Kathalgere, Rajshekhar T; Kumar, Malhar N
The sliding screw-plate devices and cephalo-medullary nail devices have performed well in stable inter-trochanteric fractures in patients with reasonably good quality of bone. However, their suboptimal performance in comminuted fractures in the presence of osteoporotic bone has prompted many surgeons to consider bipolar hemiarthroplasty as the primary modality of management of comminuted inter-trochanteric fractures in elderly patients. However, long term stability of the hemiarthroplasty implant also may be compromised due to the presence of postero-medial bone loss at the area of the calcar. We have presented a simple and effective technique of calcar grafting by harvesting cortical bone strut from the neck of the fractured femur. A total of 34 patients with inter-trochanteric fractures of the femur were treated with calcar grafting. The mean age was 79.2 years. The graft was harvested from the calcar region of the head and neck fragment of the femur and wedged between the medial femoral cortex and medial edge of the prosthesis. The mean followup period was 54.5 months. In 32 of 34 (94%) patients in our series, the calcar graft healed well without dislodgement. There was graft resorption in two patients associated with subsidence of the implant and loosening. Calcar grafting using this technique provides stability to the implant in the presence of comminution and incorporates well in the majority of patients. Donor site morbidity of graft harvesting is also avoided.
2.4±0.1) being higher than run 2. (1.6±0.1). Peak soreness occurred at 48 h for run 1 (3.8±0.4) and at 24 h for run 2 (2.3±0.3). M. tibialis anterior (Fig. 3C): There was a significant bout effect (p=0.0001), with run 1 (2.3±0.1) being higher than run.
SEP 2014 2. REPORT TYPE Final 3. DATES COVERED 4. TITLE AND SUBTITLE Ear acupuncture for acute sore throat. A randomized controlled trial...Auncular Acupuncture is a low risk option for acute pain control •Battlefield acupuncture (BFA) IS a specific auncular acupuncture technique •BFA IS...Strengths: Prospect1ve RCT •Weaknesses Small sample stze. no sham acupuncture performed, patients not blinded to treatment •Th1s study represents an
Bringard, A.; Puchaux, K.; Noakes, T. D.; Perrey, S.
The aim of this study was to investigate whether (1) spinal modulation would change after non-exhausting eccentric exercise of the plantar flexor muscles that produced muscle soreness and (2) central modulation of the motor command would be linked to the development of muscle soreness. Ten healthy subjects volunteered to perform a single bout of backward downhill walking exercise (duration 30 min, velocity 1 ms−1, negative grade −25%, load 12% of body weight). Neuromuscular test sessions [H-reflex, M-wave, maximal voluntary torque (MVT)] were performed before, immediately after, as well as 1–3 days after the exercise bout. Immediately after exercise there was a −15% decrease in MVT of the plantar flexors partly attributable to an alteration in contractile properties (−23% in electrically evoked mechanical twitch). However, MVT failed to recover before the third day whereas the contractile properties had significantly recovered within the first day. This delayed recovery of MVT was likely related to a decrement in voluntary muscle drive. The decrease in voluntary activation occurred in the absence of any variation in spinal modulation estimated from the H-reflex. Our findings suggest the development of a supraspinal modulation perhaps linked to the presence of muscle soreness. PMID:17978834
Cochrane, Darryl J
To examine the acute and short-term effect of a wearable vibration device following strenuous eccentric exercise of the elbow flexors. Physically active males (n = 13) performed vibration therapy (VT) and control following eccentric exercise. The arms were randomised and counterbalanced, separated by 14 days. 15 min of VT (120 Hz) was applied immediately and 24, 48, and 72 h after eccentric exercise while the contralateral arm performed no VT (control). Muscle (isometric and concentric) strength, range of motion, electromyography (EMG), muscle soreness and creatine kinase were taken pre-exercise, immediately and 24, 48, and 72 h post-eccentric exercise. Additionally, the acute effect of VT of muscle strength, range of motion, EMG, muscle soreness was also investigated immediately after VT. In the short-term VT was able to significantly reduce the level of biceps brachii pain at 24 h (p soreness, creatine kinase and improved range of motion; however, there was no improvement of muscle strength recovery compared to control following eccentric exercise of the elbow flexors.
Aminian-Far, Atefeh; Hadian, Mohammad-Reza; Olyaei, Gholamreza; Talebian, Saeed; Bakhtiary, Amir Hoshang
Abstract Context: Numerous recovery strategies have been used in an attempt to minimize the symptoms of delayed-onset muscle soreness (DOMS). Whole-body vibration (WBV) has been suggested as a viable warm-up for athletes. However, scientific evidence to support the protective effects of WBV training (WBVT) on muscle damage is lacking. Objective: To investigate the acute effect of WBVT applied before eccentric exercise in the prevention of DOMS. Design: Randomized controlled trial. Setting: University laboratory. Patients or Other Participants: A total of 32 healthy, untrained volunteers were randomly assigned to either the WBVT (n = 15) or control (n = 17) group. Intervention(s): Volunteers performed 6 sets of 10 maximal isokinetic (60°/s) eccentric contractions of the dominant-limb knee extensors on a dynamometer. In the WBVT group, the training was applied using a vibratory platform (35 Hz, 5 mm peak to peak) with 100° of knee flexion for 60 seconds before eccentric exercise. No vibration was applied in the control group. Main Outcome Measure(s): Muscle soreness, thigh circumference, and pressure pain threshold were recorded at baseline and at 1, 2, 3, 4, 7, and 14 days postexercise. Maximal voluntary isometric and isokinetic knee extensor strength were assessed at baseline, immediately after exercise, and at 1, 2, 7, and 14 days postexercise. Serum creatine kinase was measured at baseline and at 1, 2, and 7 days postexercise. Results: The WBVT group showed a reduction in DOMS symptoms in the form of less maximal isometric and isokinetic voluntary strength loss, lower creatine kinase levels, and less pressure pain threshold and muscle soreness (P < .05) compared with the control group. However, no effect on thigh circumference was evident (P < .05). Conclusions: Administered before eccentric exercise, WBVT may reduce DOMS via muscle function improvement. Further investigation should be undertaken to ascertain the effectiveness of WBVT in
Shahin, Yousef; Choudhary, Rakesh; Al-Naser, Saeed; Mullins, Mark
We report a case of interposition of a broken trochanteric wire in the hip joint. This caused early wear of the prosthesis and dislocation of the Charnley total hip arthroplasty. The patient was treated with a revision total hip arthroplasty. This rare complication should be taken into consideration when performing a trochanteric osteotomy fixation with wiring in Charnley total hip arthroplasty.
Pearcey, Gregory E. P.; Bradbury-Squires, David J.; Kawamoto, Jon-Erik; Drinkwater, Eric J.; Behm, David G.; Button, Duane C.
Context: After an intense bout of exercise, foam rolling is thought to alleviate muscle fatigue and soreness (ie, delayed-onset muscle soreness [DOMS]) and improve muscular performance. Potentially, foam rolling may be an effective therapeutic modality to reduce DOMS while enhancing the recovery of muscular performance. Objective: To examine the effects of foam rolling as a recovery tool after an intense exercise protocol through assessment of pressure-pain threshold, sprint time, change-of-direction speed, power, and dynamic strength-endurance. Design: Controlled laboratory study. Setting: University laboratory. Patients or Other Participants: A total of 8 healthy, physically active males (age = 22.1 ± 2.5 years, height = 177.0 ± 7.5 cm, mass = 88.4 ± 11.4 kg) participated. Intervention(s): Participants performed 2 conditions, separated by 4 weeks, involving 10 sets of 10 repetitions of back squats at 60% of their 1-repetition maximum, followed by either no foam rolling or 20 minutes of foam rolling immediately, 24, and 48 hours postexercise. Main Outcome Measure(s): Pressure-pain threshold, sprint speed (30-m sprint time), power (broad-jump distance), change-of-direction speed (T-test), and dynamic strength-endurance. Results: Foam rolling substantially improved quadriceps muscle tenderness by a moderate to large amount in the days after fatigue (Cohen d range, 0.59 to 0.84). Substantial effects ranged from small to large in sprint time (Cohen d range, 0.68 to 0.77), power (Cohen d range, 0.48 to 0.87), and dynamic strength-endurance (Cohen d = 0.54). Conclusions: Foam rolling effectively reduced DOMS and associated decrements in most dynamic performance measures. PMID:25415413
Pearcey, Gregory E P; Bradbury-Squires, David J; Kawamoto, Jon-Erik; Drinkwater, Eric J; Behm, David G; Button, Duane C
After an intense bout of exercise, foam rolling is thought to alleviate muscle fatigue and soreness (ie, delayed-onset muscle soreness [DOMS]) and improve muscular performance. Potentially, foam rolling may be an effective therapeutic modality to reduce DOMS while enhancing the recovery of muscular performance. To examine the effects of foam rolling as a recovery tool after an intense exercise protocol through assessment of pressure-pain threshold, sprint time, change-of-direction speed, power, and dynamic strength-endurance. Controlled laboratory study. University laboratory. A total of 8 healthy, physically active males (age = 22.1 ± 2.5 years, height = 177.0 ± 7.5 cm, mass = 88.4 ± 11.4 kg) participated. Participants performed 2 conditions, separated by 4 weeks, involving 10 sets of 10 repetitions of back squats at 60% of their 1-repetition maximum, followed by either no foam rolling or 20 minutes of foam rolling immediately, 24, and 48 hours postexercise. Pressure-pain threshold, sprint speed (30-m sprint time), power (broad-jump distance), change-of-direction speed (T-test), and dynamic strength-endurance. Foam rolling substantially improved quadriceps muscle tenderness by a moderate to large amount in the days after fatigue (Cohen d range, 0.59 to 0.84). Substantial effects ranged from small to large in sprint time (Cohen d range, 0.68 to 0.77), power (Cohen d range, 0.48 to 0.87), and dynamic strength-endurance (Cohen d = 0.54). Foam rolling effectively reduced DOMS and associated decrements in most dynamic performance measures.
Hawks, Michael A; Kim, Hyunchul; Strauss, Joseph E; Oliphant, Bryant W; Golden, Robert D; Hsieh, Adam H; Nascone, Jason W; O'Toole, Robert V
We assessed the biomechanical performances of a trochanteric lag screw construct and a traditional inverted triangle construct in the treatment of simulated Pauwels type 3 femoral neck fractures. An inverted triangle construct (three 7.3-mm cannulated screws placed in inverted triangle orientation) and a trochanteric lag screw construct (two 7.3-mm cannulated screws placed across the superior portion of the femoral neck and one 4.5-mm lag screw placed perpendicular to the fracture in superolateral to inferomedial orientation) were tested in nine matched pairs of non-osteoporotic human cadaveric femora. We used a previously described vertically oriented femoral neck fracture model and testing protocol that incrementally loaded the constructs along the mechanical axis of the femur to 1400 N. Specimens that survived incremental loading underwent cyclic loading. Apparent construct stiffness, force at 3mm of displacement, and survival of incremental loading were recorded. The trochanteric lag screw group had a 70% increase in stiffness (261 N/mm [29 standard deviation] versus 153 N/mm [16 standard deviation]; P=0.026) and a 43% increase in force required for displacement (620 N versus 435 N; P=0.018) compared with the inverted triangle group. One trochanteric lag screw and no inverted triangle specimen survived incremental loading. A trochanteric lag screw construct applied to vertically oriented femoral neck fractures provides marked improvement in mechanical performance compared with the inverted triangle construct. © 2013.
Batty, Antonia; Wren, M W D; Gal, Michaela
Fusobacterium necrophorum is a well established cause of Lemierre's disease (LD); a syndrome characterised by severe sore throat, septicaemia, multiple abscesses and jugular vein thrombosis. There is no published data concerning the role of F. necrophorum in recurrent sore throats. As the result of an index case of persistent sore throat attributable to this organism being diagnosed in our laboratory, a subsequent case controlled study (not yet published) isolated F. necrophorum from 21% (P=0.0001) of cases of persistent, recurrent and chronic sore throats. The object of this study was to compare isolates of F. necrophorum from cases of systemic disease with isolates from cases of persistent sore throat syndrome (PSTS) to ascertain whether strains of similar type were responsible for both throat and systemic disease or whether different strains were involved in these presentations. Throat swabs were cultured on GN anaerobe medium (Oxoid) and incubated at 37 degrees C for 5 days. Seventeen PSTS isolates were identified phenotypically. These were compared to 17 strains isolated from blood cultures which were referred to the Anaerobe Reference Unit, (ARU) cardiff, using enterogenic repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR). The control strains Fusobacterium necrophorum ssp. necrophorum (JCM 3718(T)) and Fusobacterium necrophorum ssp. funduliforme (JCM 3724(T)) from the Japanese Collection of Microrganisms (JCM) were tested in parallel with the clinical isolates. At least 12 separate types were identified. Four of 17 PSTS isolates and seven of 17 blood culture isolates grouped together with the F. necrophorum ssp. funduliforme control strain. There were also similarities between other proposed strains and clinical types but no comparison with the F. necrophorum ssp. necrophorum control. These results show that clinical disease caused by F. necrophorum has a wider spectrum than first anticipated. Similar strains are able to cause either
Raúl Alberto Aguilera Eguía; Alejandro Ibacache Palma
Introduction Late onset muscle soreness, also known as delayed onset muscle soreness, is a painful musculoskeletal condition that may occur 24-48 and up to 72 hours after the completion of unusual physical or high intensity exercise involving eccentric muscle activity. In the field of physical rehabilitation, immersion in cold water is a common intervention mainly used in sports medicine, to minimize delayed onset muscle soreness and promote recovery after exercise. Objective To ass...
Levet, T; Martens, A; Devisscher, L; Duchateau, L; Bogaert, L; Vlaminck, L
There is a lack of evidence-based data on the prevalence, outcome and risk factors of distal limb cast sores, and no objective tool has been described for the early detection of cast sores. To investigate the prevalence, location, outcome and risk factors of cast sores after application of a distal limb cast and to determine whether static thermography of the cast is a valuable tool for the assessment of sores. A prospective study was conducted on horses treated with a distal limb cast. At each cast removal, cast sores were graded as superficial sores (SS), deep dermal sores (DS) or full thickness skin ulcerations (FS). In several cases, a thermographic evaluation of the cast was performed immediately prior to removal and differences in temperature (AT) between the coolest point of the cast and 2 cast regions predisposed for sore development (dorsoproximal mc/mtIII and palmar/plantar fetlock) were calculated. Mean +/- s.d. total casting time of 70 horses was 31 +/- 18 days. Overall, 57 legs (81%) developed at least SS. Twenty-four legs (34%) ultimately developed DS and one horse had an FS. Multivariable analysis showed that the severity of sores was positively associated with increasing age (OR: 1.111, P = 0.028), a normal (vs. swollen) limb (OR: 3387, P = 0.023) and an increase in total casting time (OR per week: 1.363, P = 0.002). The thermographic evaluation (35 casts) revealed that the severity of sores was positively associated with increasing deltaT (OR: 2.100, P = 0.0005). The optimal cut-off values for the presence of SS and DS were set at, respectively, deltaT = 23 and 43 degrees C. Distal limb cast is a safe coaptation technique with increasing risk of developing sores with time. Thermography is a valuable and rapid clinical tool to monitor the development of cast sores.
Majumder, Santanu; Roychowdhury, Amit; Pal, Subrata
Hip fracture depends on various anthropometric parameters such as trochanteric soft tissue thickness, body height and body weight. The objective was to evaluate the responses to the variations in anthropometric parameters during sideways fall, and to identify the most dominant parameter among them. Seven finite element models were developed having anthropometric variations in trochanteric soft tissue thickness (5-26 mm), body height (1.70-1.88 m), and body weight (63-93.37 kg). These were simulated for sideways fall with ANSYS-LS-DYNA® code. Significant effect of trochanteric soft tissue thickness variation was found on 'normalized peak impact force with respect to the body weight' (p=0.004, r²=0.808) and strain ratio (p=0.083, r²=0.829). But, variation in body height was found to be less significant on normalized peak impact force (p=0.478, r²=0.105) and strain ratio (p=0.292, r²=0.217). Same was true for the variation in body weight on normalized peak impact force (p=0.075, r²=0.456) and strain ratio (p=0.857, r²=0.007). The risk factor for fracture was also well correlated to the strain ratio for the inter-trochanteric zone (pfractures are clinically observed to happen. Trochanteric soft tissue thickness was found likely to be the most dominant parameter over body height and body weight, signifying that a slimmer elderly person, taller or shorter, with less trochanteric soft tissue thickness should be advised to take preventive measures against hip fracture under sideways fall. © 2013.
Moss, David A; Crawford, Paul
Sore throat is a common cause of pain in outpatient encounters. Battlefield auricular acupuncture (the placing of needles in specific points in the ear) is a modality used to treat acute pain associated with a variety of ailments. The aim of our study was to determine whether auricular acupuncture reduces pain, medication usage, and missed work hours when added to standard therapy in adult patients with acute sore throat. We conducted an unblinded, pragmatic, randomized controlled trial among adult, nonpregnant patients presenting to an Air Force family medicine clinic with pain from acute sore throat. A total of 54 patients were followed for 48 hours after treatment. Patients receiving auricular acupuncture reported lower pain scores than those who did not at 15 minutes (6.0 [95% confidence interval (CI), 5.4-6.6] vs 2.6 [95% CI, 1.7-3.5]; P vs 2.5 [95% CI, 1.6-3.4]; P = .0005), and 24 hours (4.1 [95% CI, 3.3-4.9] vs 1.3 [95% CI, 1.0-2.8]; P = .0006). They also reported taking fewer cumulative doses of pain medication at 6 hours (1.07 [95% CI, 0.69-1.45] vs 0.39 [95% CI, 0.2-0.58]; P = .003), 24 hours (2.63 [95% CI, 1.95-3.31] vs 1.37 [95% CI, 0.92-1.82]; P = .004), and 48 hours (4.07 [95% CI, 2.9-5.24] vs 2.19 [95% CI, 1.44-2.94]; P = .009). There was no difference in time missed from work between the auricular acupuncture and standard therapy groups. Compared with usual treatment, battlefield auricular acupuncture was associated with reduced sore throat pain for 24 hours and decreased use of pain medication for up to 48 hours. There was no apparent effect on hours missed from work. © Copyright 2015 by the American Board of Family Medicine.
Schott, A M; Hans, D; Duboeuf, F; Dargent-Molina, P; Hajri, T; Bréart, G; Meunier, P J
Hip fractures can be separated into cervical and trochanteric fractures. Trochanteric fractures have been associated with up to twice the short-term mortality of cervical fractures in the elderly. There is also evidence suggesting that the mechanisms are different. Evidence from the literature remains limited on the predictive power of bone mineral density (BMD) and quantitative ultrasounds (QUS) for both types of hip fractures. 5703 elderly women aged 75 years or more, who were recruited from the voting lists in the EPIDOS study, and had baseline calcaneal ultrasounds (QUS) and DXA measurements at the hip and the whole body, were analyzed in this paper. Among those, 192 hip fractures occurred during an average follow-up of 4 years, 108 cervical and 84 trochanteric fractures. Femoral neck, trochanteric and whole body BMD were able to predict trochanteric hip fracture (RR's and 95% CI were, respectively, 3.2 (2.4-4.2); 4.8 (3.5-6.6); and 2.8 (2.2-3.6)) more accurately than cervical fractures (respectively, 2.1 (1.7-2.7); 2.3 (1.8-3.0); 1.2 (1.0-1.6)). All ultrasound parameters, SOS, BUA, and stiffness index (SI) were significant predictors of trochanteric (RR's respectively 3.0 (2.2-4.1), 2.5(2.0-3.1), and 3.5(2.6-4.7)) but not cervical fractures. After adjustment for femoral neck or trochanteric BMD ultrasound parameters were still significant predictors of trochanteric fracture, and stiffness tended to be a better predictor of trochanteric fractures than either BUA or SOS with a relative risk of 2.25 (1.6-3.1). A significant decrease of all bone measurements, BMD and QUS, was highly predictive of trochanteric fractures, whereas a decrease of femoral neck and trochanteric BMD were only associated with a slight increase in cervical fracture risk and a low total body BMD or QUS parameters were not significant predictors of cervical fractures. In women who sustained a hip fracture, the decrease of BMD and QUS values increases the risk of trochanteric fracture as
Hübscher, Markus; Vogt, Lutz; Bernhörster, Marcus; Rosenhagen, Andreas; Banzer, Winfried
This study was done to investigate the effects of a standardized acupuncture treatment on symptoms and muscle function in exercise-induced delayed-onset muscle soreness (DOMS). A prospective, randomized, controlled, observer and subject-blinded trial was undertaken. Twenty-two (22) healthy subjects (22-30 years; 10 males and 12 females) were randomly assigned to three treatment groups: real acupuncture (deep needling at classic acupuncture points and tender points; n = 7), sham-acupuncture (superficial needling at nonacupuncture points; n = 8), and control (no needling; n = 7). DOMS of the nondominant elbow-flexors was experimentally induced through eccentric contractions until exhaustion. The outcome measures were pain perception (visual analogue scale; VAS; range: 0-10 cm), mechanical pain threshold (MPT; pressure algometer), and maximum isometric voluntary force (MIVF; force transducer). Treatment was applied immediately, 24 and 48 hours after DOMS induction. Measurements of MPT and MIVF were made prior to DOMS induction as well as before and after every treatment session. VAS data were acquired after DOMS induction as well as pre- and post-treatment. Final pain, MPT, and MIVF measurements were performed 72 hours after DOMS induction. Following nonparametric testing, there were no significant differences between groups in outcome measures at baseline. After 72 hours, pain perception (VAS) was significantly lower in the acupuncture group compared to the sham acupuncture and control subjects. However, the mean MPT and MIVF scores were not significantly different between groups. Although acupuncture seemed to have no effects on mechanical pain threshold and muscle function, it proved to reduce perceived pain arising from exercise-induced muscle soreness.
Dabbs, Nicole C; Black, Christopher D; Garner, John
Research into alleviating muscle pain and symptoms in individuals after delayed-onset muscle soreness (DOMS) has been inconsistent and unsuccessful in demonstrating a useful recovery modality. To investigate the effects of short-term whole-body vibration (WBV) on DOMS over a 72-hour period after a high-intensity exercise protocol. Randomized controlled clinical trial. University laboratory. Thirty women volunteered to participate in 4 testing sessions and were assigned randomly to a WBV group (n = 16; age = 21.0 ± 1.9 years, height = 164.86 ± 6.73 cm, mass = 58.58 ± 9.32 kg) or a control group (n = 14; age = 22.00 ± 1.97 years, height = 166.65 ± 8.04 cm, mass = 58.69 ± 12.92 kg). Participants performed 4 sets to failure of single-legged split squats with 40% of their body weight to induce muscle soreness in the quadriceps. The WBV or control treatment was administered each day after DOMS. Unilateral pressure-pain threshold (PPT), range of motion (ROM), thigh circumference, and muscle-pain ratings of the quadriceps were collected before and for 3 days after high-intensity exercise. Each day, we collected 3 sets of measures, consisting of 1 measure before the WBV or control treatment protocol (pretreatment) and 2 sets of posttreatment measures. We observed no interactions for PPT, thigh circumference, and muscle pain (P > .05). An interaction was found for active ROM (P = .01), with the baseline pretreatment measure greater than the measures at baseline posttreatment 1 through 48 hours posttreatment 2 in the WBV group. For PPT, a main effect for time was revealed (P .05). The WBV treatment approach studied did not aid in alleviating DOMS after high-intensity exercise. Further research is needed in various populations.
Wang, Pan-Feng; Xu, Shuo-Gui; Zhang, Chun-Cai; Fu, Qing-Ge; Zhang, Yun-Tong; Liu, Xin-Wei; Niu, Yun-Fei; Tang, Yang
To introduce a new trochanteric osteotomy,and evaluate the outcome of the procedure combined a posterior lateral approach in treating acetabular fractures which involving the roof. Between March 2007 and Novmber 2010,30 patients with displaced acetabular fractures involving the dome need trochanteric osteotomy were retrospectively reviewed. There were 21 males and 9 females,ranging in age from 18 to 70 years with an average of 35.2 years at the time of injury. According to Letournel-Judet classification, there were 10 posterior wall fractures,7 posterior column fractures,5 transverse fractures, 2 T-shape fractures, 1 transverse associated with posterior wall fracture, 3 posterior column and wall fractures and 2 bicolumn fractures. The standards of Matta,the modified Merle d'Aubigne-Postel, Medical Research Council were respectively used to evaluate the reduction result, function of hip joint and the strength of hip abduction. All patients were followed up with an average time of 25 months (18 to 40) and all osteotomy sites obtained bone union with an average time of 8.4 weeks (6 to 12). No bone non-union, bone block displaceing, internal fixation looseing and breaking,infection of deep part were found. Seventeen patients got anatomic reduction, 12 got satisfied reduction, and 1 got unsatisfied result according to the criteria of Matta. At final follow-up, function of hip joint obtained excellent results in 11 cases, good in 15, fair in 3 and poor in 1. The strength of the abductors of 3 patients were grade 4 and 27 patients were grade 5. Posterior partial great trochanteric osteotomy can enhance the exposure and provide a more accurate reduction and degrade the difficulty of acetabular fracture fixation without increasing the risk of complications. The method provide a new way for the treatment of the roof involved acetabular fractures.
Gupta, Sandeep; Singh, Jagdeep; Virk, Jagandeep Singh
Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum. It also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetabulum fractures. From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d'Aubigne and Postel score. The strength of the abductors was assessed according to the Medical Research Council (MRC) grading system. Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.
Kľoc, P; Tomčovčík, L; Kľoc, J
The number of papers reporting the occurrence of specific pathological fractures in long-term biphosphonate users has recently increased. They refer to the forms of stress fracture probably resulting from an extreme decrease in bone turnover, which may involve sub-trochanteric or isolated transverse fractures, or short transverse fractures with a unicortical beak in an area of cortical hypertrophy. At the time of prodromal signs and symptoms, cortical bone at the site of impeding fracture appears rougher on radiographs. Gradually, an incomplete fracture develops, with a subsequent complete fracture often sustained without any mechanism of injury noted. The occurrence of such fractures is reported in the range of 2 to 8 years from the start of biphosphonate use. The fractures are often bilateral and, at the time the first occurs, it is often possible to diagnose contralateral pathological changes similar to those before the first fracture. The paper presents the case of a female patient who sustained a bilateral pathological sub-trochanteric fracture; the first fracture occurred after 5 and the other after 9 years of Rizendronat use. She was followed up for unilateral incomplete sub-trochanteric fracture from the fourth year of its use. In that period, magnetic resonance imaging showed a pathological finding in the contralateral extremity. She had already had prodromal signs manifested as lasting hip pain before the first fracture. Both fractures were surgically treated. Thirty-three months later she had to undergo repeat surgery for pseudoarthrosis at the site of the first fracture. The pseudoarthrosis healed without complications. However, in the second fracture non-union was still present at 7 months after surgery. The patient took Rizendronat during the whole treatment period and thereafter. In the discussion, certain aspects of long-term biphosphonate use are addressed, as well as some preventive, diagnostic and therapeutic procedures related to this rare
Silva, Paulo; Coelho, Danilo Lopes; Curi, Calim; de Oliveira, Leandro Alves; de Moraes, Frederico Barra; do Amaral, Rogério Andrade; Rebello, Percival Rosa
To evaluate valgus subtrochanteric osteotomy for the treatment of trochanteric non-union. A retrospective study of cases series. From 1998 September to 2009 January, seventeen (17) cases with a diagnosis of non-union of trochanteric fracture were re-operated by the hip group of the Ortophaedic And Traumatology service of the Hospital Geral de Goiania (HGG). The patients presented pain at the fracture site, a femoral varus angle of less than 120°, and non-union of the fracture in the 3(rd) months after the initial surgery. Patients with ages ranging from 30 to 73 years, with a maximum follow-up of 09 years and minimum of 09 years. The mean time from first surgery to osteotomy was six months. Bone union was observed in 16 patients, with a mean union time of 12 weeks after surgery. The mean hip varus angle was 105(0) (120(0) to 90(0)). After surgery, the mean hip valgus angle was 144(0) (155(0) to 135(0)). We had one unsuccessful case; a 78-year old patient who had osteogtomy, fixed with DHS of 150(0), with valgization to 154(0). After six months of follow-up without union of the fracture, it was decided to perform total cemented hip artroplasthy, without complications. Valgus subtrochanteric osteotomies can be indicated for the treatment of trochanteric treatment of pseudoarthroses, with good final results for bone union, avoiding the need for total hip artroplasthy and maintaining biological fixation, as well as reestablishing the mechanical and anatomical axis of the affected limb.
von Rüden, Christian; Hungerer, Sven; Augat, Peter; Trapp, Oliver; Bühren, Volker; Hierholzer, Christian
Mechanical breakage of cephalomedullary nail osteosynthesis is a rare complication attributed to delayed fracture union or nonunion. This study presents a series of cases of breakage and secondary lag screw dislocation after cephalomedullary nailing. The aim of this study was to identify factors that contribute to cephalomedullary nail breakage. In a retrospective case series review between 02/2005 and 12/2013, we analyzed 453 patients with trochanteric and subtrochanteric fracture who had been treated by cephalomedullary nailing. Fractures were classified according to AO/OTA classification. 13 patients with cephalomedullary nail breakage were included (failure rate 2.9 %). Seven patients were women, and six men with a mean age of 72 years (range 35-94). Implant breakage occurred 6 months postoperatively (range 1-19 months). In ten cases, breakage was secondary to delayed or nonunion, which was thought to be mainly due to insufficient reduction of the fracture, and in two cases due to loss of the lag screw because of missing set screw. In one case, breakage was apparent during elective metal removal following complete fracture healing. Short-term outcome was evaluated 6 months after operative revision using Harris hip score in 11 out of 13 patients showing a mean score of 84 %. Complete radiological fracture healing has been found in 11 patients available for follow-up within 6 months after revision surgery. Breakage of cephalomedullary nail osteosynthesis of trochanteric fractures is a severe complication. The results of our study demonstrate that revision surgery provides good clinical and radiological short-term results. Predominately, failures of trochanteric fractures are related to lack of surgeon performance. Therefore, application of the implant requires accurate preoperative planning, advanced surgical experience to evaluate the patient and the fracture classification, and precise surgical technique including attention to detail and anatomical
Bojan, Alicja J; Jönsson, Anders; Granhed, Hans; Ekholm, Carl; Kärrholm, Johan
Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out. Copyright © 2018 Elsevier Ltd. All rights reserved.
Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo
Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Pogliacomi, Francesco; Pellegrini, Andrea; Tacci, Fabrizio; Pedrini, Martina Francesca; Costantino, Cosimo; Pedrazzini, Alessio; Pedrazzi, Giuseppe; Lauretani, Fulvio; Vaienti, Enrico; Ceccarelli, Francesco
Fractures in elderly are always a dramatic event and the healing is often not complete. In a context of bone fragility, repeated fractures are a growing problem in the industrialized world, in which the mean age of population is increasing. The aim of this study was to identify those general factors which may increase the risk of subsequent trochanteric fractures after an initial lesion. Three-hundred and thirty-one patients who underwent intramedullary fixation for trochanteric fractures between January 2012 and December 2013 were studied. Forty subjects yet alive (group 1), affected by a subsequent contralateral hip fracture, were compared with 202 patients (group 2) affected by isolated trochanteric fracture. Days of hospitalization before surgery, hospitalization, period of rehabilitation, type of discharge and comorbidities, that are reported in literature as possible risk factors for hip refracture, were analyzed. In addition, all patients were interviewed in order to assess if a therapy for osteoporosis was prescribed after the initial fracture and how their gait had been modified by fractures. Days of hospitalization before surgery, hospitalization, period of rehabilitation and type of discharge were not predictive factors for subsequent fractures, as well as diabetes mellitus, hypertension and cardiac diseases. The presence of neurologic and respiratory diseases were associated to a higher risk of refractures, as well as the absence of specific medical treatment for osteoporosis. Neurologic and respiratory comorbidities and the absence of osteoporosis medical treatment are the variables associated to a higher risk of contralateral fractures. Physicians can do more in terms of prevention and strategies must consider these risk factors.
Yu, Aihong; Carballido-Gamio, Julio; Wang, Ling; Lang, Thomas F; Su, Yongbin; Wu, Xinbao; Wang, Manyi; Wei, Jie; Yi, Chen; Cheng, Xiaoguang
There is little knowledge about the spatial distribution differences in volumetric bone mineral density and cortical bone structure at the proximal femur between femoral neck fractures and trochanteric fractures. In this case-control study, a total of 93 women with fragility hip fractures, 72 with femoral neck fractures (mean ± SD age: 70.6 ± 12.7 years) and 21 with trochanteric fractures (75.6 ± 9.3 years), and 50 control subjects (63.7 ± 7.0 years) were included for the comparisons. Differences in the spatial distributions of volumetric bone mineral density, cortical bone thickness, cortical volumetric bone mineral density, and volumetric bone mineral density in a layer adjacent to the endosteal surface were investigated using voxel-based morphometry (VBM) and surface-based statistical parametric mapping (SPM). We compared these spatial distributions between controls and both types of fracture, and between the two types of fracture. Using VBM, we found spatially heterogeneous volumetric bone mineral density differences between control subjects and subjects with hip fracture that varied by fracture type. Interestingly, femoral neck fracture subjects, but not subjects with trochanteric fracture, showed significantly lower volumetric bone mineral density in the superior aspect of the femoral neck compared with controls. Using surface-based SPM, we found that compared with controls, both fracture types showed thinner cortices in regions in agreement with the type of fracture. Most outcomes of cortical and endocortical volumetric bone mineral density comparisons were consistent with VBM results. Our results suggest: 1) that the spatial distribution of trabecular volumetric bone mineral density might play a significant role in hip fracture; 2) that focal cortical bone thinning might be more relevant in femoral neck fractures; and 3) that areas of reduced cortical and endocortical volumetric bone mineral density might be more relevant for
Kummer, Frederick J
This study compared the sliding characteristics of three lag screw designs used with trochanteric nails and determined the effects of lubrication on sliding. They were tested by an established method to measure initiation and ease of lag screw sliding. These tests were then repeated with calf serum lubrication. There were significant differences (p Lubrication did not affect either parameter. Lag screw design aspects, such as diameter and, particularly, surface finish, affect sliding. Due to the small contact area between the lag screw and nail creating high interface stresses, lubrication had no effect on lag screw sliding.
Ranchordas, Mayur K; Rogerson, David; Soltani, Hora; Costello, Joseph T
Muscle soreness typically occurs after intense exercise, unaccustomed exercise or actions that involve eccentric contractions where the muscle lengthens while under tension. It peaks between 24 and 72 hours after the initial bout of exercise. Many people take antioxidant supplements or antioxidant-enriched foods before and after exercise in the belief that these will prevent or reduce muscle soreness after exercise. To assess the effects (benefits and harms) of antioxidant supplements and antioxidant-enriched foods for preventing and reducing the severity and duration of delayed onset muscle soreness following exercise. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, SPORTDiscus, trial registers, reference lists of articles and conference proceedings up to February 2017. We included randomised and quasi-randomised controlled trials investigating the effects of all forms of antioxidant supplementation including specific antioxidant supplements (e.g. tablets, powders, concentrates) and antioxidant-enriched foods or diets on preventing or reducing delayed onset muscle soreness (DOMS). We excluded studies where antioxidant supplementation was combined with another supplement. Two review authors independently screened search results, assessed risk of bias and extracted data from included trials using a pre-piloted form. Where appropriate, we pooled results of comparable trials, generally using the random-effects model. The outcomes selected for presentation in the 'Summary of findings' table were muscle soreness, collected at times up to 6 hours, 24, 48, 72 and 96 hours post-exercise, subjective recovery and adverse effects. We assessed the quality of the evidence using GRADE. Fifty randomised, placebo-controlled trials were included, 12 of which used a cross-over design. Of the 1089 participants, 961 (88.2%) were male and 128 (11.8%) were female. The age range for
Beaudouin-Bazire, Constance; Dalmas, Noémie; Bourgeois, Julie; Babinet, Antoine; Anract, Philippe; Chantelot, Christophe; Farizon, Frédéric; Chopin, Florence; Briot, Karine; Roux, Christian; Cortet, Bernard; Thomas, Thierry
Atypical sub-trochanteric and femoral shaft fractures have been reported in patients treated with bisphosphonates. Their incidence has been determined from registered data analysis using international codes. Therefore, the aim of our study was to estimate the real frequency of typical and atypical sub-trochanteric or diaphyseal fractures, based on radiological and clinical data compared to registered data. In the registers of three large French University Hospitals, patients identified with International Classification of Diseases, 10th Revision diagnosis codes for sub-trochanteric or diaphyseal fracture were selected. Frequencies of ordinary and atypical fractures were calculated after both registered data, radiological and clinical files analysis. Among the 4592 patients hospitalized for a femoral fracture over 5 years, 574 were identified to have had a sub-trochanteric or femoral shaft fracture. 47.7% of the sub-trochanteric and femoral shaft fractures were misclassified, predominantly in the sub-trochanteric fractures subset. 12 patients had an atypical fracture (4% of the sub-trochanteric and femoral shaft fractures) and 11 fractures presented radiological features of atypical fractures, whereas clinical files analysis revealed they were pathological or traumatic fractures. Atypical fractures frequency is very low. Because of their low frequency and the unreliability of registered databases, the risk of atypical fractures is very difficult to estimate retrospectively. A prospective study is needed to clarify the risk factors associated with these fractures. Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.
Impellizzeri, Franco M; Maffiuletti, Nicola A
The aim of this study was to examine the construct validity of the 7-point Likert scale of muscle soreness, assessing its relationship with Visual Analogue Scale (VAS). An additional aim was to examine its sensitivity as measure of symptom of eccentric-contraction muscle damage. Correlational study. Self-administered questionnaires collected in field setting. Twenty-six soccer players. 4-week preseason training camp, which included high-intensity plyometric training sessions. Players self-reported the perceived muscle soreness of the lower limbs using the VAS (criterion measure) and the 7-point Likert scale of muscle soreness. Significant individual correlations were found between the 2 muscle soreness scales (mean r=0.80+/-0.07; range, 0.65 to 0.94). The correlation using the pooled data was 0.81. No significant muscle soreness scale x time interaction was found for standardized measures of muscle soreness (P=0.98). The main factor for time (24, 48, 72, and 96 hours after the first plyometric training session) was significant (P=0.0001). Effect sizes for the changes in the Likert and VAS absolute scores during the first 96 hours were similar (partial eta=0.13). The results of this study provide further convergent evidence for the construct validity of the 7-point Likert scale of muscle soreness. The 2 scales showed similar sensitivity to muscle soreness caused by eccentric contractions during the first 96 hours after plyometric exercises.
Tavares, Francisco; Simões, Mário; Matos, Bruno; Smith, Tiaki B; Driller, Matthew
The purpose of the current study is to analyse the acute effects of volleyball training and to compare the responses of different perceptual and neuromuscular measures to overall training load. The training load, wellness, neuromuscular performance and perceptual measures of soreness of 13 highly-trained volleyball athletes (18 ± 1 years; 187.1 ± 7.0 cm; 84.3 ± 10.3 kg) representing the Portugal under-19 national team were monitored during a training week. Perceptual fatigue was obtained in the morning of every training day from a 5-item wellness questionnaire (sleep, soreness, mood, fatigue, stress) and a muscle soreness questionnaire surveying 9 different muscle sites from each side of the body. Neuromuscular performance was obtained from a countermovement jump (CMJ) on the morning of training day's 1, 2, 4 and 5. Small effect sizes in CMJ's were observed on days 4 and 5 when compared to baseline. Wellness items were affected by training, with the fatigue item and the total score being the most affected. Muscle soreness increased from day 2 until day 5 in comparison to baseline across various muscle sites and regions. Nevertheless, responses in soreness were different from muscle sites, average of muscle sites and a single question of muscle soreness. Volleyball training elicits meaningful changes in physiological and perceptual measures of fatigue and muscle soreness, as evident from day 2 until the last training day of the week. Muscle soreness scores obtained from different muscle sites may provide important information to coaches.
Montgomery, Paul G; Hopkins, Will G
Australian Football is an intense team sport played over ~120 min on a weekly basis. To determine the effects of game and training load on muscle soreness and the time frame of soreness dissipation, 64 elite Australian Football players (age 23.8 ± 1.8 y, height 183.9 ± 3.8 cm, weight 83.2 ± 5.0 kg; mean ± SD) recorded perceptions of muscle soreness, game intensity, and training intensity on scales of 1-10 on most mornings for up to 3 competition seasons. Playing and training times were also recorded in minutes. Data were analyzed with a mixed linear model, and magnitudes of effects on soreness were evaluated by standardization. All effects had acceptably low uncertainty. Game and training-session loads were 790 ± 182 and 229 ± 98 intensity-minutes (mean ± SD), respectively. General muscle soreness was 4.6 ± 1.1 units on d 1 postgame and fell to 1.9 ± 1.0 by d 6. There was a small increase in general muscle soreness (0.22 ± 0.07-0.50 ± 0.13 units) in the 3 d after high-load games relative to low-load games. Other soreness responses showed similar timelines and magnitudes of change. Training sessions made only small contributions to soreness over the 3 d after each session. Practitioners should be aware of these responses when planning weekly training and recovery programs, as it appears that game-related soreness dissipates after 3 d regardless of game load and increased training loads in the following week produce only small increases in soreness.
Pellegrini, Andrea; Tacci, Fabrizio; Leigheb, Massimiliano; Costantino, Cosimo; Pedrazzini, Alessio; Pedrazzi, Giuseppe; Vaienti, Enrico; Ceccarelli, Francesco; Pogliacomi, Francesco
In a context of bone fragility, primitive and subsequent fractures are a growing problem in the industrialized countries where the mean age of the population is constantly increasing. Among the various factors that favor a fragility fracture, the most important is osteoporosis, a pathology that can be prevented through diagnostic screenings and treated by pharmacological and rehabilitative therapies. The aim of this study is to identify the subjects who are likely to have a higher risk of subsequent fractures of the trochanteric region through a retrospective radiographic evaluation of patients affected by low-energy trochanteric fractures and operated by intramedullary fixation between June 2013 and June 2015, so they can be targeted for prevention interventions. Three hundred and sixty-one patients yet alive were analyzed 2 years after surgery. Fifty-one (group 1), characterized by another contralateral trochanteric femoral fracture, were included. All subjects were retrospectively examined with the analysis of contralateral femur X-ray performed at the time of initial trauma in order to detect a condition of bone fragility and a predisposition to fractures by evaluating three radiographic indices (Singh index, Dorr's classification and Cortical Thickness Index). Patients of group 1 were compared to the other 310 patients (group 2) affected by isolated trochanteric fracture. Group 1 had all radiographic indices worse than group 2. The results observed suggest that orthopedists can use radiographic indices, in particular Cortical Thickness Index, as a valuable, simple and inexpensive screening tool for prevention of recurrent osteoporotic fractures.
Full Text Available INTRODUCTION: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN. MATERIALS AND METHODS: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. RESULTS: Average duration of union was 17.08 weeks (range 13 to 32 weeks, union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. CONCLUSION: The long PFN is a reliable implant for sub-trochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.
Behera, P; Khurana, A; Saibaba, B; Aggarwal, S
Osteopetrosis is a rare hereditary condition which may have autosomal recessive or autosomal dominant inheritance. Patients tend to present most commonly with fractures but involvement of cranial nerves and hematopoetic system is not uncommon. Patients with infantile and intermediate type tend to present more often with problems other than orthopaedic problems. While diagnosis can be made on the basis of radiographs, management needs to be customized for every patient. Non operative and operative management both have their advantages and disadvantages. We are here reporting a case of sub-trochanteric fracture in an eight-year-old child which was managed successfully with a dynamic hip screw (DHS). Surgery could be performed successfully by taking precautions during reduction, drilling and screw placement. At the latest follow up, which was after one and half years of surgery, the fracture had united well and the child faced no limitations of activities. Thus, open reduction and fixation with DHS can be considered as an effective management modality for pediatric sub-trochanteric fractures in osteopetrosis.
Kempf, I; Grosse, A; Taglang, G; Favreul, E
The Gamma Nail is the latest advance in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures. Its design is based on Küntscher's Y-nail and locking intramedullary (IM) nails. This paper reports the results from the first-ever series of 121 patients operated between 1988 and 1990. They were followed until bone union was achieved. The mean patient age was 75 years. Most patients were in poor general health and had unstable fractures. Anatomical preoperative reduction was achieved in 72% of cases. Fixation was good in 66% of cases and acceptable in 27% of cases. Intra-operative complications consisted of nine fractures without consequences. Of the treated patients, 83.4% resumed weight-bearing during the first week. There was one case of deep infection that resolved with treatment. The mortality rate was 12.3% at three months. We noted 7 alunions in varus, 3 in valgus, 2 in external rotation and 1 in internal rotation. There were no cases of non-union. In six cases, the screw had cut out of the femoral head. The drawbacks associated with surgical treatment methods for trochanteric fractures also apply to the Gamma nail. Nevertheless, one of its primary advantages is the possibility of using a closed procedure. When compared to Ender nailing, knee pain is absent and weight-bearing can be achieved in all patients, no matter the fracture type. Copyright © 2014. Published by Elsevier Masson SAS.
Bajpai, Jeetendra; Maheshwari, Rajesh; Bajpai, Akansha; Saini, Sumit
To compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN. The study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2&31A3, between June 2008 to August 2011. Inclusion criteria were: all mature skeletons above 50 years of age; closed unstable trochanteric fracture classified as AO 31A2&A3. Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk inde- pendently prior to injury. Patients were randomized to 2 treatment groups based on admission sequence. Forty patients were treated with screw PFN and thirty seven were treated with helical PFN. Both groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization. In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening>1 cm buttrochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small. It is an implant of choice for osteoporotic and unstable trochanteric fractures.
Full Text Available Introduction: Delayed Onset Muscle Soreness (DOMS is a common strain resulting during therapeutic exercise with eccentric contractions. This pain can result in loss of interest by the patient and eventually in cancellation of the routine. The purpose of the present study was to determine whether vibration could have an affect on delayed onset muscle soreness. We hypothesized that the vibration training would decrease DOMS. Methods: Subjects comprised of 30 male athletes aged 18-26 years. The athletes were involved in regular sports activities since at least three years. Subjects were assigned randomly into two VT (n=15 and Non-VT (n=15 groups. The measurements included the flexed knee angle (FANG, pressure pain threshold (PPT, muscle soreness (SOR of right quadriceps muscle and maximal isometric force (MIF of both quadriceps muscles together (Base-line. A vibrator was used to apply 50 Hz vibration on the left and right quadriceps muscles for 1 min in the VT group. Then both groups trained eccentric exercise. All parameters were determined again 24 hours post-exercise (After- activity. Results: All subjects showed a loss in MIF, decrease in PPT, FANG and increase in SOR 24h after eccentric exercise (p=0/000. But the parameters were statistically significantly different in the VT and Non-VT groups [MIF (p=0/000, PPT (p=0/001, FANG (p=0/02, SOR (p=0/003]. Conclusion: Therapeutic exercise with eccentric contractions results in DOMS, but vibration training before exercise is effective and beneficial in decreasing DOMS.
Kathleen M. Kollitz, BS
Full Text Available Migrating orthopedic hardware has widely been reported in the literature. Most reported cases of migrating hardware involve smooth Kirschner wires or loosening/fracture of hardware involved with joint stabilization/fixation. It is unusual for hardware to migrate within the soft tissues. In some cases, smooth Kirschner wires have migrated within the thoracic cage—a proposed mechanism for this phenomenon is the negative intrathoracic pressure. While wires have also been reported to gain access to circulation, transporting them over larger distances, the majority of broken or retained wires remain local. We report a case of a 34-year-old man in whom numerous fragments of braided cable migrated from the hip to the knee.
Longo, Victor; Jacobson, Jon A; Fessell, David P; Mautner, Kenneth
The purpose of this series was to retrospectively characterize the ultrasound findings of delayed-onset muscle soreness (DOMS). The Institutional Review Board approved our study, and informed consent was waived. A retrospective search of radiology reports using the key phrase "delayed-onset muscle soreness" and key word "DOMS" from 2001 to 2015 and teaching files was completed to identify cases. The sonograms were reviewed by 3 fellowship-trained musculoskeletal radiologists by consensus. Sonograms were retrospectively characterized with respect to echogenicity (hypoechoic, isoechoic, or hyperechoic), distribution of muscle involvement, and intramuscular pattern (focal versus diffuse and well defined versus poorly defined). Images were also reviewed for muscle enlargement, fluid collection, muscle fiber disruption, and increased flow on color or power Doppler imaging. There were a total of 6 patients identified (5 male and 1 female). The average age was 22 years (range, 7-44 years). Of the 6 patients, there were a total of 11 affected muscles in 7 extremities (1 bilateral case). The involved muscles were in the upper extremity: triceps brachii in 27% (3 of 11), biceps brachii in 18% (2 of 11), brachialis in 18% (2 of 11), brachioradialis in 18% (2 of 11), infraspinatus in 9% (1 of 11), and deltoid in 9% (1 of 11). On ultrasound imaging, the abnormal muscle was hyperechoic in 100% (11 of 11), well defined in 73% (8 of 11), poorly defined in 27% (3 of 11), diffuse in 73% (8 of 11), and focal in 27% (3 of 11). Increased muscle size was found in 82% (9 of 11) and minimal hyperemia in 87.5% (7 of 8). The ultrasound findings of DOMS include hyperechoic involvement of an upper extremity muscle, most commonly appearing well defined and diffuse with increased muscle size and minimal hyperemia. © 2016 by the American Institute of Ultrasound in Medicine.
Steffann, Francois; Prudhon, Jean-Louis; Puch, Jean-Marc; Ferreira, André; Descamps, Loys; Verdier, Régis; Caton, Jacques
Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy), using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF) are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%-23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA) to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior) requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC), greater trochanter (GT) reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus) is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci approach could be use
Souza-Silva, E; Christensen, S W; Hirata, R P; Larsen, R G; Graven-Nielsen, T
Delayed onset muscle soreness (DOMS) occurs within 1-2 days after eccentric exercise, but the mechanism mediating hypersensitivity is unclear. This study hypothesized that eccentric exercise reduces the blood flow response following muscle contractions and cuff occlusion, which may result in accumulated algesic substances being a part of the sensitization in DOMS. Twelve healthy subjects (five women) performed dorsiflexion exercise (five sets of 10 repeated eccentric contractions) in one leg, while the contralateral leg was the control. The maximal voluntary contraction (MVC) of the tibialis anterior muscle was recorded. Blood flow was assessed by ultrasound Doppler on the anterior tibialis artery (ATA) and within the anterior tibialis muscle tissue before and immediately after 1-second MVC, 5-seconds MVC, and 5-minutes thigh cuff occlusion. Pressure pain thresholds (PPTs) were recorded on the tibialis anterior muscle. All measures were done bilaterally at day 0 (pre-exercise), day 2, and day 6 (post-exercise). Subjects scored the muscle soreness on a Likert scale for 6 days. Eccentric exercise increased Likert scores at day 1 and day 2 compared with day 0 (Pcontraction/occlusion blood flow (~16%, Peccentric contractions decreased vessel diameter, impaired the blood flow response, and promoted hyperalgesia. Thus, the results suggest that the blood flow reduction may be involved in the increased pain response after eccentric exercise. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Zhu, Chao-Jun; Zhang, Zhao-Hui; Ma, Jing; Li, Pin-Chuan; Liu, Xian-Zhou; Yin, Yue; Tian, Ying
To explore the fumigation and moxibustion therapy in treatment of ulcer and sore of yin syndrome. The fumigation and moxibustion therapy is the combination of fumigation and moxibustion, in which, smoking fumigation is provided with warming effect and the actions as moxibustion. This therapy works on the efficacy of both fumigation and moxibustion. In treatment, different herbal medicines can be selected flexibly, acting on dispersing yin and rescuing yang. The fumigation and moxibustion therapy can drain toxin and remove ulcer and sore. It contributes to the treatment of boils and chronic sores of yin syndrome and promotes wound healing.
Василь Михайлович Шимон
Full Text Available The method of interval hypoxic training (IHT is used to increase physical endurance of athletes and for treatment of certain systemic diseases, due to the ability of IHT affect metabolism, homeostasis and the immune system. The aims of the article are improving the results of treatment and rehabilitation of patients with fractures of the trochanteric area of the femur by the method of interval hypoxic training and study its influence on bone metabolism.Materials and methods. 17 patients who were hospitalized in the clinic of general surgery UzhNU with fractures of the trochanteric area of the femur are examined in the period from 2012 to 2015.The first group consisted of 6 patients who from day-patient treatment is conducted IHT by gas mixture of 12 % oxygen. The second group consisted of 4 patients with thyrotoxicosis who are also receiving IHT by gas mixture of 12% oxygen.The control group consisted of 7 patients with fractures of the trochanteric area of the femur who refused from IHT.Results and its discussion. The best physical activity is observed in the first group. Starting physical activity is the lowest in the second group, but its development is faster. Slowly increase the duration of physical activity compared with the first two groups is observed in the control group.In the control study after 1 month it is noted that calcium level increased in all three groups. Increase in the second group is biggest. The level of phosphorus decreased in the first and the control group and increased in the second group.The levels of osteocalcin and alkaline phosphatase increased. Rates were higher and increase was substantial in the first two groups in comparison with the control group.Conclusions.• Intensive growth of length of one-time physical activity most notably in patients with thyrotoxicosis is observed in patients who are receiving IHT.• Improvement of the activity of bone metabolism is observed in patients after IHT
Gazzotti, Gabriele; Matino, Giovanni; Tsatsis, Christos; Sacchetti, GianLuigi; Baudi, Paolo; Catani, Fabio
Background. Superior cut-out of a lag screw remains a serious complication in the treatment of trochanteric or subtrochanteric fractures and it is related to many factors: the type of fracture, osteoporosis and the stability of fracture reduction. Little is known about the outcome after revision surgery for complications of the gamma nail. We assessed the outcome in patients who had revision surgery because of lag screw's cut out after gamma nailing for a trochanteric fracture.Material and Method. We present a study of 20 consecutive patients who underwent treatment after 20 cut-out of the lag screw ﬁxation of a trochanteric fracture with Gamma Locking Nail from September 2004 to November 2010. In 16 patients hip prothesis was performed, in 1 the removal of the implant and in 3 the reosteosynthesis. We reviewed 13 patients: 10 total hip arthroplasty, 2 endoprothesis and 1 reosteosynthesis of nail and lag screw (mean follow up: 26 months, mean age: 73 years old), 7 patients died. Patients were reviewed retrospectively by an independent observer. Clinical evaluation was performed, Oxford score and Harris Hip score were measured. X-Ray examination was performed after a minimum of 12 months of follow up.Results. Mean Harris Hip Score mean was 67 and mean Oxford score was 32 in hip prothesis group (12 patients). We had several complications, Implant-related complications were: 2 ipometria > 2cm, 2 recurrent hip arthroplasty dislocations (1 reoperated), 4 persistent thigh pain. In only 4 patients none complications were observed. Another patient, who had been subjected to reosteosinthesis, obtained better results (HHS:95, Oxford score:45) but with a 2 cm ipometria and occasional pain in the thigh.Conclusion. Cut out after gamma nail is consequent to biological or mechanical causes. Treatment of this complication is hip prosthesis (parzial or total hip arthroplasty), reosteosynthesis of the lag screw and/or the nail and the removal of the implant. Conversion to total
Full Text Available INTRODUCTION : Unstable inter - trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut - out of the lag screw, are the common problems of attempts to fix these fractures. Pr esent study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty and trochanter reconstruction in these patients. MATERIALS AND METHOD S : This prospective study included 30 cases of elderly osteoporotic patients with mean age of 65.4 years who sustained comminuted inter - trochanteric femur fracture treated with cemented bipolar hemiarthroplasty& tension band wiring for greater trochanter rec onstruction. It is an essential technical step to avoid complication like abductor lurch gait. W e here describe a technique of reconstruction and fixation of greater trochanter using tension band wiring in figure of eight pattern. The patients were followe d up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS. RESULTS : The mean HHS score was was 85.6+SD 9.5 (range from 74 to 96. B y the end of one year. The main clinical measures were early post - opera tive full weight bearing, post - operative complication & functional outcome. The time to full weight bearing, the rate of post - operative complications & functional outcome was significantly better in cemented bipolar arthroplasty group . DISCUSSION : The chan ges in HHS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. The purpose of its use was that while Harris Hip Score (HHS provides information on a multitude of factors. Superficial infection in 2 patients, anterior thigh pain in a patient, shortening less than 2cms in 2 patients, abductor lurch in a patient are the complications noted in post - operative period, but no patient required
Puram, Chetan; Pradhan, Chetan; Patil, Atul; Sodhai, Vivek; Sancheti, Parag; Shyam, Ashok
Posteromedial and greater trochanteric fragments are a major cause of telescoping and medialization of the femoral shaft in an unstable intertrochanteric fracture. This leads to significant limb shortening, fracture collapse in varus position and implant failure, which can be prevented by trochanteric wiring in addition to dynamic hip screw (DHS) fixation. The purpose of our study is to assess the outcomes of DHS augmented with trochanteric wiring in unstable type A2 intertrochanteric fractures. One hundred and two retrospective cases of unstable intertrochanteric fractures treated with DHS between January 2010 and December 2015 with a minimum follow-up period of 12 months were reviewed. Out of 102 cases, 28 were treated with DHS and derotation screw alone (Group A), while in rest 74 cases trochanteric wiring was used as an augmentation to DHS and derotation screw (Group B). Patients were evaluated clinically for range of motion, Harris hip score and Oxford hip score. Radiologically, fracture reduction, change in neck shaft angle and neck length ratio in comparison to opposite hip and union status of greater trochanter were assessed. The mean age of the patients at the time of surgery was 72 years (range 23-94 years) with 48 males and 54 females. The mean follow-up period was 20 months (range 12-48 months). The Harris hip score, Oxford hip score, shortening, attainment of weight bearing and change in neck shaft angle was not significantly different between the two groups (all p values >0.05). Incidence of greater trochanter nonunion was greater in group A (17.85%) as compared to group B (6.75%). We found significant association between occurrence of limp with varus change in neck shaft angle, decrease in neck length ratio and greater trochanteric non-union (all p values wiring in unstable intertrochanteric fractures gives similar result to group without no wiring, although greater trochanter non-union rate was more in the latter group. Limp can be prevented by
Cullum, N; McInnes, E; Bell-Syer, SE; Legood, R
: Pressure ulcers (also known as bedsores, pressure sores, decubitus ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. : This systematic review seeks to answer the following questions: to what extent do press...
McInnes, E; Bell-Syer, SE; Dumville, JC; Legood, R; Cullum, NA
Background Pressure ulcers (also known as bedsores, pressure sores, decubitus ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. Objectives This systematic review seeks to answer the following questions: (1) t...
Xie, Yanfei; Feng, Beibei; Chen, Kedi; Andersen, Lars L; Page, Phil; Wang, Yuling
To evaluate the efficacy of dynamic contract-relax stretching on delayed-onset muscle soreness (DOMS) in the calf muscle of healthy individuals. Randomized clinical trial. Research laboratory. Three groups of 16 healthy participants (n = 48) were recruited by convenience sampling. Three sets of resisted bilateral heel-raising exercises until exhaustion were conducted to initiate DOMS. Participants were randomly allocated into control group without any interventions, dynamic contract-relax stretching (DS), or static stretching (SS) groups. Dynamic contract-relax stretching and SS groups performed DS and SS, respectively, on the dominant leg twice a day for 5 consecutive days (before time points of outcome measurements at 24, 48, 72, 96, and 120 hours postexercise, respectively). Muscle soreness, lower leg girth, pressure pain threshold (PPT), range of motion (ROM), and muscle strength were measured before exercise, immediately after, and at 24, 48, 72, 96, and 120 hours postexercise. There was a significant effect of time in all outcome measures including muscle soreness, lower leg girth, PPT, ROM, and muscle strength; however, there were no significant group differences or group by time interactions. The effect of DS on relieving DOMS in the calf muscle is insignificant in this study. Further evidence is needed to prove the efficacy of DS on DOMS. Stretching is commonly recommended before and after exercise; however, this study showed no significant impact of DS or SS in treating DOMS.
Herrlin, K.; Stroemberg, T.; Lidgren, L.; Walloee, A.; Pettersson, H.
Four hundred and thirty trochanteric factures operated upon with McLaughlin, Ender or Richard's osteosynthesis were divided into 6 different types based on their radiographic appearance before and immediately after reposition with special reference to the medial cortical support. A significant correlation was found between the fracture type and subsequent mechanical complications where types 1 and 2 gave less, and types 4 and 5 more complications. A comparison of the various osteosyntheses showed that Richard's had significantly fewer complications than either the Ender or McLaughlin types. For Richard's osteosynthesis alone no correlation to fracture type could be made because of the small number of complications in this group.
Barquet, Antonio; Giannoudis, Peter V; Gelink, Andrés
Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of FNFARIHTF and series of TF with cases of FNFARIHTF due to pain or discomfort published between inception of journals to December 2016 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of FNFARIHTF, with the objective of establishing the eventual risk factors, mechanisms and pathoanatomy, clinical presentation and diagnosis, treatment and prevention. Part II analyzed series of TF which included cases of FNFARIHTF for assessing the incidence of femoral neck fractures in this condition. Overall 24 publications with 45 cases of FNFARIHTF met the inclusion criteria. We found that the only prevalent factors for FNFARIHTF were: 1) preexisisting systemic osteoporosis, as most patients were older and elder females, with lower bone mineral density and bone mass; 2) local osteoporosis as a result of preloading by the fixation device in the femoral neck, leading to stress protection, reducing the strain at the neck, and increasing bone loss and weakness; and 3) the removal of hardware from the femoral neck, with reduction of the failure strength of the neck. The femoral neck fractures were spontaneous, i.e. not related to trauma or
Torres, Ana; Fernández-Fairen, Mariano; Sueiro-Fernández, José
Greater trochanteric pain syndrome (GTPS) affects 10-25% of people in developed countries. The underlying etiology for GTPS is most commonly the tendinosis or a tendon tear of the gluteus medius, minimus or both at the greater trochanter; the inflammation of the tendon is not a major feature. We critically evaluated conservative treatment, for which we reviewed 76 publications, grading them according to four levels of evidence. We identified a wide variety of conservative treatment options: home therapy (insoles, walking sticks/crutches, orthotic devices, stretching exercises and preventive measures); physiotherapy (massage and stretching exercises); infiltrations (corticosteroids and local anesthetics); image-guided infiltrations (fluoroscopy and ultrasound); shockwave therapy; platelet-rich plasma injection; and drug therapy. Severe complications associated with infiltrations are extremely rare, as are those associated with shockwave therapy. The most effective treatments were infiltrations with corticosteroids and shockwave therapy. We propose a graded treatment schedule for patients with GTPS.
Brown, Dick; Chevalier, Gaétan; Hill, Michael
The purpose of this pilot study was to determine whether there are markers that can be used to study the effects of grounding on delayed-onset muscle soreness (DOMS). Eight (8) healthy subjects were exposed to an eccentric exercise that caused DOMS in gastrocnemius muscles of both legs. Four (4) subjects were grounded with electrode patches and patented conductive sheets connected to the earth. Four (4) control subjects were treated identically, except that the grounding systems were not connected to the earth. Complete blood counts, blood chemistry, enzyme chemistry, serum and saliva cortisols, magnetic resonance imaging and spectroscopy and pain levels were taken at the same time of day before the eccentric exercise and 24, 48, and 72 hours afterwards. Parameters consistently differing by 10% or more, normalized to baseline, were considered worthy of further study. Parameters that differed by these criteria included white blood cell counts, bilirubin, creatine kinase, phosphocreatine/inorganic phosphate ratios, glycerolphosphorylcholine, phosphorylcholine, the visual analogue pain scale, and pressure measurements on the right gastrocnemius. In a pilot study, grounding the body to the earth alters measures of immune system activity and pain. Since this is the first intervention that appears to speed recovery from DOMS, the pilot provides a basis for a larger study.
Bucci, R; Lobbezoo, F; Michelotti, A; Orfanou, C; Koutris, M
Masticatory muscle-pain patients often complain about sensorimotor changes, but the effects of pain on the psychophysical properties remain unclear. This study aimed to investigate the effects of delayed-onset muscle soreness (DOMS) on the jaw's position sense (PS) and occlusal sensitivity (OS). In all, 12 participants underwent intense concentric-eccentric jaw exercises. Self-reported muscle fatigue and pain, pain-free maximum mouth opening (MMO), pain pressure thresholds (PPTs) at right and left masseter and right and left anterior temporalis, maximum voluntary bite force (MVBF), PS and OS were recorded before, immediately after, 24 h, 48 h and 1 week after the exercises. Data were analysed with repeated measures anova. Pain and fatigue increased significantly after the exercises, while fatigue also increased 24 h afterwards. Time and site had a significant effect for PPTs, not for MVBF. MMO decreased significantly 24 h after the exercises. OS and PS did not change significantly. Experimentally induced DOMS does not influence the psychophysical properties of the masticatory system. © 2017 John Wiley & Sons Ltd.
Vermesan, D; Prejbeanu, R; Poenaru, D V; Petrescu, H; Apostol, E; Inchingolo, F; Dipalma, G; Abbinante, A; Caprio, M; Potenza, M A; Cagiano, R; Malcangi, G; Inchingolo, A D; Haragus, H
There is currently no consensus regarding superiority of the intramedullary fixation over the sliding hip screw. Regional variation remains high and not backed up by solid evidence. Given these premises we aimed to analyze weather implant preference can influence the postoperative survival. Secondary objectives were determining the trend for implant choice and confounding factors associated with intramedullary nails compared to sliding hip screws. Retrospective data was obtained from patient charts with the main diagnosis of extracapsular/ trochanteric fractures, corresponding to ICD S72.1 codes. Between 2008-2012, 441 patients underwent osteosynthesis with a dynamic hip screw and 155 with intramedullary nail respectively. The living status was determined by comparing the patient identification number against the national population evidence records. The lifetable shows similar survival for both implants over the 5 year period. The yearly mortality was 19.4% for the dynamic hip screw and 21.8% for the intramedullary implant respectively, even though the later were used predominantly in older patients. This age difference is significant according to both parametric and non-parametric tests whereas duration of hospital stay are similar. We found a clear increase in the proportion of intramedullary implants, for a total of 11.2% over the 5 year period. There is no difference for the one year mortality and overall survival between sliding screw plates and intramedullary constructs. A clear increase in the use of intramedullary implants for trochanteric fractures was observed. This is even more apparent for older ages, presumably due to an higher surgeon confidence with the biomechanical stability of the intramedullary constructs.
Full Text Available BACKGROUND Intertrochanteric fracture is one of the most common fracture of the hip especially in the elderly. The incidence of intertrochanteric fracture is rising because of the increase in number of elderly population along with superadded osteoporosis. MATERIALS AND METHODS Study included cases of unstable intertrochanteric fractures (AO and OTA Classification 31-A2 and 31-A3 fracture patterns that were operated with the short trochanteric femoral nail, which fitted into the inclusion criteria done in medical college hospital, Vijayanagara Institute of Medical Sciences, Bellary, from February 2015 to September 2016. RESULTS The age distribution was from 40 to 80 years. The largest group of patients were from 61 to 70 years. The average age was 60.5 years. The number of male patients in our series was 20 (66.7% and female was 10 (33.3%. Right side was affected in 11 cases (36.7% and left side in 19 cases (63.3%. Good reduction was achieved in 23 patients (76.7%. Acceptable reduction was achieved in 7 (23.3% patients due to severe comminution. In our study, 25 patients (83.33% had no complications. We encountered one intraoperative complication in the form of greater trochanter splintering, while inserting the nail. In our study, we encountered following postoperative complications. We noticed one case of delayed union, one case of Z effect and 2 cases of varus malunion. CONCLUSION We conclude that short trochanteric femoral nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed leading to high rate of bone union and minimal soft tissue damage especially for Asian patients with relatively small femora.
Konstantinidis, L; Papaioannou, C; Blanke, P; Hirschmüller, A; Südkamp, N P; Helwig, P
The aim of this study is to identify osteoporosis values, beyond which there is a high risk of osteosynthesis failure. Bone mineral density (BMD) of 30 cadaveric femora with a pertrochanteric fracture osteotomy was correlated to the risk of cut out after osteosynthesis on a biomechanical testing approach. For a BMD less than 250 mg/cm(3), there is a high risk of fixation failure after surgical treatment of pertrochanteric fractures. This value can be regarded as a reference value for future experimental and clinical studies. Despite continuous modification of intramedullary load carriers for the surgical stabilization of trochanteric fractures, cut out remains the most frequent complication. The aim of this experimental study was to identify threshold osteoporosis values, beyond which there is a high risk of osteosynthesis failure. Bone mineral density (BMD) of 30 cadaveric femora was recorded for the femoral head by QCT measurement. Subsequently, a standardized osteotomy mimicking an unstable trochanteric type fracture was stabilized by intramedullary nailing. The constructs were loaded axially at a force of 2,100 N up to 20,000 cycles. Cut out at the femoral head was documented by radiograph. Statistical evaluation of the cohort group was performed by calculation of relative risk in relation to the BMD values. In total, there were six cases of cut out after 10,000 cycles. The incidence of cut out for BMD less than 250 mg/cm(3) was 0.55 (5 of 9) and for BMD greater than 250 mg/cm(3), it was 0.05 (1 of 21). Therefore, the relative risk of cut out for BMD 250 mg/cm(3). After 20,000 cycles, an additional test caused one cut out (relative risk of cut out for a BMD fractures. Although this value is based on an experimental in vitro study design with all its associated limitations, it can be regarded as a reference value for future experimental and clinical studies.
Neuerburg, C; Mehaffey, S; Gosch, M; Böcker, W; Blauth, M; Kammerlander, C
Use of standardized cement augmentation of the proximal femur nail antirotation (PFNA) for the treatment of trochanteric fragility fractures, which are associated with high morbidity and mortality, to achieve safer conditions for immediate full weight-bearing and mobilization, thus, improving preservation of function and independency of orthogeriatric patients. Trochanteric fragility fractures (type 31-A1-3). Ipsilateral arthritis of the hip, leakage of contrast agent into the hip joint, femoral neck fractures. Reduction of the fracture on a fracture table if possible, or minimally invasive open reduction of the proximal femur, i. e., using collinear forceps if necessary. Positioning of guidewires for adjustment of the PFNA and the spiral blade, respectively. Exclusion of leakage of contrast agent and subsequent injection of TRAUMACEM™ V(+) into the femoral head-neck fragment via a trauma needle kit introduced into the spiral blade. Dynamic or static locking of the PFNA at the diaphyseal level. Immediate mobilization of the patients with full weight-bearing and secondary prevention, such as osteoporosis management is necessary to avoid further fractures in the treatment of these patients. A total of 110 patients older than 65 years underwent the procedure. Of the 72 patients available for follow-up (average age 85.3 years), all fractures healed after an average of 15.3 months. No complications related with cement augmentation were observed. Approximately 60 % of patients achieved the mobility level prior to trauma.
Amputation and diabetes: How to protect your feet Good diabetes management and regular foot care help prevent severe foot sores that ... and may require amputation. By Mayo Clinic Staff Diabetes complications can include nerve damage and poor blood ...
Full Text Available biological regeneration in athletes. The aim of this study was to evaluate the effectiveness of the application of lymphatic kinesiotaping in reducing delayed onset muscle soreness of biceps brachii.
Full Text Available Postoperative sore throat (POST is a common complication of anaesthesia with endotracheal tube that affects patient satisfaction after surgery. Therefore, this complication remains to be resolved in patients undergoing endotra-cheal intubation. The aim of the study was to compare the effectiveness of ketamine gargles with placebo in prevent-ing POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anaesthesia were randomized into: Group C, water 30 ml; Group K, ketamine 50 mg in water 29 ml. Patients were asked to gargle this mixture for 40 seconds, 5 minutes before induction of anaesthesia. POST was graded at 4, 8 and 24 hours after operation on a four-point scale (0-3. In the Control group POST occurred more frequently, when compared with patients belonging to Ketamine group, at 4, 8, and 24 hours and significantly more patients suffered severe POST in Control group at 8 and 24 hours compared with Ketamine group (P< 0.05. We demonstrated that gargling with ketamine significantly attenuated POST, with no drug-related side effects were observed.
Mizumura, Kazue; Taguchi, Toru
Delayed-onset muscle soreness (DOMS) is quite a common consequence of unaccustomed strenuous exercise, especially exercise containing eccentric contraction (lengthening contraction, LC). Its typical sign is mechanical hyperalgesia (tenderness and movement related pain). Its cause has been commonly believed to be micro-damage of the muscle and subsequent inflammation. Here we present a brief historical overview of the damage-inflammation theory followed by a discussion of our new findings. Different from previous observations, we have observed mechanical hyperalgesia in rats 1-3 days after LC without any apparent microscopic damage of the muscle or signs of inflammation. With our model we have found that two pathways are involved in inducing mechanical hyperalgesia after LC: activation of the B2 bradykinin receptor-nerve growth factor (NGF) pathway and activation of the COX-2-glial cell line-derived neurotrophic factor (GDNF) pathway. These neurotrophic factors were produced by muscle fibers and/or satellite cells. This means that muscle fiber damage is not essential, although it is sufficient, for induction of DOMS, instead, NGF and GDNF produced by muscle fibers/satellite cells play crucial roles in DOMS.
Song, Hyung Keun; Yoon, Han Kuk; Yang, Kyu Hyun
Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking. We observed 95 patients (mean age, 75±2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography. Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, pfracture type (pfracture.
Ammar, Achraf; Turki, Mouna; Chtourou, Hamdi; Hammouda, Omar; Trabelsi, Khaled; Kallel, Choumous; Abdelkarim, Osama; Hoekelmann, Anita; Bouaziz, Mohamed; Ayadi, Fatma; Driss, Tarak; Souissi, Nizar
The aim of this study was to investigate the effect of natural Pomegranate juice supplementation on performance and acute and delayed responses of muscle soreness and biomarkers of muscle damage after a weightlifting training session. Nine elite weightlifters (21±0.5 years) performed two Olympic-Weightlifting-sessions after either placebo (PLA) or natural pomegranate juice (POMj) supplementations. Heart rate, blood pressure and blood samples (hematological parameters, muscle damage and C-reactive protein (CRP)) were collected at rest, 3min and 48h after each session. Weightlifting performance, RPE, and DOMS were also assessed after each training session. T-test showed higher performance (+8.30%) and lower RPE values (-4.37%) using POMj supplementation (p0.05). Additionally, during the 48h following the training session, POMj improved the recovery kinetic of SBP (pweightlifters are advised to use natural POMj during intensive training program and competition to accelerate muscle recovery. ClinicalTrials.gov NCT02697903.
Gursimrat Singh Cheema
Results: The bending moment of the PFN group was approximately 50% less than that of the DCS group (P<0.0001. The PFN group resisted more number of cycles than the DCS group (P=0.03 and showed lesser number of component failures as compared with the DCS group (P=0.003. Conclusions: The PFN is biomechanically superior to DCS for the fixation of reverse oblique trochanteric fractures of femur.
Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.
Ikegami, Shota; Kamimura, Mikio; Nakagawa, Hiroyuki; Takahara, Kenji; Hashidate, Hiroyuki; Uchiyama, Shigeharu; Kato, Hiroyuki
Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.
Dossa, J; Bonnel, F; Micallef, J P
The authors describe the Ender's technique in the treatment of fractures of the trochanteric region. They realise a blind nailing, introducing "elastic" nails in the region of the medial condyle, under Xray control. The authors have conducted a biomechanical study comparing this type of nailing with nail-plating (extensometry and mathematical theory). 51 patients were operated-on. The results are analysed. The authors point out that the surgical procedure is very fast and simple, therefore they support it for aged people.
Horii, Motoyuki; Fujiwara, Hiroyoshi; Mikami, Yasuo; Ikeda, Takumi; Ueshima, Keiichiro; Ikoma, Kazuya; Shirai, Toshiharu; Nagae, Masateru; Oka, Yoshinobu; Sawada, Koshiro; Kuriyama, Nagato; Kubo, Toshikazu
Summary Background The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period. Methods Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain. Results There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had “uncertain” as the cause of injury than trochanteric fracture in all age groups. Conclusions Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures. PMID:27252738
Horii, Motoyuki; Fujiwara, Hiroyoshi; Mikami, Yasuo; Ikeda, Takumi; Ueshima, Keiichiro; Ikoma, Kazuya; Shirai, Toshiharu; Nagae, Masateru; Oka, Yoshinobu; Sawada, Koshiro; Kuriyama, Nagato; Kubo, Toshikazu
The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period. Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain. There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had "uncertain" as the cause of injury than trochanteric fracture in all age groups. Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures.
Lee, Joong-Myung; Cho, Yongsuk; Kim, Junhyun; Kim, Dong-Won
Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation. From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability. Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases). Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.
Kumar, M; Akshat, V; Kanwariya, A; Gandhi, M
Introduction: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN). Materials and Methods: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. Results: Average duration of union was 17.08 weeks (range 13 to 32 weeks), union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. Conclusion: The long PFN is a reliable implant for subtrochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.
... hip bursitis, including: Rheumatoid arthritis Gout Pseudogout Diabetes Thyroid disease Bursitis is more common in older adults. Being out of shape or overweight may put you at greater risk for hip bursitis. Symptoms Common symptoms include: Pain at the side of ...
Martín-Pintado Zugasti, Aitor; Rodríguez-Fernández, Ángel L; García-Muro, Francisco; López-López, Almudena; Mayoral, Orlando; Mesa-Jiménez, Juan; Fernández-Carnero, Josue
To investigate (1) the effect of spray and stretch versus control on reducing postneedling soreness of 1 latent myofascial trigger point (MTrP) and (2) whether higher levels of psychological distress are associated with increased postneedling pain intensity. A 72-hour follow-up, single-blind randomized controlled trial. University community. Healthy volunteers (N=70; 40 men, 30 women) aged 18 to 36 years (mean age, 21±4y) with latent MTrP in 1 upper trapezius muscle. All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into 2 groups: an intervention group, which received spray and stretch over the needled trapezius muscle, and a control group, which did not receive any intervention. Visual analog scale (at postneedling, posttreatment, and 6, 12, 24, 48, and 72h after needling), pressure pain threshold (at preneedling, postneedling, and 24 and 48h after needling). Psychological distress was evaluated by using the Symptom Checklist-90-Revised. Repeated-measures analysis of variance demonstrated a significant interaction between group and time (F3,204.8=3.19; P.05). Repeated measures of covariance showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity, and hostility were significantly correlated (P<.05) with postneedling pain intensity. Repeated-measures analysis of variance did not show a significant effect of spray and stretch on mechanical hyperalgesia (F2.6,175=1.9; P=.131; ηp(2)=.02). The spray and stretch had a short-term (<6h) effect in reducing postneedling soreness of a latent MTrP. Pressure pain threshold did not significantly change after spray and stretch. Psychological factors are related to postneedling pain. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Nicol, Lesley M; Rowlands, David S; Fazakerly, Ruth; Kellett, John
Oral curcumin decreases inflammatory cytokines and increases muscle regeneration in mice. To determine effects of curcumin on muscle damage, inflammation and delayed onset muscle soreness (DOMS) in humans. Seventeen men completed a double-blind randomized-controlled crossover trial to estimate the effects of oral curcumin supplementation (2.5 g twice daily) versus placebo on single-leg jump performance and DOMS following unaccustomed heavy eccentric exercise. Curcumin or placebo was taken 2 d before to 3 d after eccentric single-leg press exercise, separated by 14-d washout. Measurements were made at baseline, and 0, 24 and 48-h post-exercise comprising: (a) limb pain (1-10 cm visual analogue scale; VAS), (b) muscle swelling, (c) single-leg jump height, and (d) serum markers of muscle damage and inflammation. Standardized magnitude-based inference was used to define outcomes. At 24 and 48-h post-exercise, curcumin caused moderate-large reductions in pain during single-leg squat (VAS scale -1.4 to -1.7; 90 %CL: ±1.0), gluteal stretch (-1.0 to -1.9; ±0.9), squat jump (-1.5 to -1.1; ± 1.2) and small reductions in creatine kinase activity (-22-29 %; ±21-22 %). Associated with the pain reduction was a small increase in single-leg jump performance (15 %; 90 %CL ± 12 %). Curcumin increased interleukin-6 concentrations at 0-h (31 %; ±29 %) and 48-h (32 %; ±29 %) relative to baseline, but decreased IL-6 at 24-h relative to post-exercise (-20 %; ±18 %). Oral curcumin likely reduces pain associated with DOMS with some evidence for enhanced recovery of muscle performance. Further study is required on mechanisms and translational effects on sport or vocational performance.
Background Objective: To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice. Design: Validation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'. Setting: A solo family practice in rural New South Wales, Australia Participants: Patients attending with sore throat. Methods Patients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (> 16 yrs) were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5 yr to scorecard to differentiate between bacterial and non-bacterial sore throat. 2. Patients' trust in the scorecard. Results The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity. There was a high level of patient trust in the scorecard was (85.8% agreement). Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement). Conclusions As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection. PMID:20670439
Bakare, Tony Mo; Schattner, Peter
To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice. Validation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'. A solo family practice in rural New South Wales, AustraliaParticipants: Patients attending with sore throat. Patients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (> 16 yrs) were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5 yr to scorecard to differentiate between bacterial and non-bacterial sore throat.2. Patients' trust in the scorecard. The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity.There was a high level of patient trust in the scorecard was (85.8% agreement). Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement). As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection.
Hoare, Karen J; Ward, Erin; Arroll, Bruce
AIM To examine national and international guidelines on sore throat management and subsequently, to explore the phenomenon of international medical graduates working in general and rural practice in New Zealand. METHOD Two separate systematic reviews were conducted that resulted in a contingent methodology. Contingent methodologies involve syntheses of data that are derived sequentially. The initial review for this study examined international sore throat guidelines and their key points. The results of this initial review resulted in the theory that international medical graduates may be unaware of the New Zealand specific sore throat guidelines and the problem of acute rheumatic fever in this country. The subsequent review examined the phenomenon of international medical graduates working in general or rural practice in New Zealand. Data sources were Medline, Google Scholar, Trip Database, and NHS Evidence, Embase and Scopus. Electronic databases were searched for relevant data published January 2000-December 2013. Additional hand searches found key references from articles and websites. RESULTS International guidelines for the management of sore throats differ from New Zealand guidelines. Of resource rich countries, New Zealand has the second highest number of international medical graduates: they may not use New Zealand specific sore throat guidelines. DISCUSSION Acute rheumatic fever is virtually eradicated in most resource rich countries. Rheumatic fever rates of among indigenous Māori and Pacifika people in New Zealand have failed to reduce over the last three decades. Knowledge and actions of international medical graduates in relation to sore throat management needs investigating. KEYWORDS Sore throats; acute rheumatic fever; clinical guidelines; international medical graduates; mixed methods review.
Bakare Tony MO
Full Text Available Abstract Background Objective: To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice. Design: Validation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'. Setting: A solo family practice in rural New South Wales, Australia Participants: Patients attending with sore throat. Methods Patients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (> 16 yrs were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5 yr to Main outcome measures: 1. Ability of a new scorecard to differentiate between bacterial and non-bacterial sore throat. 2. Patients' trust in the scorecard. Results The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity. There was a high level of patient trust in the scorecard was (85.8% agreement. Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement. Conclusions As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection.
Pandu Ranga Vital
Full Text Available INTRODUCTION : To avoid the complications and morbidity associated with attempted Osteosynthesis of the so called Unstable inter - trochanteric fractures in the elderly population, Primary Cemented Bipolar hemiarthroplasty been around for over three decades now. But, hardly any emphasis been given over the technical aspects to i mprove the functional outcome. Present study is one such, following reconstructive attempts ( O f primary cemented bipolar hemiarthroplasty with trochanter and calcar reconstruction in the elderly population to reduce the risk of unstable Hemiarthroplasty. MATERIALS AND METHODS: This prospective study included 20 cases of elderly patients with mean age of 73.5 years (Age range 66 to 82 yr who sustained multifragmentary/communited inter - trochanteric femur fracture treated with Primary cemented bipolar hemiar throplasty with trochanteric and calcar reconstruction to emphasize the importance of restoration soft tissue tension to reduce the risk of unstable Hemiarthroplasty. Essential Technical steps include Figure of eight / multiple wire loop technique of recons truction ( with or without K ‘wires of greater trochanter/ abductor mechanism and calcar reconstruction either by wiring Lesser trochanteric fragment and or insertion of cortical piece of bone graft (medially under the collar of the prosthesis harvested f rom head and neck fragment. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS. RESULTS: The mean HHS score was 85 (range 69 to 91 at the end of one year. The main clini cal measures were early post - operative full weight bearing, post - operative complication & functional outcome. The time to full weight bearing, the rate of post - operative complications & functional outcome was significantly better in cemented bipolar arthro plasty group. CONCLUSION: The authors strongly believe that primary cemented bipolar
Tânia Maria da Silva Mendonça
Full Text Available OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 ± 7.12 years, 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36 at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.
Wheeler, Keane; Kefford, Tamara; Mosler, Andrea; Lebedew, Alexis; Lyons, Keith
Examine the association between measures shoulder soreness and the goal shooting volume in high performance women's water polo. Seven national level female water polo players were monitored across two training camps (squad selection and team game-based). Performance analysis coded all shots for each athlete during the training camps and the shoulder soreness information was gathered through an athlete self-rating survey. Residual maximal likelihood analysis was used to predict shoulder soreness. It was shown that 74% (p=0.013) of shoulder soreness was explained by the volume of goal shooting during training (R(2) 0.743) with greater soreness associated with less rest time between shots (p=0.032). Greater levels of shoulder soreness were reported in the squad selection training camp compared to team game-based camp (p=0.002) with 29% of this shoulder soreness prediction based on individual athlete differences. Shoulder soreness increased with a greater number of shots in conjunction with less rest. Monitoring athletes on an individual basis seemed the most appropriate method of identifying increased shoulder soreness. Copyright © 2012 Sports Medicine Australia. All rights reserved.
Kawatani, Yosuke; Nishida, Kimiaki; Anraku, Yoshihisa; Kunitake, Katsuhiko; Tsutsumi, Yasujiro
The aim of this study was to investigate the outcome of 352 (71 males) patients with trochanteric fractures that were treated with the TARGON® PF nail. The mean age was 83 years. According to the Jensen classification, there were 35 cases in type 1,94 cases in type 2,75 in type 3,63 in type 4 and 85 in type 5. Postoperative all patients were allowed to fully weight bear from the first postoperative day. Clinical and radiological data were collected at regular time intervals. The average waiting time to surgical reconstruction for the 352 cases was 3.5 days (1-7). The mean length of hospital stay was 14 days (5-22). The operative times ranged from 11 to 125 minutes with an average time of 32 minutes. Fifty percent of the patients regained their mobility to their pre-injury level at the final follow up. Out of 310 patients (88%) who were available for radiographie assessment, all fractures united except one case. 300 (85%) of the lag screws were placed in the inferior area in the anteroposterior view and in the central area in the lateral view (IM), which is regarded as the optimal position. The lag screws back-slided between 0 and 19 mms with an average of 6 mm. Sliding distance of the lag screw for over 10 mm was seen in 42 cases (13%). Varus collapse of the femoral head-and-neck greater than 10° was observed in 6 cases. Postoperative complications developed in 6 cases (1.7%), including wound infection in two cases, and secondary fracture at the subtrochanteric region, nonunion, back-out of the guiding sleeve and medial perforation of the lag screw, each in one case. The presented case series indicates that the TARGON® PF system is an effective and safe internal fixation device for trochanteric proximal femoral fractures. Further, prospective comparative evidence regarding the use of this system is needed to analyse and validate the presented clinical impression of our centre. Copyright © 2011 Elsevier Ltd. All rights reserved.
Full Text Available INTRODUCTION Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilisation lands up with many complications and often fatality. Rate of failure with internal fixation has been found to be high, especially in osteoporotic bones. Revision osteosynthesis is technically demanding and it leads to complications, a second surgical procedure for revision synthesis, arthroplasty or removal of a symptomatic implant is again a risky procedure in elderly patients with lot of comorbidities. The aim of this study was to assess the efficacy of a cemented bipolar hemiarthroplasty with calcar preserving intracapsular osteotomy in the management of unstable trochanteric fractures in elderly patients with osteoporosis. Hemiarthroplasty in unstable trochanteric fractures have been described in the past with varying outcome. The reasons for poor outcome were shortening, varus positioning and abductor insufficiency. This was mainly due to the deficient medial support due to the removal of lesser trochanter and calcar. Recently, free calcar grafting excised from the removed neck for medial support was reported, but in our technique we are preserving the calcar and lesser trochanter with all its soft tissue and muscle attachments. MATERIALS AND METHODS 52 patients with mean age 71.4 (range from 65 to 89 who underwent cemented bipolar hemiarthroplasty with calcar preserving osteotomy for unstable intertrochanteric fractures were prospectively evaluated. Posterior approach was used in all patients. Harris hip score was used for the clinical evaluation. The mean followup period was 5 years. RESULT In our study, which was done on 52 cases which had a mean age 71.4 years. The average Harris hip score was 81. Excellent to fair results were obtained at followup in 50 (96% cases, and in 2(4% cases the results were poor. Average hospital stay was 14
Wirtz, C; Abbassi, F; Evangelopoulos, D S; Kohl, S; Siebenrock, K A; Krüger, A
Stable reconstruction of proximal femoral (PF) fractures is especially challenging due to the peculiarity of the injury patterns and the high load-bearing requirement. Since its introduction in 2007, the PF-locking compression plate (LCP) 4.5/5.0 has improved osteosynthesis for intertrochanteric and subtrochanteric fractures of the femur. This study reports our early results with this implant. Between January 2008 and June 2010, 19 of 52 patients (12 males, 7 females; mean age 59 years, range 19-96 years) presenting with fractures of the trochanteric region were treated at the authors' level 1 trauma centre with open reduction and internal fixation using PF-LCP. Postoperatively, partial weight bearing was allowed for all 19 patients. Follow-up included a thorough clinical and radiological evaluation at 1.5, 3, 6, 12, 24, 36 and 48 months. Failure analysis was based on conventional radiological and clinical assessment regarding the type of fracture, postoperative repositioning, secondary fracture dislocation in relation to the fracture constellation and postoperative clinical function (Merle d'Aubigné score). In 18 patients surgery achieved adequate reduction and stable fixation without intra-operative complications. In one patient an ad latus displacement was observed on postoperative X-rays. At the third month follow-up four patients presented with secondary varus collapse and at the sixth month follow-up two patients had 'cut-outs' of the proximal fragment, with one patient having implant failure due to a broken proximal screw. Revision surgeries were performed in eight patients, one patient receiving a change of one screw, three patients undergoing reosteosynthesis with implantation of a condylar plate and one patient undergoing hardware removal with secondary implantation of a total hip prosthesis. Eight patients suffered from persistent trochanteric pain and three patients underwent hardware removal. Early results for PF-LCP osteosynthesis show major
Rakesh Kumar Gupta
Full Text Available Background: Dynamic hip screw (DHS has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients with an average age of 72 years (60 − 94 years of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31, good (score 24 − 31, fair (score 16 − 23, and poor (score < 16. Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 − 16 weeks. At an average followup of 18 months (range 12 − 24 months, no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears
H. L. Yang
Full Text Available Background. Postoperative sore throat is one of the major complaints of general anesthesia in the postanesthesia care unit. This prospective study investigated the preventive effect of ketorolac tromethamine spray in postendotracheal-intubation-induced sore throat after general anesthesia. Methods. Surgical patients undergoing general anesthesia with endotracheal intubation were recruited from a medical center. Patients were randomly assigned to group K (treated with 5% ketorolac tromethamine spray or group D (treated with distilled water spray. Before intubation, each endotracheal tube was sprayed with the appropriate solution by physicians over the 20 cm length of the cuff. Each group comprised 95 patients fitting the inclusion and exclusion criteria for whom complete data sets were collected. The intensity of the sore throat was measured at 1, 3, 6, and 24 h after surgery, and data were compared. Results. The two groups had similar characteristics. Postoperative sore throat was significantly less frequent in group K than in group D (p<0.001 and the pain intensity was significantly lower in group K than in group D at each time point (all p<0.001. Conclusions. This study demonstrated that preanesthesia 5% ketorolac tromethamine spray could effectively decrease postendotracheal-intubation-induced sore throat in patients undergoing general anesthesia.
Trombold, Justin R; Reinfeld, Ari S; Casler, James R; Coyle, Edward F
The purpose of this study was to determine if pomegranate juice supplementation improved the recovery of skeletal muscle strength after eccentric exercise in subjects who routinely performed resistance training. Resistance trained men (n = 17) were randomized into a crossover design with either pomegranate juice or placebo. To produce delayed onset muscle soreness, the subjects performed 3 sets of 20 unilateral eccentric elbow flexion and 6 sets of 10 unilateral eccentric knee extension exercises. Maximal isometric elbow flexion and knee extension strength and muscle soreness measurements were made at baseline and 2, 24, 48, 72, 96, and 168 hours postexercise. Elbow flexion strength was significantly higher during the 2- to 168-hour period postexercise with pomegranate juice compared with that of placebo (main treatment effect; p = 0.031). Elbow flexor muscle soreness was also significantly reduced with pomegranate juice compared with that of placebo (main treatment effect; p = 0.006) and at 48 and 72 hours postexercise (p = 0.003 and p = 0.038, respectively). Isometric strength and muscle soreness in the knee extensors were not significantly different with pomegranate juice compared with those using placebo. Supplementation with pomegranate juice attenuates weakness and reduces soreness of the elbow flexor but not of knee extensor muscles. These results indicate a mild, acute ergogenic effect of pomegranate juice in the elbow flexor muscles of resistance trained individuals after eccentric exercise.
Petrofsky, Jerrold; Berk, Lee; Bains, Gurinder; Khowailed, Iman Akef; Lee, Haneul; Laymon, Michael
To assess the impact of heat applied for 8 hours immediately after or 24 hours after exercise on delayed-onset muscle soreness (DOMS) in large skeletal muscle groups measured by subjective and objective means. Cross-sectional repeated measure design study. Research laboratory. Three groups of 20 subjects, age range 20 to 40 years. Squats were conducted in three 5-minute bouts to initiate DOMS; 3 minutes of rest separated the bouts. One group had heat applied immediately after exercise, and a second group had heat applied 24 hours after exercise. A third group was the control group where no heat was applied. Visual analog pain scales, muscle strength of quads, range of motion of quads, stiffness of quads (Continuous Passive Motion machine), algometer to measure quadriceps soreness, and blood myoglobin. The most significant outcome was a reduction in soreness in the group that had low-temperature heat wraps applied immediately after exercise (P soreness, heat applied just after exercise seems very effective in reducing soreness. Unlike cold, it increases flexibility of tissue and tissue blood flow. For joint, it is still probably better to use cold to reduce swelling.
Khamwong, Peanchai; Paungmali, Aatit; Pirunsan, Ubon; Joseph, Leonard
High-intensity of exercise or unaccustomed eccentric exercise can cause the phenomenon of Exercise-Induced Muscle Damage (EIMD) which usually results in cramps, muscle strain, impaired muscle function and delayed-onset muscle soreness. This study investigated the prophylactic effects of sauna towards the symptoms associated with muscle damage from eccentric exercises of wrist extensor muscle group. A total of twenty-eight subjects (mean age 20.9 years old, SD = 1.6) were randomly divided into the sauna group (n = 14) and the control group (n = 14). In the sauna group, subjects received sauna before eccentric exercise of the wrist extensor. The eccentric exercises were conducted on the non-dominant arm by using an isokinetic dynamometer. Pain Intensity (PI), Pressure Pain Threshold (PPT) and passive range of motion of wrist flexion (PF-ROM) and extension (PE-ROM) were measured as pain variables. Grip Strength (GS) and Wrist Extension Strength (WES) were measured as variables of wrist extensor muscle function. All the measurements were performed at baseline, immediately after and from 1st to 8th days after the exercise-induced muscle damage. The sauna group significantly demonstrated a lower deficit in ROM (passive flexion and passive extension), GS and WES following exercise than that of the control group (P < 0.05). Sauna application prior to the exercise-induced muscle damage demonstrated effectiveness in reduction of sensory impairment (PF-ROM and PE-ROM) and improvement of muscle functions (GS, and WES) in wrist extensor muscle group.
Fleckenstein, Johannes; Niederer, Daniel; Auerbach, Kerstin; Bernhörster, Marcus; Hübscher, Markus; Vogt, Lutz; Banzer, Winfried
Delayed-onset muscle soreness (DOMS) is a common symptom in people participating in exercise, sport, or recreational physical activities. Several remedies have been proposed to prevent and alleviate DOMS. A five-arm randomized controlled study was conducted to examine the effects of acupuncture on eccentric exercise-induced DOMS of the biceps brachii muscle. Participants were recruited through convenience sampling of students and general public. Participants were randomly allocated to needle, laser, sham needle, sham laser acupuncture, and no intervention. Outcome measures included pressure pain threshold (PPT), pain intensity (visual analog scale), and maximum isometric voluntary force. Delayed-onset muscle soreness was induced in 60 participants (22 females, age 23.6 ± 2.8 years, weight 66.1 ± 9.6 kg, and height 171.6 ± 7.9 cm). Neither verum nor sham interventions significantly improved outcomes within 72 hours when compared with no treatment control (P > 0.05). Acupuncture was not effective in the treatment of DOMS. From a mechanistic point of view, these results have implications for further studies: (1) considering the high-threshold mechanosensitive nociceptors of the muscle, the cutoff for PPT (5 kg/cm) chosen to avoid bruising might have led to ceiling effects; (2) the traditional acupuncture regimen, targeting muscle pain, might have been inappropriate as the DOMS mechanisms seem limited to the muscular unit and its innervation. Therefore, a regionally based regimen including an intensified intramuscular needling (dry needling) should be tested in future studies, using a higher cutoff for PPT to avoid ceiling effects.
Lim, Chin Tat; Amanatullah, Derek F; Huddleston, James I; Hwang, Katherine L; Maloney, William J; Goodman, Stuart B
Cortical strut allografts restore bone stock and improve postoperative clinical scores after revision total hip arthroplasty (THA). However, use of a cortical strut allograft is implicated in delayed healing of an extended trochanteric osteotomy (ETO). To date, there are no reports directly comparing ETO with or without cortical strut allografts. We reviewed prospectively gathered data on 50 revision THAs performed from 2004-2014 using an ETO. We compared the demographic, radiological, and clinical outcome of patients with (16 hips) and without (34 hips) cortical strut allograft after an ETO. There were no significant differences in Western Ontario McMaster Universities Osteoarthritis Index or Harris Hip Score between the ETOs with and without a cortical strut allograft. Fifteen of the ETOs (94%) with a cortical strut allograft and 31 of the ETOs (91%) without a cortical strut allograft were in situ at final follow-up (P = 1.000). A higher proportion hips with cortical strut allograft (100%, 16 patients) had preoperative Paprosky grade bone loss more than IIIA compared to those without allograft (29%, 10 patients) (P revision THA with ETO does not reduce the rate of union, radiological or clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Introduction: We would like to analyze the role of cemented hemiarthroplasty in elderly osteoporotic unstable intertrochanteric fractures through trochanteric fracture window. Materials and Methods: The study was conducted from July 2011 to July 2014. From a total of 265 consecutive patients with intertrochanteric fractures of 42 patients were selected according to inclusion criteria and results were analyzed prospectively. All patients were operated at tertiary care institute. Patients which matched the inclusion criteria were selected. 42 patients entered the study and all completed the study. Primary cemented hemiarthroplasty was done in all patients. Modified Harris Hip Score was used to assess all the patients. Results: 42 patients were included in the study with an average age of 80.7 years. Only AO/OTA type 31-A2.2 and 31-A2.3 were included, average HHS at final follow up of three years was 86.2. No revision or reoperation was done. Conclusion: In a selected cohort of patients primary prosthetic replacement in elderly osteoporotic unstable intertrochanteric fractures is good option and the surgical technique allowed us to perform it more easily.
Ito, Juji; Takakubo, Yuya; Sasaki, Kan; Sasaki, Junya; Owashi, Kazuya; Takagi, Michiaki
Lag screw cut-out is one of the major postoperative complications on femoral trochanteric fractures. However, precise analyses of excessive sliding and lag screw cut-out were limited. The purpose of this study was to investigate the factors that induce this unfavorable event. From April 2010 to April 2013, 226 patients were operated in our institute using a short femoral nail. Among them, 177 patients (29 males and 148 females) with a mean age of 84 years (60-97 years), who were followed up >3 months, were included in this study. The postoperative sliding distance, fracture type (AO/OTA classification), tip-apex distance (TAD), reduction pattern in the postoperative X-ray (antero-posterior and lateral views), bone quality (canal flare and cortical indices), walking ability at the time of pre-injury and final follow-up, and complications were investigated retrospectively. The mean sliding distance was 3.7 mm, and one cut-out case (0.6 %) was observed. The sliding distance of the AO/OTA 31-A2 fractures was significantly longer than that of the A1 fractures (p fractures, an accurate reduction in the lateral view at surgery is important, particularly in unstable fractures.
Takigawa, Naohide; Moriuchi, Hiromitsu; Abe, Muneki; Yasui, Kenji; Eshiro, Hisako; Kinoshita, Mitsuo
The purpose of this study was to analyse clinical results of elderly patients with trochanteric fractures that were treated with use of TARGON(®) PF nail. Overall, 494 patients (113 males) were available for this study. On the basis of Jensen classification, there were 76 cases in type I, 164 cases in type II, 70 in type III, 129 in type IV and 55 in type V. (1) Sliding amount of lag screw in relation to the Jensen classification, (2) sliding amount of lag screw according to the Ikuta's classification that categorises the reduction in lateral view in three, Subtype A, Subtype N and Subtype P, (3) sliding amount of lag screw in correlation between Jensen classification and Ikuta's classification and (4) postoperative complications (9 cases; 1.7%) were assessed. Cut-out and back-out cases were seen in 6 cases (1.1%), and these severe complications were evaluated in details. In correlation between Jensen classification and Ikuta's classification, the excessive sliding of lag screw was prominent with the Subtype P, which was preoperatively in Jensen type III or V. Cut-out or back-out cases were caused either from (1) Subtype P that were preoperatively Jensen types III or V, or from (2) the fracture where there was bony defect anteriorly. Therefore, special care must be taken for these types. Copyright © 2013 Elsevier Ltd. All rights reserved.
Ganderton, Charlotte; Semciw, Adam; Cook, Jill; Pizzari, Tania
To evaluate the diagnostic accuracy of 10 clinical tests that can be used in the diagnosis of greater trochanteric pain syndrome (GTPS) in women, and to compare these clinical tests to magnetic resonance imaging (MRI) findings. Twenty-eight participants with GTPS (49.5 ± 22.0 years) and 18 asymptomatic participants (mean age ± standard deviation [SD], 52.5 ± 22.8 years) were included. A blinded physiotherapist performed 10 pain provocation tests potentially diagnostic for GTPS-palpation of the greater trochanter, resisted external derotation test, modified resisted external derotation test, standard and modified Ober's tests, Patrick's or FABER test, resisted hip abduction, single-leg stance test, and the resisted hip internal rotation test. A sample of 16 symptomatic and 17 asymptomatic women undertook a hip MRI scan. Gluteal tendons were evaluated and categorized as no pathology, mild tendinosis, moderate tendinosis/partial tear, or full-thickness tear. Clinical test analyses show high specificity, high positive predictive value, low to moderate sensitivity, and negative predictive value for most clinical tests. All symptomatic and 88% of asymptomatic participants had pathological gluteal tendon changes on MRI, from mild tendinosis to full-thickness tear. The study found the Patrick's or FABER test, palpation of the greater trochanter, resisted hip abduction, and the resisted external derotation test to have the highest diagnostic test accuracy for GTPS. Tendon pathology on MRI is seen in both symptomatic and asymptomatic women.
Duncan, J D; Clark, L L
Chronic residual ridge soreness in patients with complete dentures can be caused by various factors. A differential diagnosis between physiologic or anatomic problems (or both) and functional deficiencies in the patient's present dentures must be made. The functional deficiencies can often be eliminated easily, whereas physiologic and anatomic problems may be more difficult to correct, especially in the geriatric patient. If the functional deficiencies in the patient's dentures have been corrected and surgical procedures are not a viable alternative, placement of a long-term resilient liner can often resolve the chronic residual ridge soreness that is present in denture patients. Properly placed and properly cared for silicone or silicone rubber resilient denture liners can provide comfort for over 70% of patients with chronic residual ridge soreness for 3 to 5 years and often longer.
Andersen, Lars L; Jay, Kenneth; Andersen, Christoffer H
healthy female volunteers (mean age 32 years) participated in this examiner-blind randomized controlled trial (ClinicalTrials.gov NCT01478451). The participants performed eccentric contractions for the upper trapezius muscle on a Biodex dynamometer. Delayed onset muscle soreness (DOMS) presented 48 hours......Massage is commonly believed to be the best modality for relieving muscle soreness. However, actively warming up the muscles with exercise may be an effective alternative. The purpose of this study was to compare the acute effect of massage with active exercise for relieving muscle soreness. Twenty...... later, at which the participants (a) received 10 minutes of massage of the trapezius muscle or (b) performed 10 minutes of active exercise (shoulder shrugs 10 × 10 reps) with increasing elastic resistance (Thera-Band). First, 1 treatment was randomly applied to 1 shoulder while the contralateral...
Manimmanakorn, Nuttaset; Manimmanakorn, Apiwan; Boobphachart, Disaphon; Thuwakum, Worrawut; Laupattarakasem, Wiroon; Hamlin, Michael J
To evaluate the effects of Zingiber cassumunar (Plai cream) in either 7% or 14% concentration on delayed onset muscle soreness (DOMS). Seventy-five untrained healthy volunteers (28 males and 47 females), performed 4 sets of 25 eccentric repetitions of the dominant quadriceps muscle on an isokinetic dynamometry machine. Participants were then randomized into 3 groups: 14% Plai cream, 7% Plai cream and placebo cream. Two grams of the cream (strips of 5-cm long) were gently rubbed into the quadriceps muscles for 5 min immediately following the exercise and every 8 h thereafter for 7 d in all groups. Muscle soreness, muscle strength, jump height, thigh circumference and creatine kinase were measured before and after eccentric exercise. Compared to the placebo cream the 14% Plai cream substantially reduced muscle soreness over the 7 d by -82% (95% CI = -155% to -6%, P = 0.03), but had similar muscle soreness effects to 7% Plai cream (-34%, -96% to 27%, P = 0.2). Compared to the placebo cream the 7% Plai cream resulted in a small non-significant reduction in muscle soreness levels over the following 7 d (-40%, -116% to 36%, P = 0.3). Compared to placebo cream there was little effect of Plai cream (7% or 14%) on muscle strength, jump height, thigh circumference or creatine kinase concentration. Using 14% Plai cream over a 7-day period substantially reduced muscle soreness symptoms compared to 7% Plai cream or a placebo cream. The authors suggest that the administration of 14% Plai cream is a useful alternative in the management of DOMS. Thai Clinical Trial Registry TCTR20140215001.
Al-Qadhi, Ban Noori; Musa, Israa Salim; Al-Mulla Hummadi, Yassir Mustafa Kamal
Ninety-five Iraqi patients with cutaneous leishmaniasis (CL) caused by Leishmania tropica at AL-Karama Hospital in Baghdad were included in this study. Sixty patients were with single sore and the remaining with multiple sores. The study also included 10 atopic patients and 30 healthy individuals as a control group. Cellular and humoral immune response at different stages of the disease activity (early and late) were evaluated by estimation of serum IFN-γ, IL-4 and total IgE antibodies using ELISA kits while, the detection of specific anti leishmanial IgE antibodies was done manually. Specific IgE antibodies were only detected in early CL (<2 months) patients 68 (71.57 %) while, were not detected in late CL, atopic and healthy controls 30 (100 %). The results also showed a positive relationship between this antibody and the number of sores. Th-2 predominates during the early stage of the disease then shifts to Th-1 that proceed in the late stage, but both cytokines increased in CL patients in comparison to control group. The immune response of CL infection is possibly regulated by both Th-1 and Th-2. Multiple sores patients showed an increase of anti leishmanial IgE (0.120 ± 0.014), total IgE (120.7 ± 39.58 IU/ml), IFN-γ (87.4 ± 30.52 pg/ml) and IL-4 (63.70 ± 20.32 pg/ml) levels than single sore patients with mean value of 0.108 ± 0.14, 92.3 ± 35.23 IU/ml, 47.2 ± 27.80 pg/ml and 51.04 ± 15.0 pg/ml respectively. It can be presented also as ratio of INF-γ/IL-4 = 1.37 which is greater than those for single sore 0.9. These results indicated that the immune response of multiple sores patient's is higher than that with single sores.
Petrofsky, Jerrold; Batt, Jennifer; Bollinger, Jennifer N; Jensen, Mark C; Maru, Elyse H; Al-Nakhli, Hani H
Delayed-onset muscle soreness (DOMS) is a serious problem for people who do not exercise on a regular basis. Although the best preventive measure for diabetes and for maintaining a low hemoglobin A1c is exercise, muscle soreness is common in people with diabetes. For people with diabetes, DOMS is rarely reported in exercise studies. One hundred twenty subjects participated in three groups (young, older, and type 2 diabetes) and were examined to evaluate the soreness in the abdominal muscles after a matched exercise bout using a p90x exercise video (Beachbody LLC, Los Angeles, CA) for core fitness. Next, three heating modalities were assessed on how well they could reduce muscle soreness: ThermaCare(®) (Pfizer Consumer Healthcare, Richmond, VA) heat wraps, hydrocollator heat wraps, and a chemical moist heat wrap. The results showed that people with diabetes were significantly sorer than age-matched controls (P soreness for the people with diabetes was 73.3 ± 16.2 mm, for the older group was 56.1 ± 15.1 mm, and for the younger group was 41.5 ± 9.3 mm; these differences were significant (analysis of variance, P soreness after applying the modalities was using moist heat, both immediately after the modality and up to 2 days after the exercise. Right after the modality, moist heat reduced pain by 52.3% in the older subjects compared with 30.5% in the subjects with diabetes and 33.3% in the younger subjects. Skin blood flow in the abdominal area before exercise was greatest in the younger subjects and lower in the subjects with diabetes after heat application. Skin temperature at rest and after exercise was greatest in the diabetes group. Muscle soreness following exercise was greatest in people with diabetes, and the best modality of the three studied to reduce this type of soreness was chemical moist heat.
T. A. Grechukha
Full Text Available Sore throat is a frequent complaint of children. Another aspect considered in this article is the issue of untimely and groundless prescription of antibacterial therapy to children, as it may result both in allergic reactions and toxic effect on the body in whole. Children of all age groups are rather sensitive to pain. In case of an acute complaint, there must be an effective drug, which may safely be used in children. The article examines various pharmaceutical forms of drugs for sore throat treatment and appraises their advantages, disadvantages and usability in children over 5 years of age in detail.
Pulkkinen, P; Partanen, J; Jalovaara, P; Jämsä, T
The ability of bone mineral density (BMD) to discriminate cervical and trochanteric hip fractures was studied. Since the majority of fractures occur among people who are not diagnosed as having osteoporosis, we also examined this population to elucidate whether geometrical risk factors can yield additional information on hip fracture risk beside BMD. The study showed that the T-score criterion was able to discriminate fracture patients from controls in the cases of trochanteric fractures, whereas geometrical measures may discriminate cervical fracture cases in patients with T-score >-2.5. Low bone mineral density (BMD) is a well-established risk factor for hip fracture. However, majority of fractures occur among people not diagnosed as having osteoporosis. We studied the ability of BMD to discriminate cervical and trochanteric hip fractures. Furthermore, we examined whether geometrical measures can yield additional information on the assessment of hip fracture risk in the fracture cases in subjects with T-score >-2.5. Study group consisted of postmenopausal females with non-pathologic cervical (n = 39) or trochanteric (n = 18) hip fracture (mean age 74.2 years) and 40 age-matched controls. BMD was measured at femoral neck, and femoral neck axis length, femoral neck and shaft cortex thicknesses (FNC and FSC), and femoral neck-shaft angle (NSA) were measured from radiographs. BMD T-score threshold of -2.5 was able to discriminate trochanteric fractures from controls (p trochanteric fractures occurred in individuals with T-score fractures. Twenty of these fractures (51.3%) occurred in individuals with BMD in osteoporotic range and 19 (48.7%) in individuals with T-score >-2.5. Within these non-osteoporotic cervical fracture patients (N = 19) and non-osteoporotic controls (N = 35), 83.3% were classified correctly based on a model including NSA and FNC (p trochanteric fractures could be discriminated based on a BMD T-score fracture cases would remain under-diagnosed if
Mathus-Vliegen, Elisabeth M. H.
Wound healing is a complex, tightly regulated process, consisting of three distinct phases. In each phase of wound healing, energy and macronutrients are required. Moreover, animal studies have established a specific role for certain nutrients such as the amino acid arginine, the vitamins A, B, and
This article interrogates, in theoretical cum descriptive fashion, the nexus between corruption and democracy, using sub- Saharan Africa as a research backdrop. Drawing mainly from secondary data and leaning towards a modernisation theoretical framework, it argues that the festering sore of corruption has produced ...
Chaffin, Morgan E.; Berg, Kris E.; Meendering, Jessica R.; Llewellyn, Tamra L.; French, Jeffrey A.; Davis, Jeremy E.
The purpose of this study was to determine if a difference in interleukin-6 (IL-6) and delayed onset muscles soreness (DOMS) exists in two different phases of the menstrual cycle. Nine runners performed one 75-min high-intensity interval running session during the early follicular (EF) phase and once during the midluteal (ML) phase of the…
Full Text Available Objective of this study was to the effect of vibration on some of functional markers of delayed onset muscle soreness. Methodology: 30 college males with mean age of 21.2, were selected and were divided into two groups randomly. A vibrator was used to apply 50?Hz vibration for 1 min in the VT group, while no vibration was applied in the non?VT group. Then, Both groups performed five sets (10 repetitions per set of the eccentric contractions , at 85% of one repetition maximum (1- RM. Range of motion at elbow jount Circomference of nondominant elbow and Muscle soreness were recorded before, after, 24, 48, 72, 96 (hr after eccentric contractions. Statistical Result: The results showed vibration training do show positive effects on Range of motion at elbow joint and Muscle soreness and Circomference of nondominant elbow (p> 0.05. Discussion: A comparison by experimental groups indicates that VT before eccentric exercise may prevent and control DOMS. Key words: Eccntric exercise,Delayed onset muscle soreness, Range of motion, vibration training.
Timon, Rafael; Tejero, Javier; Brazo-Sayavera, Javier; Crespo, Carmen; Olcina, Guillermo
[Purpose] The aim of this study was to investigate whether or not a single whole-body vibration treatment after eccentric exercise can reduce muscle soreness and enhance muscle recovery. [Subjects and Methods] Twenty untrained participants were randomly assigned to two groups: a vibration group (n=10) and control group (n=10). Participants performed eccentric quadriceps training of 4 sets of 5 repetitions at 120% 1RM, with 4 min rest between sets. After that, the vibration group received 3 sets of 1 min whole body vibration (12 Hz, 4 mm) with 30 s of passive recovery between sets. Serum creatine kinase, blood urea nitrogen, muscle soreness (visual analog scale) and muscle strength (peak isometric torque) were assessed. [Results] Creatine kinase was lower in the vibration group than in the control group at 24 h (200.2 ± 8.2 vs. 300.5 ± 26.1 U/L) and at 48 h (175.2 ± 12.5 vs. 285.2 ± 19.7 U/L) post-exercise. Muscle soreness decreased in vibration group compared to control group at 48 h post-exercise (34.1 ± 11.4 vs. 65.2 ± 13.2 mm). [Conclusion] Single whole-body vibration treatment after eccentric exercise reduced delayed onset muscle soreness but it did not affect muscle strength recovery.
Peñailillo, Luis; Blazevich, Anthony J; Nosaka, Kazunori
A single bout of eccentric exercise confers a protective effect against muscle damage and soreness in subsequent eccentric exercise bouts, but the mechanisms underpinning this effect are unclear. This study compared vastus lateralis (VL) muscle-tendon behavior between two eccentric cycling bouts to test the hypothesis that muscle-tendon behavior would be different between bouts and would be associated with the protective effect. Eleven untrained men (27.1 ± 7.0 yr) performed two bouts of eccentric cycling (ECC1 and ECC2) separated by 2 wk for 10 min at 65% of maximal concentric workload (191.9 ± 44.2 W) each. Muscle soreness (by visual analog scale) and maximal voluntary isometric contraction (MVC) torque of the knee extensors were assessed before and 1-2 d after exercise. Using ultrasonography, VL fascicle length and angle changes during cycling were assessed, and tendinous tissue (TT) length changes were estimated. VL EMG amplitude, crank torque, and knee joint angles were measured during cycling. Soreness was greater (P soreness after ECC2 than ECC1; thus, changes in muscle-tendon behavior may be an important mechanism underpinning the protective effect.
Smith, Lucille L.; And Others
This study reexamined the concept that delayed muscle soreness (DMS) is a form of inflammatory pain. This was accomplished by having 32 male volunteers perform exercise known to induce DMS and then assess the total and differential white blood cell changes. In addition, an anti-inflammatory drug, idomethacin, was administered to determine whether…
Koutris, M.; Lobbezoo, F.; Sümer, N.C.; Atis, E.S.; Türker, K.S.; Naeije, M.
Objective: In a study to the possible role of overuse of the jaw muscles in the pathogenesis of jaw muscle pain, we used a protocol involving concentric and eccentric muscle contractions to provoke a state of delayed-onset muscle soreness (DOMS) in the jaw muscles of healthy individuals. We tested
Soer, Remko; Geertzen, Jan H. B.; van der Schans, Cees P.; Groothoff, Johan W.; Reneman, Michiel F.
Objectives: It is currently unknown whether specific determinants are predictive for developing delayed onset muscle soreness (DOMS) after heavy work-related activities. The aim of this study was to analyze whether personal characteristics and performance measures are predictive for onset,
was proposed by Armstrong in 1984,3 and has continued to be validated and refined by researchers in more .... 2014;12(3):112-120. 15. Hilbert JE, Sforzo GA, Swensen T. The effects of massage on delayed onset muscle soreness. Br J Sports Med. 2003;37(1):72-75. 16. Bloomer RJ. The role of nutritional supplements in ...
Full Text Available Aim: To investigate the effects of pulsed Ultrasound (US in recovery from Delayed Onset Muscle Soreness (DOMS. Methods: Twelve healthy male athletes (mean age 23.83±1.697 year performed an eccentric exercise protocol of non-dominant elbow flexors to induce muscle soreness on 2 occasions separated by 3 weeks. Subjects in experimental group received pulsed US (1 MHz, intensity 0.8 W/cm2, mark space ratio 1:10, whereas control group received sham US after 24 h, 48 h and 72 h. Perception of muscle soreness, active ROM and muscle strength were the parameters measured at 0 h, 24 h, 48 h and 72 h with the help of VAS, manual goniometer and JONEX muscles master instrument respectively. Results: Post hoc t test analysis revealed significant differences (p <0.05 between 0 h and 72 h in the parameter of ROM (t = 6.18 and muscle power (t = 2.54 as well as between 24 h and 48 h in the parameter of muscle soreness (t = 3.13 in control group. Similar differences were also observed in the experimental group. No significant inter-group differences at α level of 0.05 was observed in any parameter at any level. Conclusion: The pattern of recovery from DOMS was not influenced by the application of pulsed Ultrasound at the parameters discussed here.
Korkmaz, Mehmet Fatih; Erdem, Mehmet Nuri; Disli, Zeliha; Selcuk, Engin Burak; Karakaplan, Mustafa; Gogus, Abdullah
In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification and the American Society of Anesthesiologists' (ASA) physical status classification (ASA grade). Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. The mean age of the patients was 77.66 years (range: 37-98 years), and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range: 12-75 months). Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest), and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture.
Reynard, Floran A; Flaris, Alexandros N; Simms, Eric R; Rouvière, Olivier; Roy, Pascal; Prat, Nicolas J; Damizet, Jean-Gabriel; Caillot, Jean-Louis; Voiglio, Eric J
Pre-hospital pelvic stabilisation is advised to prevent exsanguination in patients with unstable pelvic fractures (UPFs). Kendrick's extrication device (KED) is commonly used to extricate patients from cars or crevasses. However the KED has not been tested for potential adverse effects in patients with pelvic fractures. The aim of this study was to examine the effect of the KED on pubic symphysis diastasis (SyD) with and without the use of a trochanteric belt (TB) during the extraction process following a MVC. Left-sided "open-book" UPFs were created in 18 human cadavers that were placed in seven different positions simulating pre-extraction and extraction positions using the KED with and without a TB in two different positions (through and over the thigh straps). The SyD was measured using anteroposterior radiographs. The effects of the KED with and without TB, on the SyD, were evaluated. The KED alone resulted in a non-significant increase of the SyD compared to baseline, whereas the addition of a TB to the KED resulted in a significant reduction of the SyD (p<0.001). The TB through the straps provided a significantly better reduction than the TB over the straps in the extracted position (p<0.05). Our study demonstrated that a TB in combination with the KED on UPFs is an effective way to achieve early reduction. The addition of the TB in combination with the KED could be considered for Pre-Hospital Trauma Life Support (PHTLS) training protocols. Copyright © 2016 Elsevier Ltd. All rights reserved.
Aguilera Eguía, Raúl Alberto; Ibacache Palma, Alejandro
Late onset muscle soreness, also known as delayed onset muscle soreness, is a painful musculoskeletal condition that may occur 24-48 and up to 72 hours after the completion of unusual physical or high intensity exercise involving eccentric muscle activity. In the field of physical rehabilitation, immersion in cold water is a common intervention mainly used in sports medicine, to minimize delayed onset muscle soreness and promote recovery after exercise. To assess the validity and applicability of the results regarding the effectiveness of immersion in cold water after high intensity exercise and answer the following question: In subjects who exercise regularly, can cold-water immersion compared to passive therapy (rest) reduce late-onset muscle soreness? The article "Cold Water Immersion (cryotherapy) for preventing and treating muscle soreness after exercise," a Cochrane systematic review authored by Bleakley et al (2012), was analyzed. Immersion in cold water can decrease delayed onset of muscle pain after high intensity exercise. Twenty-four hours after the intervention, the mean standardized difference was -0.55 (95% CI: -0.84 to -0.27); 48 hours after, the mean standardized difference was -0.66 (95% CI: -0.97 to -0.35); 72 hours after, the mean standardized difference was -0.93 (95% CI: -1.36 to -0.51) and up to 96 hours after, mean standardized difference was -0.58 (95% CI: -1.00 to -0.16). Despite the methodological limitations present in the studies included in the systematic review analyzed, we found the recommendation for cold water immersion (cryotherapy) reasonable in individuals with late muscle pain caused by high intensity sports.
Raúl Alberto Aguilera Eguía
Full Text Available Introduction Late onset muscle soreness, also known as delayed onset muscle soreness, is a painful musculoskeletal condition that may occur 24-48 and up to 72 hours after the completion of unusual physical or high intensity exercise involving eccentric muscle activity. In the field of physical rehabilitation, immersion in cold water is a common intervention mainly used in sports medicine, to minimize delayed onset muscle soreness and promote recovery after exercise. Objective To assess the validity and applicability of the results regarding the effectiveness of immersion in cold water after high intensity exercise and answer the following question: In subjects who exercise regularly, can cold-water immersion compared to passive therapy (rest reduce late-onset muscle soreness? Methods The article "Cold Water Immersion (cryotherapy for preventing and treating muscle soreness after exercise," a Cochrane systematic review authored by Bleakley et al (2012, was analyzed. Results Immersion in cold water can decrease delayed onset of muscle pain after high intensity exercise. Twenty-four hours after the intervention, the mean standardized difference was -0.55 (95% CI: -0.84 to -0.27; 48 hours after, the mean standardized difference was -0.66 (95% CI: -0.97 to -0.35; 72 hours after, the mean standardized difference was -0.93 (95% CI: -1.36 to -0.51 and up to 96 hours after, mean standardized difference was -0.58 (95% CI: -1.00 to -0.16. Conclusion Despite the methodological limitations present in the studies included in the systematic review analyzed, we found the recommendation for cold water immersion (cryotherapy reasonable in individuals with late muscle pain caused by high intensity sports.
Hedin, Katarina; Strandberg, Eva Lena; Gröndal, Hedvig; Brorsson, Annika; Thulesius, Hans; André, Malin
To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Qualitative content analysis was used to analyse semi-structured interviews. Swedish primary care. A strategic sample of 25 GPs. Perceived management of sore throat patients. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
Jamtvedt, Gro; Herbert, Robert D; Flottorp, Signe; Odgaard-Jensen, Jan; Håvelsrud, Kari; Barratt, Alex; Mathieu, Erin; Burls, Amanda; Oxman, Andrew D
To determine the effects of stretching before and after physical activity on risks of injury and soreness in a community population. Internet-based pragmatic randomised trial conducted between January 2008 and January 2009. International. A total of 2377 adults who regularly participated in physical activity. Participants in the stretch group were asked to perform 30 s static stretches of seven lower limb and trunk muscle groups before and after physical activity for 12 weeks. Participants in the control group were asked not to stretch. Participants provided weekly on-line reports of outcomes over 12 weeks. Primary outcomes were any injury to the lower limb or back, and bothersome soreness of the legs, buttocks or back. Injury to muscles, ligaments and tendons was a secondary outcome. Stretching did not produce clinically important or statistically significant reductions in all-injury risk (HR=0.97, 95% CI 0.84 to 1.13), but did reduce the risk of experiencing bothersome soreness (mean risk of bothersome soreness in a week was 24.6% in the stretch group and 32.3% in the control group; OR=0.69, 95% CI 0.59 to 0.82). Stretching reduced the risk of injuries to muscles, ligaments and tendons (incidence rate of 0.66 injuries per person-year in the stretch group and 0.88 injuries per person-year in the control group; HR=0.75, 95% CI 0.59 to 0.96). Stretching before and after physical activity does not appreciably reduce all-injury risk but probably reduces the risk of some injuries, and does reduce the risk of bothersome soreness. anzctr.org.au 12608000044325.
Moein, C. M. Ansari; ten Duis, H. J.; Oey, P. L.; de Kort, G. A. P.; van der Meulen, W.; van der Werken, Chr
In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a trochanteric fossa (also known as piriform fossa) entry point to a greater trochanter entry point in patients
Zhu, Qianzheng; Xu, Xiaodong; Yang, Xi; Chen, Xingzuo; Wang, Liqiang; Liu, Chenggang; Lin, Peng
The optimum treatment with intramedullary nails (IMN) or sliding hip screws (SHS) for type 31-A2 trochanteric fractures remains controversial. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to compare IMN with SHS in AO/OTA 31-A2 trochanteric fractures. Databases including PubMed, Cochrane, and Embase were searched to identify RCTs published before December 2016, which compared IMN with SHS for intraoperative and postoperative outcomes in AO/OTA 31-A2 trochanteric fractures. A total of 909 patients from six RCTs were subjected to the meta-analysis. The results showed that the IMN group was associated with less operative blood loss, leg shortening, wound infections, length of hospital stay, and days to mobilization with walking aids and also yielded a higher Parker score as compared to the SHS group. No significant difference was seen in the other parameters including operative details, fracture fixation complications, postoperative complications, and 1 year mortality. IMN fixation was found to be the superior treatment of choice for 31-A2 trochanteric fractures as compared with SHS fixation in our meta-analysis. The adverse effects appeared comparable between the two groups. However, due to the variations in the included studies, more large-sample, measures-unified, and high-quality RCTs are needed to validate these conclusions. Copyright © 2017. Published by Elsevier Ltd.
Brennan, Kindyle L; Allen, Bryce C; Maldonado, Yolanda Munoz
Study Design Prospective, randomized, partially blinded. Background Greater trochanteric pain syndrome (GTPS) is the current terminology for what was once called greater trochanteric or subgluteal bursitis. Cortisone (corticosteroid) injection into the lateral hip has traditionally been the accepted treatment for this condition; however, the effectiveness of injecting the bursa with steroids is increasingly being questioned. An equally effective treatment with fewer adverse side effects would be beneficial. Objective To investigate whether administration of dry needling (DN) is noninferior to cortisone injection in reducing lateral hip pain and improving function in patients with GTPS. Methods Forty-three participants (50 hips observed), all with GTPS, were randomly assigned to a group receiving cortisone injection or DN. Treatments were administered over 6 weeks, and clinical outcomes were collected at baseline and at 1, 3, and 6 weeks. The primary outcome measure was the numeric pain-rating scale (0-10). The secondary outcome measure was the Patient-Specific Functional Scale (0-10). Medication intake for pain was collected as a tertiary outcome. Results Baseline characteristics were similar between groups. A noninferiority test for a repeated-measures design for pain and averaged function scores at 6 weeks (with a noninferiority margin of 1.5 for both outcomes) indicated noninferiority of DN versus cortisone injection (both, PTherapy, level 1b. Registered December 2, 2015 at www.clinicaltrials.gov (NCT02639039). J Orthop Sports Phys Ther 2017;47(4):232-239. Epub 3 Mar 2017. doi:10.2519/jospt.2017.6994.
Lenz, Mark; Stoffel, Karl; Kielstein, Heike; Mayo, Keith; Hofmann, Gunther O; Gueorguiev, Boyko
Proximal plate fixation in periprosthetic femur fractures can be improved by plate anchorage in the greater trochanter (lateral tension band principle) or bicortical locking screw placement beside the prosthesis stem in an embracement configuration. Both concepts were compared in a biomechanical test using a femoral hook plate (hook) or a locking attachment plate (LAP). After bone mineral density (BMD) measurement in the greater trochanter, six pairs of fresh frozen human femora were assigned to two groups and instrumented with cemented hip endoprostheses. A transverse osteotomy was set distal to the tip of the prosthesis, simulating a Vancouver B1 fracture. Each pair was instrumented using a plate tensioner with either hook or LAP construct. Cyclic testing (2Hz) with physiologic profile and monotonically increasing load was performed until catastrophic failure. Plate stiffness was compared in a four-point-bending-test. Paired student's-t-test was used for statistical evaluation (pTrochanteric fixation is highly BMD dependent and may be restricted to major greater trochanteric involvement requiring stabilization. Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Mingo-Robinet, Juan; Torres-Torres, Miguel; Martínez-Cervell, Carmen; Alonso Del Olmo, Juan Antonio; Rivas Laso, Jose A; Aguado-Hernández, Hector; Burón-Alvarez, Isidro
The aim of this study was to compare the complications of the trochanteric gamma nail (TGN) and the Gamma3 Nail (G3), focusing on cutout failure. Retrospective comparative cohort analysis. Level II Teaching Trauma Center academic trauma center. Two hundred eighteen trochanteric fractures with a mean follow-up of 15 months were included in the study. They were treated either with the TGN or the G3 between January 2005 and December 2010. Bivariate, stratified, and logistic regression analysis was conducted to determine the association between cutout and the independent variables. Proximal anterograde nailing with either the TGN or the G3. Patient age, sex, type of intramedullary device, stability fracture pattern, tip-apex distance (TAD), distraction at the fracture site, cervical angle, and cutout. The relative risk (RR) of cutout was 4.71 times higher in the group treated with G3 (P fractures compared with stable fractures was 3.07 (1.01-9.35). In unstable fractures, the RR of cutout was 8.78 times higher in patients with G3 (P 25 mm (P = 0.4). We have not found any relationship between cutout rate and TAD. Only the fracture pattern and the type of implant have shown to be associated with cutout risk. In our study, Gamma3 Nail has higher cutout rates than TGN in unstable fractures. Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.
Background Data on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type. Methods Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 ± 8.8 years; 74.9% women) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH, leptin, adiponectin and resistin were determined. Results The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P trochanteric HF only hyperparathyroidism; for post-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery disease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF. Conclusions Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms. PMID:22333003
Carulli, Christian; Piacentini, Federico; Paoli, Tommaso; Civinini, Roberto; Innocenti, Massimo
Trochanteric fractures are frequent and generally associated with bone fragility. There is still debate on the best fixation device to treat stable or rather stable trochanteric fractures: we report our clinical and radiological results of fixation with Proximal Femoral Nail "antirotation" (PFNa) in a population of patients compared to a control group treated by Sliding Hip Screw (SHS). A prospective study was conducted in 71 consecutive patients treated by PFNa (group A), and 69 by a SHS (group B), with a mean age of 81.6 and 83.4 years respectively. Short Form 12 was administered to check postoperative results, and the following parameters were evaluated: range of motion, evaluation of pain, gait ability, X-rays, and Tip Apex Distance Index. A minimum follow-up was conducted in 128 patients: 66 subjects belonging to the PFNa group and 62 to the DHS group. All patients in the group A were able to reach partial or full weight-bearing on the operated leg before leaving the hospital. Forty-four patients (63.8%) of the group B were able to walk with partial weight-bearing before discharge. We recorded 17 complications with a final overall percentage of 17.2% on the overall study population with one single case of failure in both the two groups. A statistical significance (ptrochanteric fractures as well as DHS. The light superiority of PFNa may be principally related to its mechanical advantages.
Full Text Available We describe a case of traumatic posterior dislocation of a native hip joint associated with ipsilateral comminuted inter-trochanteric femoral fracture. In our case, closed reduction was attempted but proved unsuccessful. Taking into account the planned subsequent intra-medullary femoral nail, open reduction through a lateral incision was undertaken. Post-operatively, the planned mobility was for a non-weight bearing period of 6 weeks followed by a partial-weight bearing period of 6 weeks before progressing to full-weight bearing. Post-operatively, the patient completed a comprehensive course of physiotherapy. At five months, he was able to walk for five miles over the course of a weekend. At six months, the patient was looking at phased return to work as a fire fighter. Radiographs taken at the time demonstrated evidence of healing to his inter-trochanteric fracture. At ten months, the patient was back to normal duties at work as a fire fighter.
Poyanli, Oguz S; Soylemez, Salih; Ozkut, Afsar T; Uygur, Esat; Kemah, Bahattin; Unal, Omer K
We assessed the accuracy of a new guide system that we developed to place lag screws in the proper position with the minimum number of attempts for operative treatment of trochanteric femoral fractures. A total of 55 consecutive trochanteric femoral fractures were treated with a cephalomedullary nail. The first 27 consecutive patients were treated with the standard operation (group A), while the new guide system was used in the last 28 consecutive patients (group B). The numbers of attempts to place K wires and the duration of surgery were noted. Accuracy of lag screw placement was evaluated by measuring the angle of deviation from the central axis of the femoral head. Deviation values ranged from -11̊ to +15̊ for the 27 cases in group A, with a median absolute deviation of 8̊±6̊. That in the 28 cases after the introduction of the new guide system (group B) ranged from -5̊ to +6̊, with a median absolute deviation of 0.5̊±3̊ (Pfractures. The present study indicated that this new guide system and nail facilitate accurate placement of lag screws in the appropriate position with the minimum number of attempts. Copyright © 2015 Elsevier Ltd. All rights reserved.
Jose V. León-Hernández
Full Text Available ABSTRACT Background Dry needling (DN and percutaneous electrical nerve stimulation (PENS are widely used techniques in the treatment of myofascial pain. Objective To investigate the immediate and short-term effects of the combination of DN and PENS compared to DN alone on the upper trapezius muscle. Method This is a 72-hour follow-up single-blinded randomized controlled trial. Sixty-two volunteer patients with chronic myofascial neck pain with active Myofascial Trigger Points (MTrPs in the upper trapezius muscle were recruited. Randomization was performed, and 31 patients received DN treatment (DN group and 31 received DN and PENS (DN+PENS group. The primary outcomes were neck disability index (NDI and visual analog scale for pain for both post-needling soreness (PNS and neck pain intensity (NPI. Pressure pain threshold (PPT and cervical range of motion (CROM were the secondary outcomes. Results We detected between-group differences in NPI and PNS in favor of the DN+PENS group immediately after treatment. No between-group differences in NDI were observed. Conclusion PENS application after dry needling treatment is more effective than dry needling alone for decreasing soreness in the short term and improving neck pain intensity immediately in patients with myofascial chronic neck pain.
León-Hernández, Jose V; Martín-Pintado-Zugasti, Aitor; Frutos, Laura G; Alguacil-Diego, Isabel M; de la Llave-Rincón, Ana I; Fernandez-Carnero, Josue
Dry needling (DN) and percutaneous electrical nerve stimulation (PENS) are widely used techniques in the treatment of myofascial pain. To investigate the immediate and short-term effects of the combination of DN and PENS compared to DN alone on the upper trapezius muscle. This is a 72-hour follow-up single-blinded randomized controlled trial. Sixty-two volunteer patients with chronic myofascial neck pain with active Myofascial Trigger Points (MTrPs) in the upper trapezius muscle were recruited. Randomization was performed, and 31 patients received DN treatment (DN group) and 31 received DN and PENS (DN+PENS group). The primary outcomes were neck disability index (NDI) and visual analog scale for pain for both post-needling soreness (PNS) and neck pain intensity (NPI). Pressure pain threshold (PPT) and cervical range of motion (CROM) were the secondary outcomes. We detected between-group differences in NPI and PNS in favor of the DN+PENS group immediately after treatment. No between-group differences in NDI were observed. PENS application after dry needling treatment is more effective than dry needling alone for decreasing soreness in the short term and improving neck pain intensity immediately in patients with myofascial chronic neck pain.
León-Hernández, Jose V.; Martín-Pintado-Zugasti, Aitor; Frutos, Laura G.; Alguacil-Diego, Isabel M.; de la Llave-Rincón, Ana I.; Fernandez-Carnero, Josue
ABSTRACT Background Dry needling (DN) and percutaneous electrical nerve stimulation (PENS) are widely used techniques in the treatment of myofascial pain. Objective To investigate the immediate and short-term effects of the combination of DN and PENS compared to DN alone on the upper trapezius muscle. Method This is a 72-hour follow-up single-blinded randomized controlled trial. Sixty-two volunteer patients with chronic myofascial neck pain with active Myofascial Trigger Points (MTrPs) in the upper trapezius muscle were recruited. Randomization was performed, and 31 patients received DN treatment (DN group) and 31 received DN and PENS (DN+PENS group). The primary outcomes were neck disability index (NDI) and visual analog scale for pain for both post-needling soreness (PNS) and neck pain intensity (NPI). Pressure pain threshold (PPT) and cervical range of motion (CROM) were the secondary outcomes. Results We detected between-group differences in NPI and PNS in favor of the DN+PENS group immediately after treatment. No between-group differences in NDI were observed. Conclusion PENS application after dry needling treatment is more effective than dry needling alone for decreasing soreness in the short term and improving neck pain intensity immediately in patients with myofascial chronic neck pain. PMID:27410163
Jokinen, Heikki; Pulkkinen, Pasi; Korpelainen, Juha; Heikkinen, Jorma; Keinänen-Kiukaanniemi, Sirkka; Jämsä, Timo; Korpelainen, Raija
We evaluated the contribution of lifestyle-related factors, calcaneal ultrasound, and radial bone mineral density (BMD) to cervical and trochanteric hip fractures in elderly women in a 10-year population-based cohort study. The study population consisted of 1,681 women (age range 70-73 years). Seventy-two percent (n = 1,222) of them participated in the baseline measurements. Calcaneal ultrasound was assessed with a quantitative ultrasound device. BMD measurements were performed at the distal and ultradistal radius by dual-energy X-ray absorptiometry. Forward stepwise logistic regression analysis was used to find the most predictive variables for hip fracture risk. During the follow-up, 53 of the women had hip fractures, including 32 cervical and 21 trochanteric ones. The fractured women were taller and thinner and had lower calcaneal ultrasound values than those without fractures. High body mass index (BMI) was a protective factor against any hip fractures, while low functional mobility was a risk factor of hip fractures. Specifically, high BMI protected against cervical hip fractures, while low physical activity was a significant predictor of these fractures. Similarly, high BMI protected against trochanteric fractures, whereas low functional mobility and high coffee consumption were significant predictors of trochanteric fractures. Cervical and trochanteric hip fractures seem to have different risk factors. Therefore, fracture type should be taken into account in clinical fracture risk assessment and preventative efforts, including patient counseling. However, the study is not conclusive due to the limited number of observed fractures during follow-up, and the results have to be confirmed in future studies.
Background To investigate the differences in the characteristics of femoral neck and trochanteric fractures between urban and rural areas of Kyoto Prefecture in Japan. Methods Fracture type (neck vs. trochanteric), age, sex, place where fracture occurred (indoors vs. outdoors), and cause of injury were surveyed among patients aged ≥65 years who sustained hip fractures between 2008 and 2010 and who were treated at 1 of 13 participating hospitals (5 urban, 8 rural). The ratio of sick beds to total number of beds at the participating hospitals was 19.6% (2,188/11,158) in the urban area and 34.9% (1,963/5,623) in the rural area. We also investigated the incidence of hip fracture in Tango medical district as a representative rural area. Results There were 1,346 neck (mean age, 82.4 years) and 1,606 trochanteric fractures (mean age, 85.0 years). The ratio of neck to trochanteric fractures was higher in the urban area than in the rural area in all age groups (65–74, 75–84, and ≥ 85 years). There were no apparent differences in place or cause of injury. The incidence of hip fracture in the women of Tango medical district was lower than the national average. Conclusions There was a difference in the ratio of neck to trochanteric fractures between urban and rural areas. This difference is estimated to be caused by the high and low incidence of neck fracture in urban and rural areas, respectively. PMID:24156244
Pascarella, R; Fantasia, R; Maresca, A; Bettuzzi, C; Amendola, L; Violini, S; Cuoghi, F; Sangiovanni, P; Cerbasi, S; Boriani, S; Tigani, D S
The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.
Zhen, Ping; Liu, Xing-Yan; Gao, Ming-Xuan; Tian, Qi
To investigate the therapeutic effect and operative characteristic of the anatomic plate and trapezoid plate for treament of the comminuted intertrochanteric fracture combined with trochanteric coronal position fracture. From Jan. 1998 to Mar. 2007, 57 patients suffered from comminuted intertrochanteric fracture combined with trochanteric coronal position fracture were randomly divided into two groups, 21 patients in trapezoid plate group were treated with the trapezoid compression plate, included 11 males and 10 females with an average age of 41.8 years; and 36 patients in anatomic plate group were treated with the anatomic plate, included 17 males and 19 females with an average age of 42.1 years. All of the 57 fractures were A3 type according to AO classification. The functions of hip joints were evaluated according to the Harris hip functional standard score. All 57 patients were followed-up for 5 months to 9 years and 3 months with an average of 4.8 years. The healing time of the fractures was from 8 to 20 weeks with an average of 12.8 weeks. The results of Harris scoring showed the pain scores of the anatomic plate group were higher than that of the trapezoid plate group (P 0.05). In unstable comminuted intertrochanteric fracture combined with trochanteric coronal position fracture, the lateral wall of trochanteric is often destroyed. The anatomic plate and the trapeziod compression plate can provide effective internal fixation, while many othere internal fixation methods were limited in this kind of fracture. As compared with the anatomic plate fixation, the trapezoid compression plate fixation of comminuted intertrochanteric fracture combined with trochanteric coronal position fracture have several advantages, such as fewer complications, faster union of fracture and earlier recovery of joint functions.
Martín-Pintado-Zugasti, Aitor; López-López, Almudena; González Gutiérrez, Jose Luis; Pecos-Martín, Daniel; Rodríguez-Fernández, Ángel Luis; Alguacil-Diego, Isabel María; Gallego-Izquierdo, Tomás; Fernández-Carnero, Josue
Myofascial trigger point dry needling is frequently associated with postneedling soreness, which can generate patient dissatisfaction and reduced treatment adherence. Psychological factors may influence the perception of postneedling soreness and the effectiveness of postneedling soreness treatments. The objectives of the present study were to determine whether catastrophizing, kinesiophobia, pain anxiety, and fear of pain are significant predictors of postneedling soreness over time; and to analyze whether the relationships between psychological variables and postneedling soreness vary as a function of the postneedling soreness intervention, which included ischemic compression, placebo or control (without treatment). Repeated-measures observational study nested within a randomized controlled trial. University community. Healthy volunteers (N = 90; 40 men and 50 women) 18 to 39 years of age (mean ± standard deviation 22 ± 3 years). Catastrophizing, kinesiophobia, pain anxiety, and fear of pain were evaluated as possible predictors of postneedling pain before dry needling in a latent myofascial trigger point in the upper trapezius muscle. Participants were then divided into a treatment group that received ischemic compression as a postneedling intervention, a placebo group that received sham ischemic compression, and a control group that did not receive any treatment. Pain during needling and postneedling soreness were quantified using a visual analogue scale during needling, after treatment, and at 6, 12, 24, and 48 hours. A multilevel analysis revealed that individuals who exhibited more catastrophic thinking showed less postneedling soreness intensity immediately after needling in all participants (β = -0.049). Pain-related anxiety was linked to greater immediate postneedling soreness in the compression condition (β = 0.057). Finally, participants who exhibited more catastrophic thinking showed a slower rate of decline in postneedling soreness levels over
Temiz, Aytun; Durak, Aslihan; Atici, Teoman
To evaluate clinical-functional and radiological results of geriatric patients with unstable intertrochanteric femur fracture treated with intramedullary nail. Thirty-two patients treated with intramedullary nail (DLT trochanteric nail) due to unstable intertrochanteric femur fractures were reviewed retrospectively. Fractures 31-A2 and 31-A3 (AO classification) were evaluated. Operation time, blood loss, and blood transfusion requirements, hospitalization period, time to fracture union were evaluated and perioperative and postoperative complications were recorded. According to the modified Baumgaertner criteria fracture reduction was analyzed radiologically, and nail tip-apex distance was measured. Femoral neck-shaft angle was also evaluated. Harris Hip Score for clinical evaluation and Kyo criteria for walking capacity were used. The mean age was 72 years (65-81), mean follow up time was 18.3 months (12-26). Nineteen patients had type 31-A2 and 13 had type 31-A3 fractures. Mean operation time was 36.3min (25-45), blood loss 185.9ml (100-250). Blood transfusion was required in 7 patients. The average hospitalization duration was 6 days (4-14) while the time to surgery from admission was 2.9 days (2-6). Radiologically, in 21 of the cases fracture reduction was well (65.6%), acceptable in 9 (28.1%), and poor in 2 (6.3%). In early postoperative period, the mean collo-diaphyseal angle was 129.1° (120-140°), mean tip-apex distance was 15.5mm (10-27). The mean Harris Hip Score was 63.4 (38-90). Two patients (6.3%) had excellent, 21 patients (65.6%) had good, 7 patients (21.8%) had moderate, and 2 patients (6.3%) had poor results. Walking capacity in the last follow-up in 20 of the cases (62.5%) was pre-fracture level. While complications were observed in seventeen patients (53.1%) (5 superficial wound infections, 5 fractures of the greater trochanter, 3 cases of secondary varus angulation and 4 cases of heterotopic ossification) none of them required additional surgery
: 12–75 months. Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest, and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Conclusion: Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture. Keywords: ASA, femoral fracture, Harris score, proximal femoral nail
Barquet, Antonio; Mayora, Gabriel; Guimaraes, Joao Matheus; Suárez, Roberto; Giannoudis, Peter V
Avascular necrosis of the femoral head (ANFH) following trochanteric fractures (TFx) is infrequent. The causal relationship between ANFH and TFx remains controversial. Although several major risk factors for ANFH have been proposed, most of them remain under discussion. In this study we undertook a systematic review of the literature to investigate the incidence of AVN, risk factors and outcomes following Tfx fixation. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of ANFH and series of TFx with or without cases of ANFH published between inception of journals to December 2013 were eligible for inclusion. Relevant information was divided in two sections. Part I: included the analysis of detailed case reports of ANFH, either published isolated or included in series of TFx, with the objective of establishing potential risk factors, clinical and radiological presentation, time to development, treatment and outcome of this complication. Part II: analyzed series of TFx, which included cases of ANFH with or without details of aetiology, treatment modalities and outcomes, with the objective of assessing the incidence of ANFH in TFx. Overall 80 articles with 192 cases of ANFH after TFx met the inclusion criteria. The most probable developmental pathway appears to be a disruption of the extra osseous arterial blood supply to the femoral head. Suggested risk factors included high-energy trauma with fracture comminution and displacement, and an atypical course of the fracture line, more proximal, at the base of the neck. Most cases were diagnosed within the first two years after fracture. The clinical and radiological features appear to be similar to those of idiopathic avascular necrosis of the femoral head. The incidence of AVFH with a minimum of 1-year follow-up was calculated 0.95%, and with a minimum 2-year follow-up it was 1.37%. Total hip replacement was the mainstay of treatment. The
Full Text Available The aim of this study was to investigate the effect of natural Pomegranate juice supplementation on performance and acute and delayed responses of muscle soreness and biomarkers of muscle damage after a weightlifting training session.Nine elite weightlifters (21±0.5 years performed two Olympic-Weightlifting-sessions after either placebo (PLA or natural pomegranate juice (POMj supplementations. Heart rate, blood pressure and blood samples (hematological parameters, muscle damage and C-reactive protein (CRP were collected at rest, 3min and 48h after each session. Weightlifting performance, RPE, and DOMS were also assessed after each training session.T-test showed higher performance (+8.30% and lower RPE values (-4.37% using POMj supplementation (p0.05. Additionally, during the 48h following the training session, POMj improved the recovery kinetic of SBP (p<0.01, 7.97%, CK (p<0.001, 11.34%, LDH (p<0.05, 7.30% and ASAT (p<0.05, 6.77%. Indeed, the present study showed that 48h of recovery associated to natural POMj supplementation was sufficient to reach the resting values of the selected muscle damage markers after intensive training session.Natural POMj seems to ameliorate the capacity to adhere to an intensive training program. Therefore, elite weightlifters are advised to use natural POMj during intensive training program and competition to accelerate muscle recovery.ClinicalTrials.gov NCT02697903.
Ammar, Achraf; Turki, Mouna; Chtourou, Hamdi; Hammouda, Omar; Trabelsi, Khaled; Kallel, Choumous; Abdelkarim, Osama; Hoekelmann, Anita; Bouaziz, Mohamed; Ayadi, Fatma; Driss, Tarak; Souissi, Nizar
Purpose The aim of this study was to investigate the effect of natural Pomegranate juice supplementation on performance and acute and delayed responses of muscle soreness and biomarkers of muscle damage after a weightlifting training session. Methods Nine elite weightlifters (21±0.5 years) performed two Olympic-Weightlifting-sessions after either placebo (PLA) or natural pomegranate juice (POMj) supplementations. Heart rate, blood pressure and blood samples (hematological parameters, muscle damage and C-reactive protein (CRP)) were collected at rest, 3min and 48h after each session. Weightlifting performance, RPE, and DOMS were also assessed after each training session. Results T-test showed higher performance (+8.30%) and lower RPE values (-4.37%) using POMj supplementation (p0.05). Additionally, during the 48h following the training session, POMj improved the recovery kinetic of SBP (p<0.01, 7.97%), CK (p<0.001, 11.34%), LDH (p<0.05, 7.30%) and ASAT (p<0.05, 6.77%). Indeed, the present study showed that 48h of recovery associated to natural POMj supplementation was sufficient to reach the resting values of the selected muscle damage markers after intensive training session. Conclusion Natural POMj seems to ameliorate the capacity to adhere to an intensive training program. Therefore, elite weightlifters are advised to use natural POMj during intensive training program and competition to accelerate muscle recovery. Trial Registration ClinicalTrials.gov NCT02697903 PMID:27764091
Conclusion: Use of cryotherapy after exercise with eccentric contractions was effective to reestablish the level of biochemical markers of muscle damage and reduce muscle soreness and pain perception in subjects submitted to downhill running.
Nafiseh Shokri Mashhadi
Conclusions: Administration of ginger and cinnamon in athlete women for six weeks did not show any significant change in the IL-6 level, but showed a decrease in muscle soreness in the cinnamon and ginger groups.
Alex C. HOLLIDAY
Full Text Available The sociocultural phenomenon of herpes is attributed to two strains of the herpes simplex virus: herpes simplex virus type 1 (HSV-1 causes orolabial cold sores while herpes simplex virus type 2 (HSV-2 is typically identified in genital lesions, though both viruses may cause clinically similar signs and symptoms anywhere in or on the body. While these infections are extremely prevalent and typically benign, media sources such as film have perpetuated a negative public perception of the disease. Thus, a large portion of society continues to associate these conditions with sexual misconduct and moral failing. Despite decades of available antiviral therapy to shorten and suppress outbreaks, movies continue to exploit herpes for degradation and for humor. Portrayal of genital herpes in films is avoided in order to avert unnecessary and grotesque nude scenes, so depictions of cold sores are preferred. This article analyzes the use of orolabial herpes lesions in selected English language films released from 1984-2012.
Alex C. HOLLIDAY; Amanda SALIH; Richard F. Jr. WAGNER
[EN] The sociocultural phenomenon of herpes is attributed to two strains of the herpes simplex virus: herpes simplex virus type 1 (HSV-1) causes orolabial cold sores while herpes simplex virus type 2 (HSV-2) is typically identified in genital lesions, though both viruses may cause clinically similar signs and symptoms anywhere in or on the body. While these infections are extremely prevalent and typically benign, media sources such as film have perpetuated a negative public percep...
Chao Yen Chen
Full Text Available Although parties or get-togethers with alcoholic beverages after sporting competitions are popular, studies on the effects of alcohol ingestion after strenuous exercise on muscle damage and inflammation in non-drinkers’ are few and ambiguous. Therefore, the aim of this study was to investigate the effects of alcohol ingestion during recovery from an acute bout of exercise on muscle soreness and inflammatory markers in regular exercisers who do not regularly consume alcohol. Male participants (n = 15 completed two bouts of exercise on a rowing ergometer for 2000 m in a randomized fashion. All participants ingested 5 mL of alcoholic (AL or placebo (PL beverage per kg of body weight within 10 min post-exercise. Blood samples for blood alcohol, creatine kinase (CK, C-reactive protein (CRP, and interleukin (IL-6 concentrations were collected pre-exercise (T0, and at 1 (T1, 3 (T2, and 24 h (T3 post-ingestion. Self-reported muscle soreness was assessed at the same time points. Lactate levels were measured before exercise and within 1 h post-exercise. Muscle soreness was significantly lower in the AL than the PL trials at T3 (p < 0.05. Although CK, IL-6 and CRP levels were significantly higher during recovery than before exercising, there was no significant difference between the AL and PL trials. In addition, no significant difference in lactate concentrations between the two trials was evident in the 1 h after exercise. For regular exercisers, the alcoholic beverage ingested did not increase CK, IL-6, or CRP compared to their placebo trial, despite attenuated muscle soreness. Comparisons between drinkers and non-drinkers of high fitness ingesting permissible alcohol doses should be performed in the future. Keywords: alcohol, inflammation, strenuous exercise, muscle damage
Ding Meng, Dong Xiaosheng, Wang Xuhui, Wang Xu, Zhang Xijin
The objective of this study was to investigate the effects of suspended moxibustion upon tender point on delayed onset muscle soreness. The study was a randomized double-blind controlled trial with 50 subjects in each group. Subjects in moxibustion group received suspended moxibustion upon tender point (by palpation) twice. The controls received no treatment. Each subject received treatments twice, 24 hr and 48 hr after the delayed onset muscle soreness induction. The measurements of Pain Vis...
Ormsbee, Michael J; Ward, Emery G; Bach, Christopher W; Arciero, Paul J; McKune, Andrew J; Panton, Lynn B
The effects of multi-ingredient performance supplements (MIPS) on perceived soreness, strength, flexibility and vertical jump performance following eccentric exercise are unknown. The purpose of this study was to determine the impact of MIPS (NO-Shotgun?) pre-loaded 4?weeks prior to a single bout of downhill running (DHR) on muscle soreness and performance. Trained male runners (n?=?20) were stratified by VO2max, strength, and lean mass into two groups; MIPS (n?=?10) ingested one serving dail...
Janssen, T. W J; De Koning, A.; Legemate, K. J A; Smit, C. A J
Individuals with spinal cord injury (SCI) are at high risk of developing pressure sores, in part due to high sitting pressures under the buttocks. PURPOSE: To evaluate the effect of ES-induced activation of the gluteal and hamstring muscles on the sitting pressure in individuals with SCI. METHODS:
Jeon, Hye-Seon; Kang, Sun-Young; Park, Joo-Hee; Lee, Hyun-Sook
to compare the effects of pulsed electromagnetic field (PEMF) therapy and sham treatment on DOMS-related variables in elbow flexors at 24, 48 and 72 h after delayed onset muscle soreness (DOMS) induction exercise. randomized, double-blind, placebo-controlled study. Yonsei University laboratory. In total, 30 healthy male college students. Muscle soreness, peak torque, median frequency (MDF) and electromechanical delay (EMD) during isometric contraction at 24, 48 and 72 h after DOMS induction exercise. Overall, the application of the PEMF was found to be effective in reducing the physiological deficits associated with DOMS, including improved recovery of perceived muscle soreness, MDF, and EMD during isometric contraction. Our results did not show that PEMF treatment was mechanically more effective for isometric peak torque generation compared to the sham group. this study indicates that PEMF may be useful as a modality to reduce DOMS symptoms. However, further well-designed experiments are required to determine optimal treatment dosage and duration, and to investigate the physiological and clinical mechanisms of PEMF on DOMS. Copyright © 2014 Elsevier Ltd. All rights reserved.
Kim, Seung Kyun; Kim, Myung Chul
[Purpose] The purpose of this study was to evaluate whether ultrasound alone or ultrasound with bee venom is effective in treating delayed onset muscle soreness of the biceps brachii muscle, using the visual analogue scale, range of motion test (flexion and extension), and serum creatine kinase level. [Subjects] Twenty women participated in this study. [Methods] Repeated eccentric contractions were used to induce delayed onset muscle soreness in the elbow flexor of the subjects. The subjects were randomized to be treated with ultrasound alone or ultrasound with bee venom. We evaluated the effects of treatments in the 2 groups. Individual subjects were assessed using the visual analogue scale, range of motion test, and serum creatine kinase level. The assessment parameters were evaluated 4 times: before exercise and 24, 48, and 72 hours after exercise. [Results] The visual analogue scale scores were significantly different before and after the experiment in both the group treated with ultrasound and the group treated with ultrasound and bee venom. The difference in elbow flexion and extension before and after the experiment was significantly different in both groups. No significant difference was found in the serum creatine kinase levels before and after the experiment. [Conclusion] Treatment with ultrasound and bee venom is effective for managing delayed onset muscle soreness.
Mashhadi, Nafiseh Shokri; Ghiasvand, Reza; Askari, Gholamreza; Feizi, Awat; Hariri, Mitra; Darvishi, Leila; Barani, Azam; Taghiyar, Maryam; Shiranian, Afshin; Hajishafiee, Maryam
Ginger rhizomes (rich in gingerols, shogaols, paradols and zingerone) have been used in Asia for the treatment of asthma, diabetes, and pain, and have shown potent anti-inflammatory attributes. Common spices such as Cinnamon (including cinnamic aldehyde and cinnamyl aldehydeis) are used in food and many studies have focused on its anti-inflammatory components. Intense exercise can result in an inflammatory response to cell damage and also muscle soreness. The efficacy of dietary ginger and cinnamon as anti-inflammatory agents and their effectiveness in reducing muscle soreness has been investigated in limited studies on humans. Therefore, we have studied the effects of dietary ginger and cinnamon on inflammation and muscle soreness in Iranian female taekwondo players. Sixty healthy, trained women, aged 13-25 years, were enrolled in the six-week investigation and randomly categorized into three groups (cinnamon, ginger or placebo) and received 3 g of ginger, cinnamon or placebo powder each day, depending on the group they belonged to. The IL-6 level and Likert Scale of Muscle Soreness were evaluated at the beginning and the end of the study and compared among the groups. Forty-nine of the participants completed the six-week intervention. There were no significant changes in the IL-6 cinnamon and ginger group when compared with the placebo group, whereas, there was a significant fall in muscle soreness in the cinnamon group and placebo (P soreness in the cinnamon and ginger groups.
Meng, Ding; Xiaosheng, Dong; Xuhui, Wang; Xu, Wang; Xijin, Zhang
The objective of this study was to investigate the effects of suspended moxibustion upon tender point on delayed onset muscle soreness. The study was a randomized double-blind controlled trial with 50 subjects in each group. Subjects in moxibustion group received suspended moxibustion upon tender point (by palpation) twice. The controls received no treatment. Each subject received treatments twice, 24 hr and 48 hr after the delayed onset muscle soreness induction. The measurements of Pain Visual Analog Scale, maximum isometric muscle strength and circumference were made immediately after delayed onset muscle soreness induction, before and after every treatment session and 72 hr after delayed onset muscle soreness induction. There were no significantly statistical differences between two groups at all measurement time points on maximum isometric muscle strength and circumference. However, the Pain Visual Analog Scale scores after first treatment session and 72 hr after delayed onset muscle soreness induction in moxibustion group was less than the control group, with significant difference (p soreness. However, results need to be cautiously interpreted because of the pilot character of this study. The suspended moxibustion has a potential effect of pain relief on DOMS from the analysis of the data of this study. A large sample size trial is needed to confirm the effect of the suspended moxibustion on DOMS in the future.
Li, Kainan; Zheng, Yingjie
To retrospectively evaluated Gamma nail internal fixation in the treatment of elderly patients with post-stroke hemiplegia experiencing trochanteric hip fracture. The patients were obtained consecutively from January 2005 to December 2010 with inclusion criteria. The total number was 138 and allocated to two groups: treated with the Gamma nail (n=72,group A) and continuous skin traction (n=66,group B). Preoperative variables including patient age, gender, duration of cerebrovascular accident, duration of hypertension, ASA risk score, Harris hip score and fracture type were recorded and compared. After treatment, time of patients activity on the bed, ambulation time, Harris hip score, mortality, complications were recorded and used to compare the outcomes. (1) Follow-up was undertaken from 3 to 10 years, with an average of 5.8 years. (2) No statistical difference in preoperative variables was found between the 2 groups. (3) two groups had statistical significance (P=0.000) in the time of patients activity on the bed and ambulation time and group A can activities on the bed and ambulates earlier. (4) There were significant differences between 2 groups in Harris hip score at 1 and 3 years and group A was significantly higher than group B. (5) there were statistically significant differences in mortality of 3 years, 5 years and 10 years and the group B was significantly higher than the group A. (6) There was a statistical significance in complications between 2 groups and group B was higher than group A. Major complications in group A were pain, lag screw cut out, implant infection and distal femoral fractures caused by fall after the surgery. On elderly patients with trochanteric hip fracture on the hemiplegic lower side, Gamma nail internal fixation treatment can achieve better effect, patients can be early activity, fewer complications, and less mortality. Copyright © 2016 Elsevier Ltd. All rights reserved.
Parker, M J; Cawley, S
To compare the outcomes for trochanteric fractures treated with a sliding hip screw (SHS) or a cephalomedullary nail. A total of 400 patients with a trochanteric hip fracture were randomised to receive a SHS or a cephalomedullary nail (Targon PFT). All surviving patients were followed up to one year from injury. Functional outcome was assessed by a research nurse blinded to the implant used. Recovery of mobility, as assessed by a mobility scale, was superior for those treated with the intramedullary nail compared with the SHS at eight weeks, three and nine months (p-values between 0.01 and 0.04), the difference at six and 12 months was not statistically significant (p = 0.15 and p = 0.18 respectively). The mean difference was around 0.4 points (0.3 to 0.5) on a nine point scale. Surgical time for the nail was four minutes less than that for the SHS (p Fracture healing complications were similar for the two groups. There were no statistically significant differences between implants for any other recorded outcomes including the need for post-operative blood transfusion, wound healing complications, general medical complications, hospital stay or mortality. This study confirms the findings of a previous study that both methods of treatment produce similar results, although intramedullary fixation does result in marginally improved regain of mobility in comparison with the SHS. Cite this article: Bone Joint J 2017;99-B:1210-15. ©2017 The British Editorial Society of Bone & Joint Surgery.
Norris, Rory; Bhattacharjee, Dhritiman; Parker, Martyn J
A sliding hip screw (SHS) is currently the treatment of choice for trochanteric hip fractures, largely due to the low incidence of complications. An alternative treatment is the use of intramedullary proximal femoral nails. Unfortunately these implants have been associated with a risk of later fracture around the implant. The aim of this study was to see if any improvements have been made to the current intramedullary nails, to reduce the incidence of secondary fracture around the distal tip of the nail. We analysed data related to 13,568 patients from 89 studies, focusing on the incidence of post operative secondary femoral shaft fracture following the use of intramedullary nails in the fixation of trochanteric hip fractures. The overall reported incidence of secondary fracture around the nail was 1.7%. The incidence of fracture has reduced in the 3rd generation Gamma nails when compared to the older Gamma nail (1.7% versus 2.6%, p value 0.03). However, the incidence of secondary fracture in the 3rd generation Gamma nails is still significantly higher than the other brands of short nail (1.7% versus 0.7%, p value 0.0005). Long nails had a slight tendency towards a lower risk of fracture although the difference was not statistically significant (1.1% versus 1.7%, p value 0.28). There was a significantly lower risk of fracture for those nails with a biaxial fixation as opposed to uniaxial fixation (0.6% versus 1.9%, p value fracture around a proximal femoral nail is one of the most significant of fracture healing complications, and this study suggests that continuing design changes to this method of fixation has reduced the risk of this complication occurring. Copyright © 2011 Elsevier Ltd. All rights reserved.
Caldwell, Aaron R; Tucker, Matthew A; Butts, Cory L; McDermott, Brendon P; Vingren, Jakob L; Kunces, Laura J; Lee, Elaine C; Munoz, Colleen X; Williamson, Keith H; Armstrong, Lawrence E; Ganio, Matthew S
Caldwell, AR, Tucker, MA, Butts, CL, McDermott, BP, Vingren, JL, Kunces, LJ, Lee, EC, Munoz, CX, Williamson, KH, Armstrong, LE, and Ganio, MS. Effect of caffeine on perceived soreness and functionality following an endurance cycling event. J Strength Cond Res 31(3): 638-643, 2017-Caffeine can reduce muscle pain during exercise; however, the efficacy of caffeine in improving muscle soreness and recovery from a demanding long-duration exercise bout has not been established. The purpose of this study was to investigate the effects of caffeine intake on ratings of perceived muscle soreness (RPMS) and perceived lower extremity functionality (LEF) following the completion of a 164-km endurance cycling event. Before and after cycling RPMS (1-to-6; 6 = severe soreness) and LEF (0-to-80; 80 = full functionality) were assessed by questionnaires. Subjects ingested 3 mg/kg body mass of caffeine or placebo pills in a randomized, double-blind fashion immediately after the ride and for the next 4 mornings (i.e., ∼800 hours) and 3 afternoons (i.e., ∼1200 hours). Before each ingestion, RPMS and LEF were assessed. Afternoon ratings of LEF were greater with caffeine ingestion the first day postride (65.0 ± 6.1 vs. 72.3 ± 6.7; for placebo and caffeine, respectively; p = 0.04), but at no other time points (p > 0.05). The caffeine group tended to have lower overall RPMS in the afternoon versus placebo (i.e., main effect of group; 1.1 ± 0.2 vs. 0.5 ± 0.2; p = 0.09). Afternoon RPMS for the legs was significantly lower in the caffeine group (main effect of caffeine; 1.3 ± 0.2 vs. 0.5 ± 0.3; p = 0.05). In conclusion, ingesting caffeine improved RPMS for the legs, but not LEF in the days following an endurance cycling event. Athletes may benefit from ingesting caffeine in the days following an arduous exercise bout to relieve feelings of soreness and reduced functionality.
Full Text Available Aim: When N2Ois used for general anaesthesia, it diffuses into the air-filled endotracheal cuff causing the cuff pressure to rise by over inflating the cuff, which results in tracheal damage. This study aimed to estimate changes in the endotracheal-cuff pressure with time during oxygen-air- and oxygen-N2O -induced anaesthesia and to determine its sore throat and hoarseness incidence. Methods: Fifty patients with American Society of Anesthesiologists physical status 1-2, aged 18-60 years were icluded to our study. Orotracheal intubation was performed using polyvinyl chloride high volume-low pressure endotracheal tubes. The AIR group 40% O2/60% air and N2O group 40% O2/60% N2O was used. The endotracheal cuff pressure at 5, 10, 15, 20 minutes immediately after intubation and at 10-minute intervals were recorded. When the cuff pressure reached 45 cm H2O, was attenuated to 25-30-cm H2O. At the post operative first and the 24th hour, the patients were queried for sore throat and hoarseness. Results: The N2O -group cuff pressure rose from the fifth minute onwards. Also, the N2O group had a higher incidence of sore throat and hoarseness. Conclusion: N2O results in elevated cuff pressure and tracheal morbidities. Cuff-pressure should be routinely monitored during anaesthesia using N2O.
Chesser, T J S; Fox, R; Harding, K; Halliday, R; Barnfield, S; Willett, K; Lamb, S; Yau, C; Javaid, M K; Gray, A C; Young, J; Taylor, H; Shah, K; Greenwood, R
We wished to assess the feasibility of a future randomised controlled trial of parathyroid hormone (PTH) supplements to aid healing of trochanteric fractures of the hip, by an open label prospective feasibility and pilot study with a nested qualitative sub study. This aimed to inform the design of a future powered study comparing the functional recovery after trochanteric hip fracture in patients undergoing standard care, versus those who undergo administration of subcutaneous injection of PTH for six weeks. We undertook a pilot study comparing the functional recovery after trochanteric hip fracture in patients 60 years or older, admitted with a trochanteric hip fracture, and potentially eligible to be randomised to either standard care or the administration of subcutaneous PTH for six weeks. Our desired outcomes were functional testing and measures to assess the feasibility and acceptability of the study. A total of 724 patients were screened, of whom 143 (20%) were eligible for recruitment. Of these, 123 were approached and 29 (4%) elected to take part. However, seven patients did not complete the study. Compliance with the injections was 11 out of 15 (73%) showing the intervention to be acceptable and feasible in this patient population. Only 4% of patients who met the inclusion criteria were both eligible and willing to consent to a study involving injections of PTH, so delivering this study on a large scale would carry challenges in recruitment and retention. Methodological and sample size planning would have to take this into account. PTH administration to patients to enhance fracture healing should still be considered experimental. Cite this article: Bone Joint J 2016;98-B:840-5. ©2016 Chesser et al.
Dunn, John; Kusnezov, Nicholas; Bader, Julia; Waterman, Brian R; Orr, Justin; Belmont, Philip J
Both long and short cephalomedullary nails (CMN) may be used to treat trochanteric femur fractures. The objective of this paper was to compare the clinical outcomes between long and short CMN in the treatment of trochanteric hip fractures. A literature search was performed, identifying 135 papers; 4 of which met inclusion and exclusion criteria. Papers included were those that compared cohorts of long and short nails for stable trochanteric femur fractures of level III evidence or superior. Data was pooled and analyzed, focusing on reoperation rate, secondary femoral shaft fracture rate, estimated blood loss, transfusion rate, operative time and length of stay. Included in the analysis were 1276 patients, with 438 short and 838 long CMN. The average age was 82.0 years for short CMN and 79.0 years for long CMN (P = 0.0002). The average follow up was 18 months, 46 % were male, and 71 % had an ASA (American Society of Anesthesiologists score) classification ≥3. The rate of reoperation was 5.0 % and 3.8 % for short and long CMN, respectively (P = 0.31). The rate of refracture was 1.6 % and 0.95 % for short and long CMN, respectively (P = 0.41). As compared to long nails, short nails had an average blood loss of 39 mL less (P = 0.0003), an 8.8 % decrease in transfusion rate (P = 0.07), and incurred 19 min less operative time (P trochanteric femur fractures, short CMN have a low reoperation rate while significantly decreasing operative time and estimated blood loss with the additional benefit of being cost effective. Level 3.
Horii, Motoyuki; Fujiwara, Hiroyoshi; Sakai, Ryo; Sawada, Koshiro; Mikami, Yasuo; Toyama, Syogo; Ozaki, Etsuko; Kuriyama, Nagato; Kurokawa, Masao; Kubo, Toshikazu
Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm 3 ), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius. There might be
Seyhan, Mustafa; Turkmen, Ismail; Unay, Koray; Ozkut, Afsar Timucin
To clinically and radiologically compare third-generation intramedullary nails used in the treatment of trochanteric hip fractures and to determine their efficacy. Seventy-five of 88 patients admitted to our hospital with trochanteric fractures were enrolled in the study; 43 were treated with PFNA devices and 32 with Intertan nails. The amount of compression applied during the procedure, duration of the procedure, amount of subsequent shortening in the proximal femoral area, subsequent backup of proximal screws, and changes in the tip-apex and tip-cortex distances were compared between groups. The postoperative change in the varus angle of the proximal femur and times to mobilization, full weight bearing, and fracture union were also evaluated. On early postoperative radiographs, the tip-apex distance was ≤25 mm in 86 % of patients in the PFNA group and 96.9 % of those in the Intertan group. Twelve months postoperatively, the tip-apex distance did not differ between groups. No cut-out of the screws into the coxofemoral joint was observed. Fracture healing was achieved in all patients. At 12 months postoperatively, the rates of proximal screw backup, proximal femoral shortening, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Trochanteric fractures may be treated effectively with PFNA devices or Intertan nails. During the healing period, the rates of reverse displacement of the proximal screw, shortening of the proximal femur, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Surgical technique, implant positioning, and the choice of implant play roles in the successful treatment of trochanteric fractures. Level 1, prospective, prognostic study.
Ligia Drovandi Braga Rotundo
Full Text Available Objectives: This study aimed to assess the hypothesis that recurrent denture-related sores association may be associated with the risk of oral cancer. Methods: We conducted a hospital-based case-control study comprising 71 new cases of oral cancer in two hospitals in São Paulo, Brazil, and 240 controls without cancer, recruited from outpatient units of the same hospitals. All cases had histologically confirmed squamous cell carcinoma in anatomic sites of the mouth that may be specifically consi-dered at risk of sores by ill-fitting dentures. Denture-related sores were assessed by the self-report of recurrent oral sores due to the use of ill-fitting complete removable dental prosthesis. Associations were assessed by multivariate logistic regression conditioned on socio-demographic and behavioral characteristics. Results: The association between ill-fitting dentures and oral cancer was statistically significant in the multivariate model: odds ratio 3.98; 95% confidence interval 1.06 - 14.96. The specific assessment of association between tumors in the lower jaw and sores by mandibular dentures confirmed this result: odds ratio 6.39; 95% confidence interval 1.49 - 29.52. Conclusion: The potential contribution of denture-related sores to oral carcinogenesis still fuels controversies. This study reinfor-ces the hypothesis that recurrent denture-related sores may be associated with the risk of oral cancer. Results reported here also suggest that an appropriate application and monitoring of dental prosthesis represent a non-negligible scope for cancer prevention.
Fletcher, Ben D; Twist, Craig; Haigh, Julian D; Brewer, Clive; Morton, James P; Close, Graeme L
Rugby League (RL) is a high-impact collision sport characterised by repeated sprints and numerous high-speed impacts and consequently players often report immediate and prolonged muscle soreness in the days after a match. We examined muscle soreness after matches during a full season to understand the extent to which match characteristics influence soreness. Thirty-one elite Super League players provided daily measures of muscle soreness after each of the 26 competitive fixtures of the 2012 season. Playing position, phase of the season, playing surface and match characteristics were recorded from each match. Muscle soreness peaked at day 1 and was still apparent at day 4 post-game with no attenuation in the magnitude of muscle soreness over the course of the season. Neither playing position, phase of season or playing surface had any effects on the extent of muscle soreness. Playing time and total number of collisions were significantly correlated with higher ratings of muscle soreness, especially in the forwards. These data indicate the absence "contact adaptations" in elite rugby players with soreness present throughout the entire season. Strategies must now be implemented to deal with the physical and psychological consequences of prolonged feeling of pain.
Kelli A. Herrlinger
Full Text Available Background: Exercise can initiate a cascade of inflammatory and oxidative stress–related events leading to delayed onset muscle soreness. Polyphenols possess antioxidant and anti-inflammatory properties. Objective: The current study examined the effects of a proprietary polyphenolic blend (PB, containing catechins and theaflavins, on exercise performance and recovery following an eccentric exercise challenge. Design: Male participants (18–35 years of age received placebo or PB at a low dose (PB-L, 1,000 mg/d or high dose (PB-H, 2,000 mg/d for 13 weeks. During the 13th week of supplementation, participants completed an eccentric exercise (40 min downhill treadmill run followed by a strength assessment (peak torque on isokinetic leg extensions pre-exercise, and 24, 48, and 96 h post-exercise. Muscle soreness (subjective questionnaire, markers of muscle stress (cortisol and creatine phosphokinase [CK], and antioxidant capacity (ferric reducing ability of plasma [FRAP] were also assessed. Results: PB-H attenuated the decrease in peak torque observed in the placebo group from pre-exercise to 48 h (p=0.012 and 96 h (p=0.003 post-exercise. At 48 h post-exercise, PB-H reduced whole body and hamstring soreness (p=0.029 versus placebo. Chronic consumption of PB improved serum FRAP (p=0.039. As expected, serum cortisol and CK increased from pre- to post-exercise in all groups; however, by 96 h, cortisol and CK levels returned to pre-exercise levels following PB supplementation. At 96 h, the change in cortisol from pre- to post-exercise was significantly greater in placebo versus PB-H (p=0.039. Conclusion: These findings show that chronic consumption of PB improved antioxidant status, reduced markers of muscle stress, and promoted strength recovery post-exercise.
Herrlinger, Kelli A; Chirouzes, Diana M; Ceddia, Michael A
Exercise can initiate a cascade of inflammatory and oxidative stress-related events leading to delayed onset muscle soreness. Polyphenols possess antioxidant and anti-inflammatory properties. The current study examined the effects of a proprietary polyphenolic blend (PB), containing catechins and theaflavins, on exercise performance and recovery following an eccentric exercise challenge. Male participants (18-35 years of age) received placebo or PB at a low dose (PB-L, 1,000 mg/d) or high dose (PB-H, 2,000 mg/d) for 13 weeks. During the 13th week of supplementation, participants completed an eccentric exercise (40 min downhill treadmill run) followed by a strength assessment (peak torque on isokinetic leg extensions) pre-exercise, and 24, 48, and 96 h post-exercise. Muscle soreness (subjective questionnaire), markers of muscle stress (cortisol and creatine phosphokinase [CK]), and antioxidant capacity (ferric reducing ability of plasma [FRAP]) were also assessed. PB-H attenuated the decrease in peak torque observed in the placebo group from pre-exercise to 48 h (p=0.012) and 96 h (p=0.003) post-exercise. At 48 h post-exercise, PB-H reduced whole body and hamstring soreness (p=0.029) versus placebo. Chronic consumption of PB improved serum FRAP (p=0.039). As expected, serum cortisol and CK increased from pre- to post-exercise in all groups; however, by 96 h, cortisol and CK levels returned to pre-exercise levels following PB supplementation. At 96 h, the change in cortisol from pre- to post-exercise was significantly greater in placebo versus PB-H (p=0.039). These findings show that chronic consumption of PB improved antioxidant status, reduced markers of muscle stress, and promoted strength recovery post-exercise.
Guo, Jianmin; Li, Linjin; Gong, Yuxiang; Zhu, Rong; Xu, Jiake; Zou, Jun; Chen, Xi
Purpose: The purpose of this systematic review and meta-analysis was to evaluate the effects of massage on alleviating delayed onset of muscle soreness (DOMS) and muscle performance after strenuous exercise. Method: Seven databases consisting of PubMed, Embase, EBSCO, Cochrane Library, Web of Science, CNKI and Wanfang were searched up to December 2016. Randomized controlled trials (RCTs) were eligible and the outcomes of muscle soreness, performance (including muscle maximal isometric force (MIF) and peak torque) and creatine kinase (CK) were used to assess the effectiveness of massage intervention on DOMS. Results: Eleven articles with a total of 23 data points (involving 504 participants) satisfied the inclusion criteria and were pooled in the meta-analysis. The findings demonstrated that muscle soreness rating decreased significantly when the participants received massage intervention compared with no intervention at 24 h (SMD: -0.61, 95% CI: -1.17 to -0.05, P = 0.03), 48 h (SMD: -1.51, 95% CI: -2.24 to -0.77, P < 0.001), 72 h (SMD: -1.46, 95% CI: -2.59 to -0.33, P = 0.01) and in total (SMD: -1.16, 95% CI: -1.60 to -0.72, P < 0.001) after intense exercise. Additionally, massage therapy improved MIF (SMD: 0.56, 95% CI: 0.21-0.90, P = 0.002) and peak torque (SMD: 0.38, 95% CI: 0.04-0.71, P = 0.03) as total effects. Furthermore, the serum CK level was reduced when participants received massage intervention (SMD: -0.64, 95% CI: -1.04 to -0.25, P = 0.001). Conclusion: The current evidence suggests that massage therapy after strenuous exercise could be effective for alleviating DOMS and improving muscle performance.
Full Text Available Delayed onset muscle soreness usually occurs after doing a new unusual physical activity, especially when, associated with repeated eccentric contractions and then it gradually disappears. There is not an extensive agreement in the case of treatment method of soreness signs quick reduction. This research was carried out with the aim of investigation caffeine consumption effect to find a good way in order to reduce the signs of delayed onset muscle soreness. In this semi-experimental with Double-blind design, 16 female volleyball player with an age average of 22.5+2.5 in 2 homogeneous 8 subject control and experimental group were studied. In this research, the effect of caffeine existing in coffee in 5 stages (24h before exercise, 12h before, immediately before exercise, after exercise and 12h after it and 1mg per 1kg of body weight on amount of perceived pain and range of motion of the joint and edema due to delay onset muscle soreness because of 50 jumps and lands of a 1 meter stage was investigated. The results showed that caffeine consumption has a meaningful effect on reduction of all the expressed signs after eccentric contractions. So it is recommended that physio thrapysts, doctors and athletes use this method to reduce delayed onset muscle soreness consequences after the injury.
Rocha, Clarice S; Lanferdini, Fábio J; Kolberg, Carolina; Silva, Marcelo F; Vaz, Marco A; Partata, Wania A; Zaro, Milton A
This study was undertaken to examine the acute effect of interferential current on mechanical pain threshold and isometric peak torque after delayed onset muscle soreness induction in human hamstrings. Forty-one physically active healthy male volunteers aged 18-33 years were randomly assigned to one of two experimental groups: interferential current group (n = 21) or placebo group (n = 20). Both groups performed a bout of 100 isokinetic eccentric maximal voluntary contractions (10 sets of 10 repetitions) at an angular velocity of 1.05 rad · s(-1) (60° · s(-1)) to induce muscle soreness. On the next day, volunteers received either an interferential current or a placebo application. Treatment was applied for 30 minutes (4 kHz frequency; 125 μs pulse duration; 80-150 Hz bursts). Mechanical pain threshold and isometric peak torque were measured at four different time intervals: prior to induction of muscle soreness, immediately following muscle soreness induction, on the next day after muscle soreness induction, and immediately after the interferential current and placebo application. Both groups showed a reduction in isometric torque (P interferential current group showed a significant increase in pain threshold (P = 0.002) with no changes in isometric torque. The results indicate that interferential current was effective in increasing hamstrings mechanical pain threshold after eccentric exercise, with no effect on isometric peak torque after treatment.
Kato, Hiroyuki; Suzuki, Hiromi; Mimura, Masako; Inoue, Yoshiko; Sugita, Mayu; Suzuki, Katsuya; Kobayashi, Hisamine
Eccentric exercise results in prolonged muscle weakness and muscle soreness, which are typical symptoms of muscle damage. Recovery from muscle damage is related to mammalian target of rapamycin (mTOR) activity. Leucine-enriched essential amino acids (LEAAs) stimulate muscle protein synthesis via activation of the mTOR pathway. Therefore, we investigated the effect of LEAAs on muscle protein synthesis and muscle soreness after eccentric contractions (EC). Male Sprague-Dawley rats (9-11 weeks old) were administered an LEAA solution (AminoL40; containing 40 % leucine and 60 % other essential amino acids) at 1 g/kg body weight or distilled water (control) 30 min before and 10 min after EC. Tibialis anterior (TA) muscle was exposed to 500 EC by electrical stimulation under anesthesia. The fractional synthesis rate (FSR; %/h) in the TA muscle was measured by incorporating L-[ring-(2)H5] phenylalanine into skeletal muscle protein. Muscle soreness was evaluated by the paw withdrawal threshold using the Randal-Selitto test with some modifications from 1 to 3 days after EC. The FSR in the EC-control group (0.147 ± 0.016 %/h) was significantly lower than in the sedentary group (0.188 ± 0.016 %/h, p soreness. Furthermore, AminoL40 administration alleviated the decreased paw withdrawal threshold. These findings suggest that LEAA supplementation improves the rate of muscle protein synthesis and ameliorates muscle soreness after eccentric exercise.
Ormsbee, Michael J; Ward, Emery G; Bach, Christopher W; Arciero, Paul J; McKune, Andrew J; Panton, Lynn B
The effects of multi-ingredient performance supplements (MIPS) on perceived soreness, strength, flexibility and vertical jump performance following eccentric exercise are unknown. The purpose of this study was to determine the impact of MIPS (NO-Shotgun®) pre-loaded 4 weeks prior to a single bout of downhill running (DHR) on muscle soreness and performance. Trained male runners (n = 20) were stratified by VO2max, strength, and lean mass into two groups; MIPS (n = 10) ingested one serving daily of NO-Shotgun® for 28 days and 30 min prior to all post-testing visits, Control (CON; n = 10) consumed an isocaloric maltodextrin placebo in an identical manner as MIPS. Perceived soreness and performance measurements (strength, flexibility, and jump height) were tested on 6 occasions; 28 days prior to DHR, immediately before DHR (PRE), immediately post (POST) DHR, 24, 48, and 72 hr post-DHR. Perceived soreness significantly increased (p soreness, muscle damage, strength, flexibility, or jump performance compared to an isocaloric placebo in trained male runners following a single bout of DHR.
McBrier, Nicole M; Vairo, Giampietro L; Bagshaw, Dee; Lekan, Jaimy M; Bordi, Peter L; Kris-Etherton, Penny M
The purpose of this pragmatic preliminary analysis was to examine the effectiveness of a cocoa-based protein and carbohydrate prototype drink on skeletal muscle damage and perceived soreness after exhaustive exercise. A repeated-measures experimental design was used. Common biomarkers indicative of skeletal muscle damage included creatine kinase (CK), urinary isoprostanes and inflammatory markers (IL-6, IL-8, C-Reactive Protein [CRP]). Self-reported perception of postexercise soreness was also evaluated. Seven men participated in an exercise session consisting of a 30-minute run on a declined treadmill (-10% grade). Running speed was adjusted accordingly so that participants consistently maintained 75% maximal heart rate. Drinks were ingested immediately after exercise, 2 hours postexercise, and before bed. Blood draws were sampled 30, 60, 120, and 360 minutes postexercise; urine was collected 24 and 48 hours postexercise. A perceived soreness questionnaire was administered 24 and 48 hours postexercise. The test drink had no effect on IL-6, CK, IL-8, CRP, or urinary isoprostanes (p > 0.05). However, the drink decreased the change in perceived soreness from 24 to 48 hours (p = 0.03). Consuming the drink after exercise resulted in a mean change of 2.6 +/- 6 compared to 13.7 +/- 10 for the control. In summary, the drink was effective in decreasing the level of self-reported perceived soreness after exhaustive exercise.
Al-Nakhli, Hani H; Petrofsky, Jerrold S; Laymon, Michael S; Berk, Lee S
Delayed onset muscle soreness (DOMS), also known as exercise induced muscle damage (EIMD), is commonly experienced in individuals who have been physically inactive for prolonged periods of time, and begin with an unexpected bout of exercise, but can also occur in athletes who exercise beyond their normal limits of training. The symptoms associated with this painful phenomenon can range from slight muscle tenderness, to severe debilitating pain. The intensity of these symptoms and the related discomfort increases within the first 24 hours following the termination of the exercise, and peaks between 24 to 72 hours post exercise. For this reason, DOMS is one of the most common recurrent forms of sports injury that can affect an individual's performance, and become intimidating for many. For the last 3 decades, the DOMS phenomenon has gained a considerable amount of interest amongst researchers and specialists in exercise physiology, sports, and rehabilitation fields. There has been a variety of published studies investigating this painful occurrence in regards to its underlying mechanisms, treatment interventions, and preventive strategies. However, it is evident from the literature that DOMS is not an easy pathology to quantify, as there is a wide amount of variability between the measurement tools and methods used to quantify this condition. It is obvious that no agreement has been made on one best evaluation measure for DOMS, which makes it difficult to verify whether a specific intervention really helps in decreasing the symptoms associated with this type of soreness or not. Thus, DOMS can be seen as somewhat ambiguous, because many studies depend on measuring soreness using a visual analog scale (VAS), which is a subjective rather than an objective measure. Even though needle biopsies of the muscle, and blood levels of myofibre proteins might be considered a gold standard to some, large variations in some of these blood proteins have been documented, in addition
Serinken, Mehmet Akif; Gençoğlu, Celal; Kayatekin, Berkant Muammer
Background: Eccentric exercise is defined as a type of exercise in which the muscle produces power by extending. In contrast to isometric and concentric exercises, eccentric muscle activity is much more effective mechanically; however, it may expose the muscle to soreness. Delayed-Onset Muscle Soreness (DOMS) emerges a couple of hours after an eccentric activity, especially in individuals who are not used to this kind of exercise, and causes a temporary decrease in muscle performance, joint movement angle and muscle power, and also a temporary increase in the blood creatine kinase (CK) activity. Aims: This study investigates the effect of DOMS on the upper extremities motor performance by conducting an eccentric exercise load on the elbow flexor muscles. Study design: Cross sectional study. Methods: The study included 10 wheelchair basketball players. First, the participants underwent blood CK activity, positioning sense, muscle pain, shooting performance measurements tests at the base, and after 30 minutes and 24 and 48 hours. Then, one week later, the one-repetition-maximums of biceps curls were determined in order to define the intensity of the eccentric exercise. An eccentric exercise protocol which would cause DOMS was applied to all players. All tests were replaced with acute exhaustive eccentric exercise; the same tests were repeated in the same order after the exercise. Blood CK activity was measured by taking an earlobe capillary blood sample. The muscle pain level was measured by using a Visual Analogue Scale (VAS). Positioning sense loss was assessed via goniometer at 30º, 60° and 90° degrees horizontally. Results: The study found a statistically significant increase in blood CK activity and positioning sense loss, and a decrease in the pressure-pain threshold, as well as the shooting percentages in the exercise group when compared with the control. Conclusion: These findings suggest that DOMS negatively affects the upper extremities motor performance
Mehmet Akif Serinken
Full Text Available Background: Eccentric exercise is defined as a type of exercise in which the muscle produces power by extending. In contrast to isometric and concentric exercises, eccentric muscle activity is much more effective mechanically; however, it may expose the muscle to soreness. Delayed-Onset Muscle Soreness (DOMS emerges a couple of hours after an eccentric activity, especially in individuals who are not used to this kind of exercise, and causes a temporary decrease in muscle performance, joint movement angle and muscle power, and also a temporary increase in the blood creatine kinase (CK activity. Aims: This study investigates the effect of DOMS on the upper extremities motor performance by conducting an eccentric exercise load on the elbow flexor muscles. Study design: Cross sectional study. Methods: The study included 10 wheelchair basketball players. First, the participants underwent blood CK activity, positioning sense, muscle pain, shooting performance measurements tests at the base, and after 30 minutes and 24 and 48 hours. Then, one week later, the one-repetition-maximums of biceps curls were determined in order to define the intensity of the eccentric exercise. An eccentric exercise protocol which would cause DOMS was applied to all players. All tests were replaced with acute exhaustive eccentric exercise; the same tests were repeated in the same order after the exercise. Blood CK activity was measured by taking an earlobe capillary blood sample. The muscle pain level was measured by using a Visual Analogue Scale (VAS. Positioning sense loss was assessed via goniometer at 30º, 60º and 90º degrees horizontally. Results: The study found a statistically significant increase in blood CK activity and positioning sense loss, and a decrease in the pressure-pain threshold, as well as the shooting percentages in the exercise group when compared with the control. Conclusion: These findings suggest that DOMS negatively affects the upper extremities
Serinken, Mehmet Akif; Gençoğlu, Celal; Kayatekin, Berkant Muammer
Eccentric exercise is defined as a type of exercise in which the muscle produces power by extending. In contrast to isometric and concentric exercises, eccentric muscle activity is much more effective mechanically; however, it may expose the muscle to soreness. Delayed-Onset Muscle Soreness (DOMS) emerges a couple of hours after an eccentric activity, especially in individuals who are not used to this kind of exercise, and causes a temporary decrease in muscle performance, joint movement angle and muscle power, and also a temporary increase in the blood creatine kinase (CK) activity. This study investigates the effect of DOMS on the upper extremities motor performance by conducting an eccentric exercise load on the elbow flexor muscles. Cross sectional study. The study included 10 wheelchair basketball players. First, the participants underwent blood CK activity, positioning sense, muscle pain, shooting performance measurements tests at the base, and after 30 minutes and 24 and 48 hours. Then, one week later, the one-repetition-maximums of biceps curls were determined in order to define the intensity of the eccentric exercise. An eccentric exercise protocol which would cause DOMS was applied to all players. All tests were replaced with acute exhaustive eccentric exercise; the same tests were repeated in the same order after the exercise. Blood CK activity was measured by taking an earlobe capillary blood sample. The muscle pain level was measured by using a Visual Analogue Scale (VAS). Positioning sense loss was assessed via goniometer at 30º, 60° and 90° degrees horizontally. The study found a statistically significant increase in blood CK activity and positioning sense loss, and a decrease in the pressure-pain threshold, as well as the shooting percentages in the exercise group when compared with the control. These findings suggest that DOMS negatively affects the upper extremities motor performance of wheelchair basketball players at least 48 hours after
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Margolis, Lee M; Murphy, Nancy E; Martini, Svein; Spitz, Marissa G; Thrane, Ingjerd; McGraw, Susan M; Blatny, Janet-Martha; Castellani, John W; Rood, Jennifer C; Young, Andrew J; Montain, Scott J; Gundersen, Yngvar; Pasiakos, Stefan M
Physiological consequences of winter military operations are not well described. This study examined Norwegian soldiers (n = 21 males) participating in a physically demanding winter training program to evaluate whether short-term military training alters energy and whole-body protein balance, muscle damage, soreness, and performance. Energy expenditure (D2(18)O) and intake were measured daily, and postabsorptive whole-body protein turnover ([(15)N]-glycine), muscle damage, soreness, and performance (vertical jump) were assessed at baseline, following a 4-day, military task training phase (MTT) and after a 3-day, 54-km ski march (SKI). Energy intake (kcal·day(-1)) increased (P soreness increased and performance decreased progressively (P < 0.05). The physiological consequences observed during short-term winter military training provide the basis for future studies to evaluate nutritional strategies that attenuate protein loss and sustain performance during severe energy deficits.
Yoon, Richard S; Gage, Mark J; Galos, David K; Donegan, Derek J; Liporace, Frank A
Intramedullary nailing (IMN) has become the standard of care for the treatment of most femoral shaft fractures. Different IMN options include trochanteric and piriformis entry as well as retrograde nails, which may result in varying degrees of femoral rotation. The objective of this study was to analyze postoperative femoral version between three types of nails and to delineate any significant differences in femoral version (DFV) and revision rates. Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (AO/OTA 32A-C). Of these patients, 316 met inclusion criteria and obtained postoperative computed tomography (CT) scanograms to calculate femoral version and were thus included in the study. In this study, our main outcome measure was the difference in femoral version (DFV) between the uninjured limb and the injured limb. The effect of the following variables on DFV and revision rates were determined via univariate, multivariate, and ordinal regression analyses: gender, age, BMI, ethnicity, mechanism of injury, operative side, open fracture, and table type/position. Statistical significance was set at ptrochanteric entry nails (n=67). Univariate regression analysis revealed that a lower BMI was significantly associated with a lower DFV (p=0.006). Controlling for possible covariables, multivariate analysis yielded a significantly lower DFV for trochanteric entry nails than piriformis or retrograde nails (7.9±6.10 vs. 9.5±7.4 vs. 9.4±7.8°, ptrochanteric entry nails also had a significantly lower revision rate, even when controlling for all other variables (ptrochanteric nails had a significantly lower DFV and a lower revision rate, even after regression analysis. However, this is not to state that the other nail types exhibited abnormal DFV. Translation to the clinical impact of a few degrees of DFV is also unknown. Future studies to more in-depth study the intricacies of femoral version may lead to improved technology in addition to
Full Text Available Post-operative sore throat is one of the most common complications and complaints of patients after general anesthesia especially in operations that need endotracheal intubations. Its causes are: size of endotracheal tube and type of its cuff, inadequate airway humidification, trauma during intubation and suctioning, high flow of inspiratory gases, surgical manipulation of airway and adjacent organs, ect. Use of instruments with less invasion to upper respiratory tract, for example, face mask and airway, LMA or CPT are methods, used for decreasing the rate of post-operative sore throat. This study was performed to compare the rate of sore throat after general anesthesia between Laryngeal Mask Airway (LMA and Cuffed Pharyngeal Tube (CPT. From the patients, 120 ASA: PS-I cases, were selected, who were candidates for elective surgery of Orthopedics, Urology, General surgery and Gynecology in Hazrat Rasool-Akram Hospital Complex in the year 2000. Their operation were performed in supine position and did not need muscle relaxation and the patients had spontaneous breathing. Duration of surgery was less than 2 hours. The patients were randomly allocated into two groups: LMA was used for one group and CPT for others. Immediately after operation, in the recovery room and at 6, 12, 18 and 24 hours after removing the tube, the patients were asked about sore throat and the results were recorded in the related sheets. The results was 31.7 percent of patients in group LMA and 0 percent of patients in group CPT, had sore throat. There were significant difference between groups (LMA and CPT in presentation of sore throat (P<0.001.
Tojima, Michio; Noma, Kensuke; Torii, Suguru
Muscle tightness (MT) is believed to be an important cause of injury for runners. This study evaluated the change of serum creatine kinase (CK), MT in the leg muscles, and delayed onset muscle soreness after running. We evaluated 11 college students who completed a full marathon race. Participants completed a questionnaire on the right quadriceps muscle soreness. The CK activity and MT (iliopsoas, rectus femoris, hamstrings, gastrocnemius, and soleus muscles) were measured. The time points for CK measurements were before; immediately after; and at 1, 2, and 5 days after the race. The time points for MT measurements were the same as for CK except MT was not measured one day after the race. The time points for muscle soreness analysis were before the race and then every morning and night for 5 days after the race. Long-distance running led to significant increases in CK, MT, and muscle soreness. The CK levels peaked day 1 after the race. MT of iliopsoas peaked on day 5; of rectus femoris immediately after the race; and of hamstrings, gastrocnemius, and soleus on day 2. muscle soreness peaked at night on day 1. MT did not decrease to the pre-race levels on day 5. There were no significant changes but CK tended to correlate with the peak of MT of the rectus femoris (r=0.55, P=0.082) and hamstrings (r=0.57, P=0.065). Long-distance running may cause muscle fiber microdamage that may consequently increase CK, MT, and muscle soreness.
Tarazona-Díaz, Martha P; Alacid, Fernando; Carrasco, María; Martínez, Ignacio; Aguayo, Encarna
l-Citrulline is an excellent candidate to reduce muscle soreness, and watermelon is a fruit rich in this amino acid. This study investigated the potential of watermelon juice as a functional drink for athletes. An in vitro study of intestinal absorption of l-citrulline in Caco-2 cells was performed using unpasteurized (NW), pasteurized (80 °C for 40 s) watermelon juice (PW) and, as control, a standard of l-citrulline. l-citrulline bioavailability was greater when it was contained in a matrix of watermelon and when no heat treatment was applied. In the in vivo experiment (maximum effort test in a cycloergometer), seven athletes were supplied with 500 mL of natural watermelon juice (1.17 g of l-citrulline), enriched watermelon juice (4.83 g of l-citrulline plus 1.17 g from watermelon), and placebo. Both watermelon juices helped to reduce the recovery heart rate and muscle soreness after 24 h.
Kargarfard, Mehdi; Lam, Eddie T C; Shariat, Ardalan; Shaw, Ina; Shaw, Brandon S; Tamrin, Shamsul B M
It is believed that sport massage after intensive exercise might improve power and perceptual recovery in athletes. However, few studies have been done in this area. This study aimed to examine the effect of massage on the performance of bodybuilders. Thirty experienced male bodybuilders were randomly assigned to either a massage group (n = 15) or a control group (n = 15). Both groups performed five repetition sets at 75-77% of 1RM of knee extensor and flexor muscle groups. The massage group then received a 30-min massage after the exercise protocol while the control group maintained their normal passive recovery. Criteria under investigation included: plasma creatine kinase (CK) level, agility test, vertical jump test, isometric torque test, and perception of soreness. All variables were measured over 6 time periods: baseline, immediately after the DOMS inducing protocol, right after the massage, and 24, 48, and 72 h after the massage. Both groups showed significant (P soreness levels. The massage group in general demonstrated a better recovery rate. As such, a post-exercise massage session can improve the exercise performance and recovery rate in male bodybuilders after intensive exercise.
Gray, Patrick; Chappell, Andrew; Jenkinson, Alison McE; Thies, Frank; Gray, Stuart R
Due to the potential anti-inflammatory properties of fish-derived long chain n-3 fatty acids, it has been suggested that athletes should regularly consume fish oils-although evidence in support of this recommendation is not clear. While fish oils can positively modulate immune function, it remains possible that, due to their high number of double bonds, there may be concurrent increases in lipid peroxidation. The current study aims to investigate the effect of fish oil supplementation on exercise-induced markers of oxidative stress and muscle damage. Twenty males underwent a 6-week double-blind randomized placebo-controlled supplementation trial involving two groups (fish oil or placebo). After supplementation, participants undertook 200 repetitions of eccentric knee contractions. Blood samples were taken presupplementation, postsupplementation, immediately, 24, 48, and 72 hr postexercise and muscle soreness/maximal voluntary contraction (MVC) assessed. There were no differences in creatine kinase, protein carbonyls, endogenous DNA damage, muscle soreness or MVC between groups. Plasma thiobarbituric acid reactive substances (TBARS) were lower (p < .05) at 48 and 72 hr post exercise and H2O2 stimulated DNA damage was lower (p < .05) immediately postexercise in the fish oil, compared with the control group. The current study demonstrates that fish oil supplementation reduces selected markers of oxidative stress after a single bout of eccentric exercise.
Candia-Luján, Ramón; De Paz Fernández, José Antonio; Costa Moreira, Osvaldo
In recent years, antioxidant supplements have become popular to counter the effects of free radicals and muscle damage symptoms, including delayed onset muscle soreness (DOMS). To conduct a systematic review in different databases to determine the effects of antioxidant supplements on DOMS. We conducted a search in databases; Cochrane, Pubmed, Scopus and SportDiscus and Web of Science (WOS). The words and acronyms used were; Delayed onset muscle soreness, exercise induced muscle damage, DOMS, EIMD, antioxidant and oxidative stress. 54 articles were identified of which 48 were retreived, all in English, 17 related to vitamin C and E, supplements polyphenolic correspond to fourteen, eleven other antioxidant supplements and six to commercial supplements, all of them used to diminish the DOMS and other variables. Both vitamins and commercial supplements have low effectiveness in reducing DOMS, while polyphenols and other antioxidant supplements show moderate to good effectiveness in combating DOMS. However, most of the studies have effectiveness in reducing other symptoms of muscle damage besides helping in the post-exercise recovery. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Zhu, Zhonglin; Ding, Hui; Shao, Hongyi; Zhou, Yixin; Wang, Guangzhi
The wire fixation and the cable grip fixation have been developed for the extended trochanteric osteotomy (ETO) in the revision of total hip arthroplasty (THA). Many studies reported the postoperative performance of the patients, but with little quantitative biomechanical comparison of the two fixation systems. An in-vitro testing approach was designed to record the loosening between the femoral bed and the greater trochanter after fixations. Ten cadaveric femurs were chosen in this study. Each femur underwent the THA, revision by ETO and fixations. The tension to the greater trochanter was from 0 to 500N in vertical and lateral direction, respectively. The translation and rotation of the greater trochanter with respect to the bony bed were captured by an optical tracking system. In the vertical tension tests, the overall translation of the greater trochanter was observed 0.4 mm in the cable fixations and 7.0 mm in the wire fixations. In the lateral tension tests, the overall motion of the greater trochanter was 2.0 mm and 1.2° in the cable fixations, while it was 6.2 mm and 5.3° in the wire fixations. The result was significantly different between the two fixation systems. The stability of the proximal femur after ETO using different fixations in the revision THA was investigated. The cable grip fixation was significantly more stable than the wire fixation.
Full Text Available The aim of the study was to investigate the efficacy of greater trochanteric fixation using a multifilament cable to ensure abductor lever arm continuity in patients with a proximal femoral fracture undergoing partial hip arthroplasty. Mean age of the patients (12 men, 20 women was 84.12 years. Mean follow-up was 13.06 months. Fixation of the dislocated greater trochanter with or without a cable following load application was assessed by finite element analysis (FEA. Radiological evaluation was based on the distance between the fracture and the union site. Harris hip score was used to evaluate final results: outcomes were excellent in 7 patients (21.8%, good in 17 patients (53.1%, average in 5 patients (15.6%, and poor in 1 patient (9.3%. Mean abduction angle was 20.21°. Union was achieved in 14 patients (43.7%, fibrous union in 12 (37.5%, and no union in 6 (18.7%. FEA showed that the maximum total displacement of the greater trochanter decreased when the fractured bone was fixed with a cable. As the force applied to the cable increased, the displacement of the fractured trochanter decreased. This technique ensures continuity of the abductor lever arm in patients with a proximal femoral fracture who are undergoing partial hip arthroplasty surgery.
Ozan, Fırat; Koyuncu, Şemmi; Pekedis, Mahmut; Altay, Taşkın; Yıldız, Hasan; Toker, Gökhan
The aim of the study was to investigate the efficacy of greater trochanteric fixation using a multifilament cable to ensure abductor lever arm continuity in patients with a proximal femoral fracture undergoing partial hip arthroplasty. Mean age of the patients (12 men, 20 women) was 84.12 years. Mean follow-up was 13.06 months. Fixation of the dislocated greater trochanter with or without a cable following load application was assessed by finite element analysis (FEA). Radiological evaluation was based on the distance between the fracture and the union site. Harris hip score was used to evaluate final results: outcomes were excellent in 7 patients (21.8%), good in 17 patients (53.1%), average in 5 patients (15.6%), and poor in 1 patient (9.3%). Mean abduction angle was 20.21°. Union was achieved in 14 patients (43.7%), fibrous union in 12 (37.5%), and no union in 6 (18.7%). FEA showed that the maximum total displacement of the greater trochanter decreased when the fractured bone was fixed with a cable. As the force applied to the cable increased, the displacement of the fractured trochanter decreased. This technique ensures continuity of the abductor lever arm in patients with a proximal femoral fracture who are undergoing partial hip arthroplasty surgery. PMID:25177703
Zwart, S; Sachs, APE; Ruijs, GJHM; Gubbels, JW; Hoes, AW; de Melker, RA
Objective To assess whether treatment with penicillin for three days and the traditional treatment for seven days were equally as effective at accelerating resolution of symptoms in patients with sore throat compared with placebo. Design Randomised double blind placebo controlled trial. Setting 43
Full Text Available Introduction: Post-operative sore throat and cough are common complications of endotracheal intubation. These conditions may be very distressing for the patient and may lead to unpleasant memories. This study was performed in order to determine whether beclomethasone and lidocaine spray could reduce the frequency of post-operative sore throat and hoarseness after tracheal extubation. Materials and Methods: Ninety women (18–60 years of age with an American Society of Anesthesiologists (ASA physical status I or II and undergoing elective mastoidectomy were randomized into three groups of 30 patients. The endotracheal tubes in each group were sprayed with 50% beclomethasone, 10% lidocaine hydrochloride, or normal saline (control group before endotracheal intubation. Patients were examined for sore throat (none, mild, moderate, or severe, cough, and hoarseness at 1 and 24 h after extubation. Results: There was a significantly lower incidence and severity of post-operative sore throat in the beclomethasone group than the lidocaine and control groups (P
Liu, Bin; Jiang, Yin-Hua; Xiao, Jian; Li, Xiao-Kun
To observe the effect of recombinant human basic fibroblast growth factor (bFGF) atomization inhalation on postoperative sore throat following oral and maxillofacial operation under general anethesia. Forty patients in whom oral and maxillofacial operation trachea was removed under general anesthesia were randomly divided into treatment and control groups; the treatment group received bFGF 35000IU + normal saline 20 mL, compression inhalation, day 1, every 20min, continued for 3 d; the control group was given normal saline 5 mL + dexamethasone 5 mg + gentamicin 80000 U + chymotrypsin 4000 U, compression inhalation, twice a day, every 20 min, continued for 3 d. Occurrence of postoperative sore throat 12 h after operation was recorded and visual analog scale (VAS) of sore throat (swallowing) 12,24,48,72 h after operation was measured. SPSS l4.0 software package was used for statistical analysis. The incidence of sore throat in the treatment group was significantly lower than that in the control group (Poral and maxillofacial surgery after endotracheal intubation.
Lund, Henrik; Vestergaard-Poulsen, P; Kanstrup, I.L.
The aim of this study was to measure if passive stretching would influence delayed onset muscle soreness (DOMS), dynamic muscle strength, plasma creatine kinase concentration (CK) and the ratio of phosphocreatine to inorganic phosphate (PCr/P(i)) following eccentric exercise. Seven healthy...
Farias Junior, Luiz F; Browne, Rodrigo A V; Frazão, Danniel T; Dantas, Teresa C B; Silva, Paulo H M; Freitas, Rodrigo P A; Aoki, Marcelo S; Costa, Eduardo C
The aim of this study was to compare the effect of a single session of a low-volume high-intensity interval exercise (HIIE) and a continuous exercise (CE) on the magnitude of delayed onset-muscle soreness (DOMS) in untrained healthy males. Fifteen participants (25.1±4.4 years) completed 2 experimental sessions in a randomized order: (a) low-volume HIIE: 10 x 60 s at 90% of maximal velocity (MV) interspersed with 60s of active recovery at 30% of MV; and (b) CE: 20 min at 60% of MV. Pressure-pain threshold (PPT), pressure-pain tolerance (PPTol) and perceived pain intensity (PPI) were assessed in the rectus femoris, biceps femoris and gastrocnemius before and 24 hours post-exercise. There was a decrease of PPT in the rectus femoris (-0.5 kg/cm) and PPTol in the gastrocnemius (-1.4 kg/cm) and an increase of PPI in the rectus femoris (14.4 mm) and in the biceps femoris (11.7 mm) 24 hours following the low-volume HIIE session (P0.05). In conclusion, a single session of low-volume HIIE and CE elicited a similar mild DOMS 24 hours post-exercise in untrained healthy males.
Shoda, Etsuo; Kitada, Shimpei; Sasaki, Yu; Hirase, Hitoshi; Niikura, Takahiro; Lee, Sang Yang; Sakurai, Atsushi; Oe, Keisuke; Sasaki, Takeharu
Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.
Brunner, Alexander; Büttler, Markus; Lehmann, Uwe; Frei, Hans Curd; Kratter, Renato; Di Lazzaro, Marco; Scola, Alexander; Sermon, An; Attal, Rene
To evaluate the outcome after different types of revision operations for blade 'cut-out' and 'cut-through' after fixation of trochanteric fractures with proximal femoral nail antirotation (PFNA) or a trochanter fixation nail (TFN). Twenty hospitals participated in this multicentre study. A total of 4109 patients were retrospectively screened for cut-out or cut-through complications after nailing of trochanteric fractures using PFNA or TFN. Fifty-seven patients (28 with 'cut-through' and 29 with 'cut-out') were included in the study. In the 'cut-through' group, 16 patients underwent a blade exchange, six patients had a blade exchange with bone cement augmentation, and six received total hip arthroplasty (THA). In the 'cut-out' group, three patients had a blade exchange, one had a blade exchange with augmentation, three underwent re-nailing of the fracture with a new PFNA, one had a girdlestone procedure and 21 had THA procedures. In the 'cut-through' group, eight patients who had a blade exchanges (50%) and two patients with blade exchange and augmentation (33%) required further revision operations. THA was the definite treatment in all 6 cases. In the 'cut-out' group, two patients (66%) who had blade exchanges and two (66%) who underwent re-nailing required additional revision operations during the subsequent course. One patient (4%) who had total hip arthroplasty needed revision surgery for acetabular replacement. Overall, a total of 81 revision procedures were performed. Based on the data from this study, we recommend THA as the only valid salvage procedure for 'cut-out' and 'cut-through' of helical blades after fixation of trochanteric fractures with the PFNA and TFN. Copyright © 2015 Elsevier Ltd. All rights reserved.
Wei, Jie; Qin, De-an; Guo, Xiu-sheng
To explore clinical efficacy and key matters for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall by proximal frmoral nail antirotation (PFNA). From June 2010 to December 2012,210 femoral intertrochanteric fracture patients treated with PFNA were retrospectively analyzed, including 76 males and 134 females aged from 46 to 96 years old with an average of 71 years old. All fracture were caused by injury and classified to type I (5 cases) type II (16 cases), type III (73 cases) and type IV (116 cases) according to Evans classification. The time of getting out of bed, postoperative complications and displacement of screw blade and fracture healing were observed, Baumgaertner criteria were used to evaluate quality of fracture reduction, Harris criteria were used to evaulate hip joint function. All incisions were healed at stage I, no complications occurred except incomplete of lateral trochanteric wall patients without reconstruction, other patients could get out of bed with crutches at one week and all patients discharged from hospital at 10 days after operation. One hundred and seventy-eight patients were followed up from 3 to 17 months with an average of 10 months. One case occurred unhealed fracture displacement caused by screw blade cutting, 2 cases occurred screw blade transfomed to proximal and out femoral head, other patients obtained fracture healing at 12 to 16 weeks after operation. According to Baumgaertner criteria, 130 cases obtained good results, 45 cases acceptable, and 3 poor; while 107 cases obtained excellent results, 65 good, 3 good and 3 poor according to Harris score. PFNA with mechanical advantage of intramedullary fixation has advantsges of stable fixation, shorter operation time, minimally invasive. Satisfied clinical effects could obtained by grasping fixation principle, dealing with negative factors in operation. Intraoperative reconstruction for integrity of lateral trochanteric wall could assure
Han, Jun-Ho; Kim, Min-Jeong; Yang, Hyuk-Jin; Lee, Yu-Jin; Sung, Yun-Hee
Unfamiliar or sudden exercise can induce delayed onset muscle soreness (DOMS) within 12-24 h. So, several researchers have reported various interventions to treat DOMS. Massage is generally known to eliminate muscle fatigue. However, effect of massage after DOMS is still not clear. We investigated whether the massage is effective on pain and gait after DOMS. The participants were divided into a control group (n= 10) with DOMS and an experimental group (n= 11) with the massage treated after DOMS. We induced DOMS by taking isotonic exercise with going up and down 20 times in 5-story building. We applied the massage and assessment on gastrocnemius of dominant foot. The change of gait and pain was assessed using gaitrite and algometer. In the present results, the massage on gastrocnemius after DOMS showed significant difference in pain (Psoreness.
Unaccustomed and intense eccentric exercise is a common cause of delayed-onset muscle soreness (DOMS). There are multiple remedies for the treatment of DOMS, but its clinical and laboratory pieces of evidence are scarce. Currently, the treatments proposed for DOMS are numerous and include pharmaceuticals, herbal remedies, stretching, massage, nutritional supplements, and other alternatives. To find a holistic treatment with effective pain relief and minimum side effects, complementary and alternative medicine, including herbal therapies, plays a main role. In this review, the existing published studies investigating the efficacy of herbal and natural supplementation therapies for the prevention or treatment of side effects, symptoms, and signs of DOMS are summarized. Previous studies have documented the efficacy of herbal therapies to treat pain, inflammation, as well as laboratory and clinical side effects of DOMS. The use of herbs in DOMS seems safer and has lower side effects than pharmacotherapy. However, the potential for side effects and drug interactions should be considered.
Matre, Kjell; Havelin, Leif Ivar; Gjertsen, Jan-Erik; Vinje, Tarjei; Espehaug, Birgitte; Fevang, Jonas Meling
Intramedullary nailing is commonly recommended as the treatment of choice for transverse/reverse oblique trochanteric (AO/OTA type A3=intertrochanteric) and subtrochanteric fractures. However, only to a limited extent is this approach supported by superior results in well designed clinical trials, and the sliding hip screw (SHS) is still a frequently used implant for these fractures. The aim of the present study was to compare IM nails and SHS in the treatment of transverse/reverse oblique trochanteric and subtrochanteric fractures using data from the Norwegian Hip Fracture Register (NHFR). Data on 2716 operations for acute transverse/reverse oblique trochanteric or subtrochanteric fractures were collected from the NHFR from 2005 to 2010. Surgeons reported patient characteristics and details from initial surgery and reoperations, and patients answered questionnaires about pain, satisfaction, and quality of life (EQ-5D) 4, 12, and 36 months postoperatively. Reoperation rates were calculated using Kaplan-Meier analyses. Primary outcome measures were pain (Visual Analogue Scale (VAS)), satisfaction (VAS), quality of life (EQ-5D), and reoperation rates at one year. The treatment groups were similar regarding age, gender, ASA-class, cognitive impairment, and preoperative EQ-5Dindex score. At one year reoperation rates were 6.4% and 3.8% for SHS and IM nails, respectively (p=0.011). Patients treated with SHS also had slightly more pain (VAS 30 vs. 27, p=0.037) and were less satisfied (VAS 31 vs. 36, p=0.003) compared to patients treated with IM nail. There was no statistically significant difference in the EQ-5Dindex score, but the mobility was significantly better for the IM nail group. 12 months postoperatively patients with transverse/reverse oblique trochanteric and subtrochanteric fractures operated with a SHS had a higher reoperation rate compared to those operated with an IM nail. Small differences regarding pain, satisfaction, quality of life, and mobility were
Full Text Available Background and Aims: Post-operative sore throat (POST occurs in 21-65% of patients. Ketamine used earlier as gargle for reducing POST has limitations. The aim of this study was to see if nebulised ketamine reduces POST. Methods: We conducted a prospective, randomised, placebo-control, and double-blind controlled trial. After written informed consent, 100 patients belonging to American Society of Anaesthesiologists physical status I-II in the age group 20-60 years, of either sex undergoing surgery under general anaesthesia (GA were enrolled. Patients were randomised into two groups; group saline (S received saline nebulisation 5.0 ml and group ketamine (K received ketamine 50 mg (1.0 ml with 4.0 ml of saline nebulisation for 15 min. GA was induced 10 min after completion of nebulisation in the patients. The POST and haemodynamic monitoring were done pre-nebulization, pre-induction, on reaching post-anaesthesia care unit, and at 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3. Results: The overall incidence of POST was 33%; 23 patients (46% in saline and 10 patients (20% in ketamine group experienced POST (Fisher′s exact P = 0.01. The use of ketamine nebulization attenuated POST at 2 h and 4 h post-operatively (P < 0.05. The primary outcome was incidence of POST at 4 h; 13 patients in group S versus 4 patients in group K (P = 0.03 experienced POST at 4 h. The moderate sore throat occurred in 6 patients in group S and none in group K at 2 h, post-operatively (P = 0.02. Conclusion: Ketamine nebulization significantly attenuated the incidence and severity of POST, especially in the early post-operative period, with no adverse effects.
Ahuja, Vanita; Mitra, Sukanya; Sarna, Rashi
Post-operative sore throat (POST) occurs in 21-65% of patients. Ketamine used earlier as gargle for reducing POST has limitations. The aim of this study was to see if nebulised ketamine reduces POST. We conducted a prospective, randomised, placebo-control, and double-blind controlled trial. After written informed consent, 100 patients belonging to American Society of Anaesthesiologists physical status I-II in the age group 20-60 years, of either sex undergoing surgery under general anaesthesia (GA) were enrolled. Patients were randomised into two groups; group saline (S) received saline nebulisation 5.0 ml and group ketamine (K) received ketamine 50 mg (1.0 ml) with 4.0 ml of saline nebulisation for 15 min. GA was induced 10 min after completion of nebulisation in the patients. The POST and haemodynamic monitoring were done pre-nebulization, pre-induction, on reaching post-anaesthesia care unit, and at 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3). The overall incidence of POST was 33%; 23 patients (46%) in saline and 10 patients (20%) in ketamine group experienced POST (Fisher's exact P = 0.01). The use of ketamine nebulization attenuated POST at 2 h and 4 h post-operatively (P < 0.05). The primary outcome was incidence of POST at 4 h; 13 patients in group S versus 4 patients in group K (P = 0.03) experienced POST at 4 h. The moderate sore throat occurred in 6 patients in group S and none in group K at 2 h, post-operatively (P = 0.02). Ketamine nebulization significantly attenuated the incidence and severity of POST, especially in the early post-operative period, with no adverse effects.
Hoseinzadeh, Khadijeh; Daryanoosh, Farhad; Baghdasar, Parvin Javad; Alizadeh, Hamid
Inflammation and pain induced by delayed onset muscle soreness (DOMS) as a result of eccentric exercise (EE) or unaccustomed activity cause some difficulties in exercise for athletes. The purpose of this study was to survey the effect of ginger extract on biochemical and functional symptom of delayed onset muscle soreness. In a quasi-experimental study, 36 healthy female subjects, who were recruited by intra dormitory calls, randomly divided into 3 groups, including: ginger intake 1 hour before exercise (GIBE), ginger intake immediately after exercise (GIAE) and placebo group (PL). Subjects consumed capsules contain 60 mg of ginger extract (equivalent of 2 g dried ginger powder) or placebo before and after exercise. The exercise protocol consisted of a 20 minute step test using a 46cm step at a rate of 15 steps per minute. The blood samples were taken before, 1, 24 and 48 hour after exercise to assay creatine kinase (CK) and interleukin-6 (IL-6). Muscle pain scores, isometric strength and circumference of thigh muscle, and hip range of motion were recorded at mentioned times. The analysis of variance (ANOVA) with repeated measure was used to determine the differences between groups. The results showed a significant reduction of pain in GIBE compared to GIAE after 24 and 48h of EE and GIAE compared to PL (p<0.05). IL-6 changed significantly in GIBE compared to PL (p<0.05) after 1, 24, and 48h after EE. The other factors didn't change meaningfully. The finding of this study suggests that 2 grams of ginger may have anti-inflammation and analgesic effect on DOMS.
Mankovsky-Arnold, Tsipora; Wideman, Timothy H; Larivière, Christian; Sullivan, Michael J L
This study sought to determine whether repetition-induced summation of activity-related pain (RISP) could be demonstrated in healthy individuals in response to experimentally induced musculoskeletal pain. This study also assessed the effects of transcutaneous electrical nerve stimulation on RISP. The relation between the index of RISP and psychological factors such as catastrophizing and fear of pain was also explored. The sample consisted of 56 healthy (35 women, 21 men) participants who underwent 2 testing sessions, separated by 24 hours. In the first session, musculoskeletal pain was induced with a delayed-onset muscle soreness protocol. During the second session, participants were randomly assigned to the transcutaneous electrical nerve stimulation or placebo condition and were asked to rate their pain as they lifted a series of 18 weighted canisters. An index of RISP was derived as the change in pain ratings across repeated lifts. Approximately 25% of participants showed evidence of RISP. Results also revealed that transcutaneous electrical nerve stimulation attenuated the RISP effect. Psychological measures (fear of pain, catastrophizing) were not significantly correlated with the index of RISP, but the index of RISP was significantly correlated with a measure of physical tolerance. Discussion addresses the clinical implications of the findings as well as the potential mechanisms underlying RISP. This study showed that RISP could be demonstrated in healthy individuals in response to experimentally induced musculoskeletal pain with delayed-onset muscle soreness. Transcutaneous electrical nerve stimulation led to a significant reduction in RISP. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.
Paquette, Max R; Peel, Shelby A; Schilling, Brian K; Melcher, Dan A; Bloomer, Richard J
Runners often experience delayed onset muscle soreness (DOMS), especially of the knee extensors, following prolonged running. Sagittal knee joint biomechanics are altered in the presence of knee extensor DOMS but it is unclear how muscle soreness affects lower limb biomechanics in other planes of motion. The purpose of this study was to assess the effects of knee extensor DOMS on three-dimensional (3D) lower limb biomechanics during running. Thirty-three healthy men (25.8 ± 6.8 years; 84.1 ± 9.2 kg; 1.77 ± 0.07 m) completed an isolated eccentric knee extensor damaging protocol to elicit DOMS. Biomechanics of over-ground running at a set speed of 3.35 m s -1 ±5% were measured before eccentric exercise (baseline) and, 24 h and 48 h following exercise in the presence of knee extensor DOMS. Knee flexion ROM was reduced at 48 h (P = 0.01; d = 0.26), and peak knee extensor moment was reduced at 24 h (P = 0.001; d = 0.49) and 48 h (P 0.05). Peak positive ankle and knee joint powers and, peak negative knee joint power were all reduced from baseline to 24 h and 48 h (P < 0.05). These findings suggest that knee extensor DOMS greatly influences sagittal knee joint angular kinetics and, reduces sagittal power production at the ankle joint. However, knee extensor DOMS does not affect frontal and transverse plane lower limb joint biomechanics during running.
Oosthuyse, Tanja; Bosch, Andrew N
Serum creatine kinase (CK) activity reflects muscle membrane disruption. Oestrogen has antioxidant and membrane stabilising properties, yet no study has compared the CK and muscle soreness (DOMS) response to unaccustomed exercise between genders when all menstrual phases are represented in women. Fifteen eumenorrhoeic women (early follicular, EF ( n = 5); late follicular, LF ( n = 5); mid-luteal, ML ( n = 5) phase) and six men performed 20 min of downhill running (-10% gradient) at 9 km/h. Serum CK activity and visual analogue scale rating of perceived muscle soreness were measured before, immediately, 24-h, 48-h and 72-h after exercise. The 24-h peak CK response (relative to pre-exercise) was similar between women and men (mean change (95% confidence interval): 58.5 (25.2 to 91.7) IU/L; 68.8 (31.3 to 106.3) IU/L, respectively). However, serum CK activity was restored to pre-exercise levels quicker in women (regardless of menstrual phase) than men; after 48-h post exercise in women (16.3 (-4.4 to 37.0) IU/L; 56.3 (37.0 to 75.6) IU/L, respectively) but only after 72-h in men (14.9 (-14.8 to 44.6) IU/L). Parallel to the CK response, muscle soreness recovered by 72-h in men. Conversely, the women still reported muscle soreness at 72-h despite CK levels being restored by 48-h; delayed recovery of muscle soreness appeared mainly in EF and LF. The CK and DOMS response to downhill running is gender-specific. The CK response recovers quicker in women than men. The CK and DOMS response occur in concert in men but not in women. The DOMS response in women is prolonged and may be influenced by menstrual phase.
Liu, Wanjun; Wang, Junqiang; Weaver, Michael J; Vrahas, Mark S; Zhou, Dongsheng
The trochanteric fixation nail (TFN) can be used to treat stable and unstable fractures of intertrochanteric hip fractures. We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes. Patient demographic information, fracture type (Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification), radiographic data, and clinical data were collected. Lateral migration with telescoping was measured. Statistical analyses were performed to determine which variables predicted lateral migration with telescoping. Patient outcome scores were recorded using the Modified Harris Hip Score (MHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL), and Visual Analog Scale for pain. Two hundred and twenty-three patients (67 males, 156 females) fitted the radiographic and follow-up (average 24.6 months) criteria. The average age was 77.2 years. The average lateral migration with telescoping was 4.8 mm. Twenty-one patients (9.4%) had excessive lateral migration with telescoping ( = 10 mm). The quality of calcar reduction (P = 0.01) and unstable fracture patterns (P = 0.006) were significant predictive factors of lateral migration with telescoping. The mean outcome scores (MHHS and HOS-ADL) were 80.1 points and 78.7 points, respectively. All subjects had no significant relationship to lateral migration with telescoping (P > 0.05). Of all the patients who developed lateral migration with telescoping, only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months. Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure. It was predicted by the quality of calcar reduction and fracture type. However, this did not affect stable fixation and fracture healing, so rarely leads to
Limpaphayom, Noppachart; Osateerakun, Phatcharapa; Wilairatana, Vajara; Prasongchin, Pairatch
The objectives were to evaluate a technique, outcome and complications following anterior greater trochanteric with gluteus medius muscle pedicle bone graft (AMG) procedure in the treatment of adolescent and active adult hip disorders. 20 patients (20 hips) with a mean age of 22.7 ± 15.6 (range 10.0-63.5) years who had undergone AMG and been followed up more than 12 months postoperative were retrospectively enrolled in our study. The AMG procedure was performed in conjunction with subcapital osteotomy for slipped capital femoral epiphysis in 12 and open reduction for fracture/dislocation in 8 hips. At the most recent evaluation, patient functional status was rated by the Harris Hip Score (HHS) and radiographic changes were graded according to Tönnis criteria. Complications were defined as Tönnis grade >2 or hip requiring further surgery. Univariate analysis was used to explore factors associated with complications. Spearman's rank correlation coefficient was calculated between HHS and Tönnis grading. At mean follow-up of 4.4 ± 2.6 (range 1.1-9.5) years, mean HHS was 87.4. Tönnis grading was rated as 0 in 10 hips, 1 in 5 hips, 2 in 2 hips, and 3 in 3 hips. Avascular necrosis of the femoral head as a complication developed in 3 hips (15%). Clinical parameters including age at surgery, duration of follow-up and diagnosis were not significantly associated with postoperative complications. A negative correlation between HHS and Tönnis grade was shown by Spearman's rank correlation (rs = -0.49, p = 0.03). The AMG can be safely recommended as an adjunct bone graft procedure when performing anterior open reduction of adolescent and active adult hip disorders.
Mekhemar, Nashwa Abdallah; El-Agwany, Ahmed Samy; Radi, Wafaa Kamel; El-Hady, Sherif Mohammed
Postoperative sore throat is a common complication after endotracheal intubation. After tracheal intubation, the incidence of sore throat varies from 14.4% to 50%. The aim of the study was to compare between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on the endotracheal tube cuff as regards postoperative sore throat. The present study was carried out on 124 patients admitted to Alexandria university hospitals for lumbar fixation surgery requiring general anesthesia. Patients were randomly allocated into 4 groups. Benzydamine hydrochloride gel, 5% lidocaine hydrochloride gel, 10% lidocaine hydrochloride spray, or normal saline were applied on endotracheal tube cuffs before endotracheal intubation. The patients were examined for sore throat (none, mild, moderate, or severe) at 0, 1, 6, 12, and 24h after extubation. The results were collected, analyzed and presented in table and figure. The highest incidence of postoperative sore throat occurred at 6h after extubation in all groups. There was a significantly lower incidence of postoperative sore throat in the benzydamine group than 5% lidocaine gel, 10% lidocaine spray, and normal saline groups. The benzydamine group had significantly decreased severity of postoperative sore throat compared with the 10% lidocaine, 5% lidocaine, and normal saline groups at observation time point. Compared with the 5% lidocaine the 10% lidocaine group had significantly increased incidence and severity of postoperative sore throat after extubation. Compared with normal saline the 10% lidocaine group had increased incidence of postoperative sore throat. There were no significant differences among groups in local or systemic side effects. So in conclusion, benzydamine hydrochloride gel on the endotracheal tube cuff is a simple and effective method to reduce the incidence and severity of postoperative sore throat. Application of 10% lidocaine spray should be avoided because of worsening of postoperative sore
Full Text Available BACKGROUND: Many strategies are in use with the intention of preventing or minimizing delayed onset muscle soreness and fatigue after exercise. Cold-water immersion, in water temperatures of less than 15 °C, is currently one of the most popular interventional strategies used after exercise. OBJECTIVES: To determine the effects of cold-water immersion in the management of muscle soreness after exercise. SEARCH METHODS: In February 2010, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1, Medline, Embase, Cumulative Index to Nursing and Allied Health (CINAHL, British Nursing Index and archive (BNI, and the Physiotherapy Evidence Database (PEDro. We also searched the reference lists of articles, handsearched journals and conference proceedings and contacted experts. In November 2011, we updated the searches of Central (2011, Issue 4, Medline (up to November Week 3 2011, Embase (to 2011 Week 46 and CINAHL (to 28 November 2011 to check for more recent publications. SELECTION CRITERIA: Randomized and quasi-randomized trials comparing the effect of using cold-water immersion after exercise with: passive intervention (rest/no intervention, contrast immersion, warm-water immersion, active recovery, compression, or a different duration/dosage of cold-water immersion. Primary outcomes were pain (muscle soreness or tenderness (pain on palpation, and subjective recovery (return to previous activities without signs or symptoms. DATA COLLECTION AND ANALYSIS: Three authors independently evaluated study quality and extracted data. Some of the data were obtained following author correspondence or extracted from graphs in the trial reports. Where possible, data were pooled using the fixed-effect model. MAIN RESULTS: Seventeen small trials were included, involving a total of 366 participants. Study quality was low. The temperature, duration and
Bleakley, Chris; McDonough, Suzanne; Gardner, Evie; Baxter, G David; Hopkins, J Ty; Davison, Gareth W
Many strategies are in use with the intention of preventing or minimising delayed onset muscle soreness and fatigue after exercise. Cold-water immersion, in water temperatures of less than 15°C, is currently one of the most popular interventional strategies used after exercise. To determine the effects of cold-water immersion in the management of muscle soreness after exercise. In February 2010, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), British Nursing Index and archive (BNI), and the Physiotherapy Evidence Database (PEDro). We also searched the reference lists of articles, handsearched journals and conference proceedings and contacted experts.In November 2011, we updated the searches of CENTRAL (2011, Issue 4), MEDLINE (up to November Week 3 2011), EMBASE (to 2011 Week 46) and CINAHL (to 28 November 2011) to check for more recent publications. Randomised and quasi-randomised trials comparing the effect of using cold-water immersion after exercise with: passive intervention (rest/no intervention), contrast immersion, warm-water immersion, active recovery, compression, or a different duration/dosage of cold-water immersion. Primary outcomes were pain (muscle soreness) or tenderness (pain on palpation), and subjective recovery (return to previous activities without signs or symptoms). Three authors independently evaluated study quality and extracted data. Some of the data were obtained following author correspondence or extracted from graphs in the trial reports. Where possible, data were pooled using the fixed-effect model. Seventeen small trials were included, involving a total of 366 participants. Study quality was low. The temperature, duration and frequency of cold-water immersion varied between the different trials as did the exercises and settings. The
Mike, Jonathan N; Cole, Nathan; Herrera, Chris; VanDusseldorp, Trisha; Kravitz, Len; Kerksick, Chad M
Mike, JN, Cole, N, Herrera, C, VanDusseldorp, T, Kravitz, L, and Kerksick, CM. The effects of eccentric contraction duration on muscle strength, power production, vertical jump, and soreness. J Strength Cond Res 31(3): 773-786, 2017-Previous research has investigated the effects of either eccentric-only training or comparing eccentric and concentric exercise on changes related to strength and power expression, but no research to date has investigated the impact of altering the duration of either the concentric or the eccentric component on these parameters. Therefore, the purpose of this study was to assess the duration of eccentric (i.e., 2-second, 4-second vs. 6-second) muscle contractions and their effect on muscle strength, power production, vertical jump, and soreness using a plate-loaded barbell Smith squat exercise. Thirty college-aged men (23 ± 3.5 years, 178 ± 6.8 cm, 82 ± 12 kg, and 11.6 ± 5.1% fat) with 3.0 ± 1.0 years of resistance training experience and training frequency of 4.3 ± 0.9 days per week were randomized and assigned to 1 of 3 eccentric training groups that incorporated different patterns of contraction. For every repetition, all 3 groups used 2-second concentric contractions and paused for 1 second between the concentric and eccentric phases. The control group (2S) used 2-second eccentric contractions, whereas the 4S group performed 4-second eccentric contractions and the 6S group performed 6-second eccentric contractions. All repetitions were completed using the barbell Smith squat exercise. All participants completed a 4-week training protocol that required them to complete 2 workouts per week using their prescribed contraction routine for 4 sets of 6 repetitions at an intensity of 80-85% one repetition maximum (1RM). For all performance data, significant group × time (G × T) interaction effects were found for average power production across all 3 sets of a squat jump protocol (p = 0.04) while vertical jump did not reach
Full Text Available Klaus Baum,1 Richard D Telford,2 Ross B Cunningham,3 1Trainingsinstitut Prof Baum, Köln, Germany; 2College of Medicine, Biology, and Environment, Australian National University, Canberra, ACT, Australia; 3The Fenner School of Environment and Society, Australian National University, Canberra, ACT, Australia Objective: Runners are prone to delayed onset muscle soreness (DOMS during long distance training. This especially holds for unaccustomed training volumes at moderate to high intensities. We investigated the effects of a marine oil complex, PCSO-524®, derived from the New Zealand green-lipped mussel (formulated as Lyprinol® and Omega XL® on DOMS after a 30 km training run. Methods: Initially, peak oxygen uptake of 32 distance runners (4 female, 28 male; median age 45 years, range 28–53 was measured on a treadmill with a 1.5 km hour-1 increase every 4 minutes starting from 8.5 km hour-1. At least 1-week after this initial test, they participated in a 30 km road run at a speed corresponding to about 70% of their individual peak oxygen uptake on a flat terrain. Before and after (0, 24, and 48 hours the run, blood concentration of creatine kinase (CK were measured and pain sensation was determined (pain scale from 0 = no pain to 10 = extremely painful. Runners were then matched in pairs based on maximal CK and peak oxygen uptake, and allocated randomly into two different groups. One group was supplemented with 400 mg per day of PCSO-524® for 11 weeks, the other group with an olive oil placebo. After that period, CK and pain sensations were remeasured following a second 30 km run at the same speed and on the same terrain. Results: The general pattern of soreness in the PCSO-524® supplemented group was reduced by 1.1 units (standard error 0.41 compared to the placebo (P < 0.05, the effects being greater in lesser trained runners (P < 0.05. CK levels were positively associated with pain sensation (P < 0.05, but trends toward lower CK in the
Baum, Klaus; Telford, Richard D; Cunningham, Ross B
Objective Runners are prone to delayed onset muscle soreness (DOMS) during long distance training. This especially holds for unaccustomed training volumes at moderate to high intensities. We investigated the effects of a marine oil complex, PCSO-524®, derived from the New Zealand green-lipped mussel (formulated as Lyprinol® and Omega XL®) on DOMS after a 30 km training run. Methods Initially, peak oxygen uptake of 32 distance runners (4 female, 28 male; median age 45 years, range 28–53) was measured on a treadmill with a 1.5 km hour−1 increase every 4 minutes starting from 8.5 km hour−1. At least 1-week after this initial test, they participated in a 30 km road run at a speed corresponding to about 70% of their individual peak oxygen uptake on a flat terrain. Before and after (0, 24, and 48 hours) the run, blood concentration of creatine kinase (CK) were measured and pain sensation was determined (pain scale from 0 = no pain to 10 = extremely painful). Runners were then matched in pairs based on maximal CK and peak oxygen uptake, and allocated randomly into two different groups. One group was supplemented with 400 mg per day of PCSO-524® for 11 weeks, the other group with an olive oil placebo. After that period, CK and pain sensations were remeasured following a second 30 km run at the same speed and on the same terrain. Results The general pattern of soreness in the PCSO-524® supplemented group was reduced by 1.1 units (standard error 0.41) compared to the placebo (P < 0.05), the effects being greater in lesser trained runners (P < 0.05). CK levels were positively associated with pain sensation (P < 0.05), but trends toward lower CK in the PCSO-524® group, which were also more pronounced in the lesser trained runners, were not statistically significant. Conclusion Pain sensations experienced by distance runners following a 30 km run were reduced by supplementation with the marine oil complex PCSO-524®, an effect which was greater in lesser trained
Souza-Silva, Eduardo; Wittrup Christensen, Steffan; Hirata, Rogerio Pessoto
Purpose: Delayed onset muscle soreness (DOMS) occur within 1-2 days after eccentric exercise but the mechanism mediating hypersensitivity is unclear. This study hypothesized that eccentric exercise reduces the blood flow response following muscle contractions and cuff occlusion, which may result...... anterior muscle. All measures were done bilaterally at day-0 (pre-exercise), day-2 and day-6 (post-exercise). Subjects scored the muscle soreness on a Likert scale for 6 days. Results: Eccentric exercise increased Likert scores at day-1 and day-2 compared with day-0 (P... in accumulated algesic substances being a part of the sensitization in DOMS. Methods: Twelve healthy subjects (5 women) performed dorsiflexion exercise (5 sets of 10 repeated eccentric contractions) in one leg, while the contralateral leg was the control. The maximal voluntary contraction (MVC) of the tibialis...
Naoko Aminaka; Tiffany Fohey; Attila Kovacs; Roksana Zak
Background: Delayed-onset muscle soreness (DOMS) causes muscle damage and edema that can hinder performance and increase risks for secondary injuries. Kinesiology Tape (KT) may be an effective modality for aiding in recovery, however, no study has investigated the effects of KT on the physiological biomarkers such as serum creatine kinase (CK) level, concurrently with measures of performance and function, during recovery from DOMS. Objective: Investigate the effects of KT on serum CK level, e...
Full Text Available The purpose of this study was to investigation of the effects of two different dose of BCAA supplementation on serum indices of muscle damage and soreness in soccer players. 30 male soccer players (age: 20.2+-0.6 yr participated as subjects in this study. Subjects were randomly divided into three groups (double-blind design. All subjects performed lower- body resistance exercise (6 sets, 10 repetitions, 70% 1RM. The BCAA was given at doses of 200 and 450 mg.kg -1 BW for supplemental groups 1 and 2, respectively, 30 minutes before and after to exercise tests and carbohydrate was given at dose of 200 mg.kg -1 BW for placebo group. To identify enzymes activity (IU/L, venous blood samples were collected 30 min prior to exercise and at 24 and 48 hrs post exercise. Data were statistically analyzed using repeated measures ANOVA and Bonfferoni test. Baseline CK, CK-MB and muscle soreness were determined 30 minutes before the exercise test. Baseline serum values for CK, CK-MB and baseline muscle soreness were not different between groups in the 30 minutes before the exercise test (p>0/05. However, there were significant increases between the pre-exercise and post-exercise values for CK, CK-MB and muscle soreness from 24 hrs to 48 hrs post-test (p<0/05, but there were no significant differences between two groups (p< 0.05(. These results suggested that two different dosages of BCAA supplementation did not affect muscle damage and muscle sureness during resistance exercise bout in soccer players.
Johar, Pramod; Grover, Varun; Topp, Robert; Behm, David G
Pain can adversely affect muscle functioning by inhibiting muscle contractions. Delayed onset muscle soreness was used as a tool to ascertain whether a topical menthol-based analgesic or ice was more effective at reducing pain and permitting greater muscular voluntary and evoked force. Sixteen subjects were randomized to receive either a topical gel containing 3.5% menthol or topical application of ice to the non-dominant elbow flexors two days following the performance of an exercise designed to induce muscle soreness. Two days later, DOMS discomfort was treated with a menthol based analgesic or ice. Maximum voluntary contractions and evoked tetanic contractions of the non-dominant elbow flexors were measured at baseline prior to inducing muscle soreness (T1), two days following inducing DOMS after 20 (T2), 25 (T3) and 35 (T4) minutes of either menthol gel or ice therapy. Pain perception using a 10-point visual analog scale was also measured at these four data collection points. Treatment analysis included a 2 way repeated measures ANOVA (2 × 4). Delayed onset muscle soreness decreased (p = 0.04) voluntary force 17.1% at T2 with no treatment effect. Tetanic force was 116.9% higher (p<0.05) with the topical analgesic than ice. Pain perception at T2 was significantly (p=0.02) less with the topical analgesic versus ice. Compared to ice, the topical menthol-based analgesic decreased perceived discomfort to a greater extent and permitted greater tetanic forces to be produced. Level 2b.
Costello, Joseph T; Baker, Philip Ra; Minett, Geoffrey M; Bieuzen, Francois; Stewart, Ian B; Bleakley, Chris
Delayed-onset muscle soreness, or 'DOMS', affects many people after exercise and can impair future performance. It usually peaks one to four days after exercise and several strategies are used to overcome it. The effectiveness and safety of many of these strategies applied and promoted is unknown. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Ozmen, Tarik; Yagmur Gunes, Gokce; Dogan, Hanife; Ucar, Ilyas; Willems, Mark
The purpose of this study was to examine the effects of static stretching, proprioceptive neuromuscular facilitation (PNF) stretching, or kinesio taping (KT) on muscle soreness and flexibility during recovery from exercise. Sixty-five females were randomly assigned to four groups: PNF stretching (n = 15), static stretching (n = 16), KT (n = 17), and control (n = 17). All participants performed nordic hamstring exercise (5 sets of 8 repetitions). In all groups, hamstring flexibility at 24 h and 48 h was not changed from baseline (p > .05). The muscle soreness was measured higher at 48 h post-exercise compared with baseline in the control group (p = .04) and at 24 h post-exercise compared with baseline in the PNF group (p .05). The KT application and pre-exercise stretching have no contribute to flexibility at 24 h and 48 h after exercise, but may attenuate muscle soreness. Copyright © 2016 Elsevier Ltd. All rights reserved.
Legault, Zachary; Bagnall, Nicholas; Kimmerly, Derek S
The study aimed to examine the effects that L-glutamine supplementation has on quadriceps muscle strength and soreness ratings following eccentric exercise. It was hypothesized that glutamine ingestion would quicken the recovery rate of peak force production and decrease muscle soreness ratings over a 72-hr recovery period. Sixteen healthy participants (8♀/8♂; 22 ± 4 years) volunteered in a double-blind, randomized, placebo-controlled crossover study. Supplement conditions consisted of isoenergetic placebo (maltodextrin, 0.6 g·kg-1·day-1) and L-glutamine (0.3 g·kg-1·day-1 + 0.3 g·kg-1·day-1 maltodextrin) ingestion once per day over 72 hr. Knee extensor peak torque at 0°, 30°, and 180° per second and muscle soreness were measured before, immediately following, 24, 48, and 72 hr posteccentric exercise. Eccentric exercise consisted of 8 sets (10 repetitions/set) of unilateral knee extension at 125% maximum concentric force with 2-min rest intervals. L-glutamine resulted in greater relative peak torque at 180°/sec both immediately after (71 ± 8% vs. 66 ± 9%), and 72 hr (91 ± 8% vs. 86 ± 7%) postexercise (all, p exercise. The effect of L-glutamine on muscle force recovery may be greater in men than women.
Glasgow, Philip D; Ferris, Roisin; Bleakley, Chris M
Cold Water Immersion (CWI) is commonly used to manage delayed onset muscle soreness (DOMS) resulting from exercise. Scientific evidence for an optimal dose of CWI is lacking and athletes continue to use a range of a treatment protocols and water temperatures. To compare the effectiveness of four different water immersion protocols and a passive control intervention in the management of DOMS. Randomised controlled trial with blinded outcome assessment. University Research Laboratory. 50 healthy participants with laboratory induced DOMS randomised to one of five groups: Short contrast immersion (1 min 38 °C/1 min 10 °C × 3), Short intermittent CWI (1 min × 3 at 10 °C); 10 min CWI in 10 °C; 10 min CWI in 6 °C; or control (seated rest). muscle soreness, active range of motion, pain on stretch, muscle strength and serum creatine kinase. 10 min of CWI in 6 °C was associated with the lowest levels of muscle soreness and pain on stretch however values were not statistically different to any of the other groups. There were no statistically significant differences between groups for any other outcomes. Altering the treatment duration, water temperature or dosage of post exercise water immersion had minimal effect on outcomes relating to DOMS. Copyright © 2014 Elsevier Ltd. All rights reserved.
Williams, S; Trewartha, G; Kemp, S P T; Michell, R; Stokes, K A
This prospective cohort study investigated the influence of an artificial playing surface on injury risk and perceptions of muscle soreness in elite English Premiership Rugby Union players. Time loss (from 39.5 matches) and abrasion (from 27 matches) injury risk was compared between matches played on artificial turf and natural grass. Muscle soreness was reported over the 4 days following one match played on each surface by 95 visiting players (i.e., normally play on natural grass surfaces). There was a likely trivial difference in the overall injury burden relating to time-loss injuries between playing surfaces [rate ratio = 1.01, 90% confidence interval (CI): 0.73-1.38]. Abrasions were substantially more common on artificial turf (rate ratio = 7.92, 90% CI: 4.39-14.28), although the majority of these were minor and only two resulted in any reported time loss. Muscle soreness was consistently higher over the 4 days following a match on artificial turf in comparison with natural grass, although the magnitude of this effect was small (effect sizes ranging from 0.26 to 0.40). These results suggest that overall injury risk is similar for the two playing surfaces, but further surveillance is required before inferences regarding specific injury diagnoses and smaller differences in overall injury risk can be made. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Laupheimer, M W; Perry, M; Benton, S; Malliaras, P; Maffulli, N
Objective We investigated whether the inflammatory response and delayed onset of muscle soreness after a marathon are altered by resveratrol, a natural polyphenolic flavonoid antioxidant. Design: Double blind placebo-controlled randomised pilot study. Setting: London Marathon. Participants: Marathon race participants Interventions: 7 healthy male athletes were randomised to receive Resveratrol (600 mg Resveratrol daily for 7 days immediately before the marathon) or a placebo. Main Outcome Measurements: Blood samples taken 48 hours before and 18–32 hours after the marathon were analysed for white blood cell count (WBC) and C-reactive protein (CRP). A VAS score was taken at the same times as the blood samples to assess delayed onset muscle soreness. Results: There were no significant differences between the two groups in terms of changes occurring between pre- and post- tests for WBC, CRP or VAS. Conclusions: There were no differences in immune response or delayed onset muscle soreness between resveratrol and placebo after a marathon. Further investigations are needed with longer treatment time and higher doses, analysing additional parameters such interleukins for a possible effect of resveratrol on the inflammatory response due to extensive exercise. To avoid a type II error, 17 subjects in each group would be required. PMID:25147765
Haddad, Monoem; Chaouachi, Anis; Wong, Del P; Castagna, Carlo; Hambli, Mourad; Hue, Olivier; Chamari, Karim
The aim of this study was to assess the effects of the Hooper's Index variations (i.e., self-ratings of fatigue, stress, delayed onset muscle soreness (DOMS), and sleep) on rating of perceived exertion during a 10 min submaximal exercise training session (RPE-10 min) and then check the stability and the internal consistency of RPE-10 min. Seventeen junior soccer players took part in this study. The individual Hooper's indices taken before each training session were correlated with RPE-10 min during a constant intensity and duration effort (10 min) using Pearson product moment correlation. Intraclass correlation (ICC) was used to assess the internal consistency of the RPE-10 min. All individual correlations between RPE-10 min and quality of sleep and quantity of fatigue, stress, and DOMS were non-significant (p>0.05). No significant correlations were resulted between RPE-10 min and Hooper's Index in all athletes. The ICC of RPE-10 min was 0.77 thus demonstrating internal consistency. The results of the present study demonstrated the objectivity and utility of RPE as a psychological tool for monitoring training during traditional soccer training. Therefore, the results of the present study suggest that fatigue, stress, DOMS and sleep are not major contributors of perceived exertion during traditional soccer training without excessive training loads. It seems that psychobiological factors other than fatigue, stress, DOMS and sleep may have mediated the 10 min exercise perceptual intensity. © 2013.
Full Text Available Objective: Unaccustomed and intense eccentric exercise is a common cause of delayed-onset muscle soreness (DOMS. There are multiple remedies for the treatment of DOMS, but its clinical and laboratory pieces of evidence are scarce. Currently, the treatments proposed for DOMS are numerous and include pharmaceuticals, herbal remedies, stretching, massage, nutritional supplements, and other alternatives. To find a holistic treatment with effective pain relief and minimum side effects, complementary and alternative medicine, including herbal therapies, plays a main role.Methods: In this review, the existing published studies investigating the efficacy of herbal and natural supplementation therapies for the prevention or treatment of side effects, symptoms, and signs of DOMS are summarized.Results: Previous studies have documented the efficacy of herbal therapies to treat pain, inflammation, as well as laboratory and clinical side effects of DOMS.Conclusion: The use of herbs in DOMS seems safer and has lower side effects than pharmacotherapy. However, the potential for side effects and drug interactions should be considered.
Esch, G.W. (Wake Forest Univ., Winston-Salem, NC); Hazen, T.C.
The body conditions, K = 10/sup 5/(weight, g)/(standard length)/sup 3/, and various hematological characters were examined for largemouth bass (Micropterus salmoides) taken from Par Pond, a reservoir heated by effluent from a nuclear production reactor at the Savannah River Plant near Aiken, South Carolina. Largemouth bass with K less than 2.0 had significantly lower (P < 0.05) hematocrits, hemoglobin concentrations, total red blood cell counts, total white blood cell counts, and lymphocyte fractions, and significantly higher granulocyte fractions and cortisol concentrations, than those with K greater than 2.0; monocyte, thrombocyte, and reticulocyte fractions were not different between the two K-factor groupings. When data were pooled, all blood variables except the reticulocyte fraction were significantly correlated with K. Hematocrit, the lymphocyte fraction, and cortisol concentration account for 20.5% of the variation in K. These data support a previous hypothesis that elevated water temperature promotes stress. Stress within the Par Pond largemouth bass population may play an important role in the epizootiology of red-sore disease caused by the gram-negative bacterium, Aeromonas hydrophila.
Kim, Jooyoung; Lee, Joohyung
This review is focused on the effect of nutritional intervention on delayed onset muscle soreness (DOMS) that occurs after exercise. In general, high force eccentric contractions and/or unaccustomed exercise result in DOMS attributed to reduction in performance such as muscle strength and range of motion (ROM) for both athletes and non-athletes. Nutritional intervention is one of the preventive or therapeutic ways to reduce DOMS. Previous research studies have suggested the following nutrition intervention: caffeine, omega-3 fatty acids, taurine, polyphenols, and so on. Nutritional intervention with these nutrients before and after exercise was reported to be effective in reducing DOMS. These nutritional interventions have also been reported to affect inflammatory responses and oxidative stress leading to DOMS reduction. However, other studies have reported that these nutritional interventions have no effect on DOMS. It is suggested that intake of proper nutrition intervention can effectively reduce DOMS after exercise and quickly help an athlete return to exercise or training program. In addition, nutritional intervention may help both athletes and non-athletes who engage in physical therapy or rehabilitative programs after surgery or any injurious events.
Miller, Paul D; McCarthy, Edward F
Bisphosphonate-associated atypical sub-trochanteric femur fractures (ASFF) may be seen with long-term bisphosphonate use, though these fractures are also seen in patients never exposed to bisphosphonates. One theory for the mechanism of action whereby bisphosphonates may induce these ASFF is over-suppression of bone turnover. Bisphosphonates suppress bone turnover, but in bisphosphonate clinical trials, over-suppression defined whether by maintaining the biochemical markers of bone turnover below the defined reference range or by quantitative bone histomorphometry, has not been observed. We studied 15 clinic patients referred to The Colorado Center for Bone Research (CCBR) after they had a bisphosphonate-associated ASFF and performed quantitative bone histomorphometry both before and after 12 months of teriparatide (20µg SQ/day). All patients had been on long-term alendronate (mean = 7 years, range: 6-11 years) and had already had intramedullary rods placed when first seen (6 weeks to 7 months after rod placement). Alendronate had been discontinued in all patients at the time of their first clinic visit to CCBR. All of the fractures fulfilled The American Society for Bone and Mineral Research major radiological criteria for ASFF. Three key dynamic histomorphometric features show that 7 of the 15 patients had unmeasurable bone formation, mineralizing surface, and mineral apposition, while the other 8 patients had measurable dynamic parameters; although for all 15 patients, the mean values for all 3 dynamic parameters was far below the average for the published normal population. Administration of teriparatide was associated with an increase in all 3 dynamic histomorphometric parameters. Baseline bone turnover markers did not correlate with the baseline histomorphometry. While there is heterogeneity in the bone turnover in patients with bisphosphonate ASFF, there is a large portion in this uncontrolled series that had absent bone turnover at the standard biopsy site
Kaltenborn, Alexander; Carl, Ulrich Martin; Hinsche, Tanja; Nitsche, Mirko; Hermann, Robert Michael
Low-dose external beam radiotherapy (ED-EBRT) is frequently used in the therapy of refractory greater trochanteric pain syndrome (GTPS). As studies reporting treatment results are scarce, we retrospectively analyzed our own patient collectives. In all, 60 patients (74 hips) received LD-EBRT (6 x 0.5 Gy in 29 hips, 6 x 1 Gy in 45). The endpoint was the patient's reported subjective response to treatment. The influence of different patient and treatment characteristics on treatment outcome was investigated. At the end of LD-EBRT, 69% reported partial remission, 4% complete remission, no change 28%. A total of 3 months later (n = 52 hips), the results were 37, 33, and 30% and 18 months after LD-EBRT (n = 47) 21, 51, and 28%. In univariate analysis ''inclusion of the total femoral head into the PTV'' and ''night pain before LD-EBRT'' were correlated with symptom remission at the end of LD-EBRT, while ''initial increase in pain during LD-EBRT'' was significantly associated with treatment failure. In multivariable modeling ''initial increase in pain'' was identified as a risk factor for treatment failure (p = 0.007; odds ratio [OR] 0.209; 95% confidence interval [CI] 0.048-0.957), while ''night pain'' was an independent factor for remission (p = 0.038; OR 3.484; 95% CI 1.004-12.6). Three months after LD-EBRT ''night pain'' and ''inclusion of the complete femoral neck circumference into the PTV'' were predictive for remission. LD-EBRT represents a useful treatment option for patients suffering from GTPS. Three months after therapy two-thirds of the patients reported a partial or complete symptom remission. Especially patients who suffered from nocturnal pain seemed to benefit. Treatment appeared to be more effective when the entire circumference of the femoral neck was encompassed. (orig.) [de
Full Text Available Managing pressure ulcers remain a challenge and call for a multidisciplinary team approach to care. Even more daunting is the management of such patients in remote locations and in resource constrained situations. The management of pressure sores in a patient with progressive muscular atrophy has been discussed using resources that were locally available, accessible, and affordable. Community participation was encouraged. A holistic approach to care was adopted.
Buecking, Benjamin; Bliemel, Christopher; Struewer, Johannes; Eschbach, Daphne; Ruchholtz, Steffen; Müller, Thorben
Trochanteric fractures are common fractures in the elderly. Due to characteristic demographic changes, the incidence of these injuries is rapidly increasing. Treatment of these fractures is associated with high rates of complications. In addition, the long-term results remain poor, with high morbidity, declines in function, and high mortality. Therefore, in this study, complication rates and patients' outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3™ nail. Patients aged 60 years old or older, with pertrochanteric and subtrochanteric femoral fractures, were included. Patients with polytrauma or pathological fractures were excluded. Age, sex, and fracture type were collected on admission. In addition, data were recorded concerning the surgeon (resident vs. consultant), time of operation, and local or systemic perioperative complications. Complications were also collected at the 6- and 12-month follow-ups after trauma. Barthel Index, IADL, and EQ-5D measurements were evaluated retrospectively on admission, as well as at discharge and during the follow-up. Ninety patients were prospectively included between April 2009 and September 2010. The patients' average age was 81 years old, and their average ASA score was 3. The incision/suture time was 53 min (95% CI 46-60 min). Hospital mortality was 4%, and overall mortality was 22% at the 12-month follow-up. Eight local complications occurred (4 haematomas, 1 deep infection, 1 cutting out, 1 irritation of the iliotibial tract, 1 periosteosynthetic fracture). The incidence of relevant systemic complications was 6%. Forty-two percent of the patients were operated on by residents in training, without significant differences in duration of surgery, complication rate, or mortality rate. The Barthel Index (82 to 71, p fracture levels during the follow-up period of 12 months. The results showed a relatively low complication rate using the Gamma3™ nail, even if the nailing was performed
Gervasi, Marco; Sisti, Davide; Benelli, Piero; Fernández-Peña, Eneko; Calcabrini, Cinzia; Rocchi, Marco B.L.; Lanata, Luigi; Bagnasco, Michela; Tonti, Andrea; Vilberto, Stocchi; Sestili, Piero
Abstract In professional road cyclists, the majority of overuse injuries affect the lower limbs and are mostly represented by contractures or muscle shortening, characterized by an increase of tone and stiffness and a variation of elasticity. Treatment and prevention of these specific conditions may include physical, supplementary, and pharmacologic support. The aim of this real-life study was to determine: first, the alterations of tone, stiffness, elasticity, and soreness of rectus femoris (RF) and biceps femoris (BF) in top class cyclists engaged in 3 multistage races, and second, whether any variable in the management of the athletes may affect the prevention and/or reduction of such alterations. Twenty-three professional cyclists competing in 3 international, cycling stage races were assessed. Athletes could receive, upon the approval of the medical staff, physical, dietary, and/or pharmacological management which could include treatments with topical over-the-counter myorelaxants to prevent and/or reduce muscle contractures. MyotonPro was used to daily measure tone, stiffness, and elasticity in RF and BF in relaxed and contracted state after every stage. In parallel, BF and RF soreness was also assessed with a Likert scale. All athletes received the same general massage management; none of them received dietary supplements; some of the athletes were treated with a topical myorelaxant thiocolchicoside (TCC 0.25%) foam 3 times daily. TCC was identified as the only variable able to affect these muscle parameters in the cyclists. Tone, stiffness (regardless of the state), and soreness significantly increased over time either in BF or RF in all athletes. In the group of athletes that used TCC (n = 11; TCC+) the increase in tone, stiffness, and soreness was significantly lower than in the group not receiving TCC (n = 12; No-TCC). Elasticity varied coherently with tone and stiffness. A very intense and protracted sport activity increases muscular tone
Kwon, Keun-Sang; Wang, Sung Il; Lee, Ju-Hyung; Moon, Young Jae; Kim, Jung Ryul
This is a retrospective observational study. Greater trochanteric epiphysiodesis (GTE) has been recommended to prevent Trendelenburg gait and limitation of the hip joint motion due to trochanteric overgrowth after femoral varus osteotomy (FVO) in Legg-Calvé-Perthes disease (LCPD). However, capital femoral physeal arrest frequently occurs in patients with severe disease (lateral pillar C), so GTE might not be as effective in these patients. The aim of this study was to compare trochanteric growth inhibition due to GTE after FVO between 2 age groups (8 years) in patients with lateral pillar B and B/C border LCPD and evaluate the effectiveness of GTE compared with the normal, unaffected hip.This study included 19 children with lateral pillar B and B/C border LCPD in 1 leg who underwent FVO followed by GTE. Of the 19 children, 9 underwent GTE before the age of 8 years and 10 underwent GTE after 8 years of age. On radiographs taken at the immediate postoperative period and at skeletal maturity, the articulo-trochanteric distance (ATD), center-trochanteric distance (CTD), and neck-shaft angle (NSA) were compared between the 2 age groups. The amount of correction was compared between groups. The contralateral, unaffected hip was used as a control for trochanteric growth. The patients were clinically evaluated with Iowa hip score at the final follow-up.There was no significant difference between the 2 age groups in terms of time to GTE, length of follow-up, or lateral pillar classification. In the affected hip, the amount of correction of the ATD, CTD, and NSA was significantly greater in patients 8 years. However, in the unaffected hip, the change in the ATD, CTD, and NSA did not differ significantly between the 2 groups.We suggest that FVO followed by GTE for lateral pillar B and B/C border LCPD in patients under the age of 8 years can affect growth of the greater trochanter. However, effective growth inhibition due to GTE was not achieved after 8 years of age.
Full Text Available The in vitro antibacterial activities of 29 traditional medicinal plants used in respiratory ailments were assessed on multidrug resistant Gram-positive and Gram-negative bacteria isolated from the sore throat patients and two reference strains. The methanolic, n-hexane, and aqueous extracts were screened by the agar well diffusion assay. Bioactive fractions of effective extracts were identified on TLC coupled with bioautography, while their toxicity was determined using haemolytic assay against human erythrocytes. Qualitative and quantitative phytochemical analysis of effective extracts was also performed. Methanolic extract of 18 plants showed antimicrobial activity against test strains. Adhatoda vasica (ZI = 17–21 mm, MIC: 7.12–62.5 μg/mL, Althaea officinalis (ZI = 16–20 mm, MIC: 15.62–31.25 μg/mL, Cordia latifolia (ZI = 16–20 mm, MIC: 12.62–62.5 μg/mL, Origanum vulgare (ZI = 20–22 mm, MIC: 3–15.62 μg/mL, Thymus vulgaris (ZI = 21–25 mm, MIC: 7.81–31.25 μg/mL, and Ziziphus jujuba (ZI = 14–20 mm, MIC: 7.81–31.25 μg/mL showed significant antibacterial activity. Alkaloid fractions of Adhatoda vasica, Cordia latifolia, and Origanum vulgare and flavonoid fraction of the Althaea officinalis, Origanum vulgare, Thymus Vulgaris, and Ziziphus jujuba exhibited antimicrobial activity. Effective plant extracts show 0.93–0.7% erythrocyte haemolysis. The results obtained from this study provide a scientific rationale for the traditional use of these herbs and laid the basis for future studies to explore novel antimicrobial compounds.
Sellwood, Kylie Louise; Brukner, Peter; Williams, David; Nicol, Alastair; Hinman, Rana
Objective To determine if ice‐water immersion after eccentric quadriceps exercise minimises the symptoms of delayed‐onset muscle soreness (DOMS). Design A prospective randomised double‐blind controlled trial was undertaken. 40 untrained volunteers performed an eccentric loading protocol with their non‐dominant leg. Interventions Participants were randomised to three 1‐min immersions in either ice water (5±1°C) or tepid water (24°C). Main outcome measures Pain and tenderness (visual analogue scale), swelling (thigh circumference), function (one‐legged hop for distance), maximal isometric strength and serum creatine kinase (CK) recorded at baseline, 24, 48 and 72 h after exercise. Changes in outcome measures over time were compared to determine the effect of group allocation using independent t tests or Mann–Whitney U tests. Results No significant differences were observed between groups with regard to changes in most pain parameters, tenderness, isometric strength, swelling, hop‐for‐distance or serum CK over time. There was a significant difference in pain on sit‐to‐stand at 24 h, with the intervention group demonstrating a greater increase in pain than the control group (median change 8.0 vs 2.0 mm, respectively, p = 0.009). Conclusions The protocol of ice‐water immersion used in this study was ineffectual in minimising markers of DOMS in untrained individuals. This study challenges the wide use of this intervention as a recovery strategy by athletes. PMID:17261562
Vaile, Joanna; Halson, Shona; Gill, Nicholas; Dawson, Brian
This study independently examined the effects of three hydrotherapy interventions on the physiological and functional symptoms of delayed onset muscle soreness (DOMS). Strength trained males (n = 38) completed two experimental trials separated by 8 months in a randomised crossover design; one trial involved passive recovery (PAS, control), the other a specific hydrotherapy protocol for 72 h post-exercise; either: (1) cold water immersion (CWI: n = 12), (2) hot water immersion (HWI: n = 11) or (3) contrast water therapy (CWT: n = 15). For each trial, subjects performed a DOMS-inducing leg press protocol followed by PAS or one of the hydrotherapy interventions for 14 min. Weighted squat jump, isometric squat, perceived pain, thigh girths and blood variables were measured prior to, immediately after, and at 24, 48 and 72 h post-exercise. Squat jump performance and isometric force recovery were significantly enhanced (P < 0.05) at 24, 48 and 72 h post-exercise following CWT and at 48 and 72 h post-exercise following CWI when compared to PAS. Isometric force recovery was also greater (P < 0.05) at 24, 48, and 72 h post-exercise following HWI when compared to PAS. Perceived pain improved (P < 0.01) following CWT at 24, 48 and 72 h post-exercise. Overall, CWI and CWT were found to be effective in reducing the physiological and functional deficits associated with DOMS, including improved recovery of isometric force and dynamic power and a reduction in localised oedema. While HWI was effective in the recovery of isometric force, it was ineffective for recovery of all other markers compared to PAS.
Minder, P M; Noble, J G; Alves-Guerreiro, J; Hill, I D; Lowe, A S; Walsh, D M; Baxter, G D
This study was designed to assess the analgesic effects of interferential therapy (IFT) on experimentally induced muscular pain under randomized, double-blind, placebo-controlled conditions. After ethical approval and written consent were obtained, 40 healthy human volunteers (20 males: 20 females) aged 18-25 years were recruited and randomly assigned to one of four experimental groups (n = 10 per group: male = female): IFT 1, IFT 2, control or placebo. Delayed onset muscle soreness (DOMS) was induced in the elbow flexors of the non-dominant arm of each subject using a single bout of eccentric exercises to exhaustion. Measurements of isometric peak torque, resting angle, mechanical pain threshold and visual analogue scales were performed at set time points. Treatment was applied for 30 min daily over the biceps brachii muscle, for five consecutive days, according to group allocation. IFT 1 received 10-20 Hz, whilst subjects in IFT 2 were treated with 80-100 Hz (bi-pole; carrier frequency: 4 kHz; pulse duration: 125 microseconds). For the placebo group, the procedure was identical to that in the active treatment groups; however, no interferential current was delivered. The control group received no treatment. No significant between group difference was identified at any time point (P > or = 0.14). However, some inconsistent, yet significant differences in daily treatment effects, interactive effects and effects over time were detected. Based on the results of this study it can be concluded that application of IFT at the parameters used here, had no overall beneficial effect on DOMS.
Singla, Neil; Desjardins, Paul J.; Cosca, Evelyn B.; Parulan, Cherri; Arriaga, Anne; Poole, Kelly C.; Batz, Dan M.; Chang, Phoebe D.
Abstract Based on a thorough review of the available literature in the delayed-onset muscle soreness (DOMS) model, we identified multiple study design characteristics that are considered to be normative in acute pain research but have not been followed in a majority of published DOMS experiments. We designed an analgesic investigation using the DOMS model that both complied with current scientifically accepted standards for the conduct of analgesic studies and demonstrated reasonable assay sensitivity. This randomized, double-blind, placebo-controlled within-subject study compared the efficacy of topical diclofenac sodium 1% with a matching placebo in reducing pain associated with DOMS. After exercise, subjects reporting DOMS received topical diclofenac sodium gel 1% (DSG 1%) applied to one leg and placebo to the other every 6 hours for 48 hours. Pain intensity was assessed at rest, upon standing, and when walking in the 48 hours after initial drug application (T0). The primary end point was the reduction in pain intensity (SPID 24) on walking. Subjects receiving DSG 1% had less pain while walking compared with those receiving placebo at 24 hours (SPID 24 = 34.9 [22.9] and 23.6 [19.4], respectively; P = 0.032). This investigation used experimental techniques that have been vetted in the field of exercise physiology and superimposed techniques that are considered to be best practice in the field of analgesic research. Over time and with the help of colleagues in both fields of study, similar investigations will validate design features that impact the assay sensitivity of analgesic end points in DOMS models. In addition, the study confirmed the analgesic efficacy of topical DSG 1% over placebo in subjects experiencing DOMS. PMID:25633158
Matsumura, Melissa D; Zavorsky, Gerald S; Smoliga, James M
Ginger possesses analgesic and pharmacological properties mimicking non-steroidal antiinflammatory drugs. We aimed to determine if ginger supplementation is efficacious for attenuating muscle damage and delayed onset muscle soreness (DOMS) following high-intensity resistance exercise. Following a 5-day supplementation period of placebo or 4 g ginger (randomized groups), 20 non-weight trained participants performed a high-intensity elbow flexor eccentric exercise protocol to induce muscle damage. Markers associated with muscle damage and DOMS were repeatedly measured before supplementation and for 4 days following the exercise protocol. Repeated measures analysis of variance revealed one repetition maximum lift decreased significantly 24 h post-exercise in both groups (p < 0.005), improved 48 h post-exercise only in the ginger group (p = 0.002), and improved at 72 (p = 0.021) and 96 h (p = 0.044) only in the placebo group. Blood creatine kinase significantly increased for both groups (p = 0.015) but continued to increase only in the ginger group 72 (p = 0.006) and 96 h (p = 0.027) post-exercise. Visual analog scale of pain was significantly elevated following eccentric exercise (p < 0.001) and was not influenced by ginger. In conclusion, 4 g of ginger supplementation may be used to accelerate recovery of muscle strength following intense exercise but does not influence indicators of muscle damage or DOMS. Copyright © 2015 John Wiley & Sons, Ltd.
Urakawa, Susumu; Takamoto, Kouichi; Nakamura, Tomoya; Sakai, Shigekazu; Matsuda, Teru; Taguchi, Toru; Mizumura, Kazue; Ono, Taketoshi; Nishijo, Hisao
Delayed-onset muscle soreness (DOMS) can be induced by lengthening contraction (LC); it can be characterized by tenderness and movement-related pain in the exercised muscle. Manual therapy (MT), including compression of exercised muscles, is widely used as physical rehabilitation to reduce pain and promote functional recovery. Although MT is beneficial for reducing musculoskeletal pain (i.e. DOMS), the physiological mechanisms of MT remain unclear. In the present study, we first developed an animal model of MT in DOMS; LC was applied to the rat gastrocnemius muscle under anesthesia, which induced mechanical hyperalgesia 2-4 days after LC. MT (manual compression) ameliorated mechanical hyperalgesia. Then, we used capillary electrophoresis time-of-flight mass spectroscopy (CE-TOFMS) to investigate early effects of MT on the metabolite profiles of the muscle experiencing DOMS. The rats were divided into the following three groups; (1) normal controls, (2) rats with LC application (LC group), and (3) rats undergoing MT after LC (LC + MT group). According to the CE-TOFMS analysis, a total of 171 metabolites were detected among the three groups, and 19 of these metabolites were significant among the groups. Furthermore, the concentrations of eight metabolites, including branched-chain amino acids, carnitine, and malic acid, were significantly different between the LC + MT and LC groups. The results suggest that MT significantly altered metabolite profiles in DOMS. According to our findings and previous data regarding metabolites in mitochondrial metabolism, the ameliorative effects of MT might be mediated partly through alterations in metabolites associated with mitochondrial respiration. © 2015 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.
Singla, Neil; Desjardins, Paul J; Cosca, Evelyn B; Parulan, Cherri; Arriaga, Anne; Poole, Kelly C; Batz, Dan M; Chang, Phoebe D
Based on a thorough review of the available literature in the delayed-onset muscle soreness (DOMS) model, we identified multiple study design characteristics that are considered to be normative in acute pain research but have not been followed in a majority of published DOMS experiments. We designed an analgesic investigation using the DOMS model that both complied with current scientifically accepted standards for the conduct of analgesic studies and demonstrated reasonable assay sensitivity. This randomized, double-blind, placebo-controlled within-subject study compared the efficacy of topical diclofenac sodium 1% with a matching placebo in reducing pain associated with DOMS. After exercise, subjects reporting DOMS received topical diclofenac sodium gel 1% (DSG 1%) applied to one leg and placebo to the other every 6 hours for 48 hours. Pain intensity was assessed at rest, upon standing, and when walking in the 48 hours after initial drug application (T0). The primary end point was the reduction in pain intensity (SPID 24) on walking. Subjects receiving DSG 1% had less pain while walking compared with those receiving placebo at 24 hours (SPID 24 = 34.9 [22.9] and 23.6 [19.4], respectively; P = 0.032). This investigation used experimental techniques that have been vetted in the field of exercise physiology and superimposed techniques that are considered to be best practice in the field of analgesic research. Over time and with the help of colleagues in both fields of study, similar investigations will validate design features that impact the assay sensitivity of analgesic end points in DOMS models. In addition, the study confirmed the analgesic efficacy of topical DSG 1% over placebo in subjects experiencing DOMS.
Petrofsky, Jerrold S; Khowailed, Iman Akef; Lee, Haneul; Berk, Lee; Bains, Gurinder S; Akerkar, Siddhesh; Shah, Jinal; Al-Dabbak, Fuad; Laymon, Mike S
Because of the differences in the exercise type, temperature, and timing of the use of cold and heat after exercise in different studies, there is no clear conclusion as to the efficacy of either modality on reducing delayed onset muscle soreness. One hundred subjects at similar fitness levels were examined. They accomplished leg squats for 15 minutes and heat and cold were applied after or 24 hours after exercise using ThermaCare heat or cold wraps. Measurements obtained were strength, the force to passively move the knee, analog visual pain scales, and blood myoglobin. Control subjects lost 24% strength after exercise. Subjects with heat or cold just after exercise only lost 4% strength (p < 0.01). For strength recovery, cold applied after 24 hours was better than heat at 24 hours. Heat or cold applied after exercise was significantly better to prevent elastic tissue damage (p < 0.01), whereas heat and cold immediately after exercise caused no loss in muscle myoglobin and heat or cold after 24 hours showed no less muscle damage from myoglobin than in control subjects. Myoglobin in the control and heat and cold 24-hour groups averaged 135.1% of the baseline data but averaged 106.1% of baseline in the immediate heat and cold groups. For reducing pain, control subjects showed a significant amount of pain the days after exercise. But cold immediately after exercise or 24 hours later was superior to heat in reducing pain. In conclusion, both cold and heat appear to be efficacious in reducing muscle damage after exercise.
Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate.
Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola
In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database. All consecutive trochanteric fracture operations during 2011-2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications. The relative risk of intermediate or major technical complications was 4.2 (1.2-14) times higher in unstable pertrochanteric fractures and 4.6 (1.1-19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%. The
Cho, Jae-Woo; Kent, William T; Yoon, Yong-Cheol; Kim, Youngwoo; Kim, Hyungon; Jha, Ashutosh; Durai, Senthil Kumar; Oh, Jong-Keon
This study was designed to assess the incidence and morphology of coronal plane fragments in AO/OTA 31-A trochanteric fractures. 156 cases of AO/OTA 31-A trochanteric fractures were retrospectively evaluated. Lateral radiographs were analyzed for the presence of coronal plane fragments followed by analysis of 3D CT reconstructions in these fractures. The incidence of coronal fragments identified on the lateral radiograph and 3D CT reconstructions were both calculated. Coronal fragment morphology was described based upon the origin and exit points of fracture lines and the number of fragments. On plain radiographs, a coronal plane fracture was identified in 59 cases, an incidence of 37.8% (59/156). In comparison, 3D CT reconstructions identified coronal plane fractures in 138 cases for an incidence of 88.4% (138/156). 3D CT reconstructions identified coronal fracture fragments in 81.9% (50/61) of AO/OTA 31-A1 cases, 94.5% (69/73) of 31-A2 cases, and 86.3% (19/22) of 31-A3 cases. Incidence of coronal fractures identified on plain radiographs of 3 AO/OTA 31-A1,A2,A3 groups was lower when compared to the incidence of coronal fractures identified on 3D CT. Of the 138 cases that had coronal plane fracture, 82 cases (59.4%) had a single coronal fragment (GT fragment 35 cases, GLT fragment 19 cases, GLPC fragment 28 cases). The remaining 56 cases (40.5%) had two coronal fragments. There is a high incidence of coronal fragments in intertrochanteric femur fractures when analyzed with 3D CT reconstructions. Our study suggests that these coronal fragments are difficult to identify on plain radiographs. Knowledge of the incidence and morphology of coronal fragments helps to avoid potential intraoperative pitfalls. Copyright © 2016 Elsevier Ltd. All rights reserved.
Bojan, Alicja J; Bragdon, Charles; Jönsson, Anders; Ekholm, Carl; Kärrholm, Johan
The accuracy and precision of RSA were evaluated in the experimental study of screw cut-out complication after fixation of trochanteric fractures. A plastic bone model of a two-part trochanteric fracture was constructed with a Gamma nail implant incorporating RSA markers. The femoral head fragment was attached to a separate rotational table and the femoral shaft was mounted on the micrometer. Three main motions were simulated: Femoral head translation and rotation along the axis of the lag screw and fracture fragment translation along anatomical axes. Accuracy and precision were determined according to ISO 16,087 and ASTM standard F2385-04. Translations along the lag screw axis were measured with a precision within ±0.14 mm and an accuracy within ±0.03 mm. With simultaneous translations along all three anatomical axes, lowest precision was measured for the x-axis (±0.29, 0.07 mm, respectively), but improved when analyzed as a vector (±0.08, 0.03 mm). The precision and accuracy of femoral head rotations were within 0.5° and 0.18°, respectively. The resolution of the RSA method tested in this model was high, though it varied depending on the type of analyzed motion. This information is valuable when selecting and interpreting outcome parameters evaluating implant migration and osteosynthesis stability in future clinical RSA studies. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
Gonnelli, Stefano; Caffarelli, Carla; Rossi, Stefania; Siviero, Paola; Maggi, Stefania; Crepaldi, Gaetano; Nuti, Ranuccio
The hypothesis tested in this study, carried out on elderly Italian women with recent hip fracture, was to assess the extent to which the effect of a condition of being overweight/obese on short-term functional recovery as evaluated by the "time to permitted load" could be explained by a mediator variable (type of hip fracture). We studied 727 women aged 60 years or over with a recent low trauma surgically treated hip fracture and for whom an information on post-surgery complications and on the time to permitted load was available. To assess for mediation, the statistical analyses were carried out following the procedure described by Baron and Kenny. In this study, 46 % of women with hip fracture presented a time to permitted load of ≥ 10 days. The women with a post-surgery time to permitted load of ≥ 10 days showed a significantly higher proportion of trochanteric fracture localization (72.1 vs 42 %), of total overweight/obesity (46.5 vs 36.8 %) and of post-surgery complications (38.8 vs 18.8 %). The mediating effect of hip fracture localization on the association between overweight/obesity and the time of permitted load was demonstrated and confirmed in a multivariate logistic regression model. This study, carried out using a "mediator" statistical analysis, suggests that in elderly women with hip fracture being overweight/obese is associated with a slower short-term functional recovery as evaluated by the time to permitted load and that this association is mediated by the trochanteric localization of hip fracture.
Tavares, Francisco; Healey, Phil; Smith, Tiaki B; Driller, Matthew
In the elite Rugby setting, it is critical to understand the effects of training load on the levels of fatigue, soreness and readiness of the athletes. The training load, wellness, neuromuscular markers of fatigue and various perceptual measures of soreness of 16 elite Rugby athletes were monitored during a training week. Training load was obtained for field training sessions, extra conditioning and gym-based sessions. Perceptual fatigue was obtained every morning from a 5-item wellness questionnaire and a questionnaire on the muscle soreness of 9 different muscle sites from each side of the body. Neuromuscular performance was obtained from a countermovement jump. Although the training performed on day 4 had a significantly (psoreness and neuromuscular performance were more adversely effected after the cumulative workloads of days 1 and 2. Moreover, the effect of training load on muscle soreness was only evident in the lower body muscles. Data from the present study also suggest that two days off training are adequate for complete recovery from a high load training week in elite Rugby athletes. There were no significant differences in soreness ratings between left and right sides for any of the 9 muscles sites. There was a clear effect of training load on soreness and neuromuscular fatigue, with greater fatigue following two training days in a row when compared to a single training day. Monitoring soreness from different lower body muscle sites may provide important information that relates to the fatigue levels of Rugby athletes and therefore it is recommended to be included as part of the training load monitoring protocol.
Beliard, Samuel; Chauveau, Michel; Moscatiello, Timothée; Cros, François; Ecarnot, Fiona; Becker, François
Compression garments on the lower limbs are increasingly popular among athletes who wish to improve performance, reduce exercise-induced discomfort, and reduce the risk of injury. However, the beneficial effects of compression garments have not been clearly established. We performed a review of the literature for prospective, randomized, controlled studies, using quantified lower limb compression in order to (1) describe the beneficial effects that have been identified with compression garments, and in which conditions; and (2) investigate whether there is a relation between the pressure applied and the reported effects. The pressure delivered were measured either in laboratory conditions on garments identical to those used in the studies, or derived from publication data. Twenty three original articles were selected for inclusion in this review. The effects of wearing compression garments during exercise are controversial, as most studies failed to demonstrate a beneficial effect on immediate or performance recovery, or on delayed onset of muscle soreness. There was a trend towards a beneficial effect of compression garments worn during recovery, with performance recovery found to be improved in the five studies in which this was investigated, and delayed-onset muscle soreness was reportedly reduced in three of these five studies. There is no apparent relation between the effects of compression garments worn during or after exercise and the pressures applied, since beneficial effects were obtained with both low and high pressures. Wearing compression garments during recovery from exercise seems to be beneficial for performance recovery and delayed-onset muscle soreness, but the factors explaining this efficacy remain to be elucidated. Key pointsWe observed no relationship between the effects of compression and the pressures applied.The pressure applied at the level of the lower limb by compression garments destined for use by athletes varies widely between
Muñoz-Mahamud, E; Bori, G; Cuñé, J; Font, L; Domingo, A; Suso, S
This retrospective study reports on the clinical results of a group of 23 patients with subtrochanteric femoral fractures using the Long Trochanteric Fixation Nail (LTFN). Between January 2005 and January 2008, 23 patients (20 women, 3 men; average age: 64.8 years old) with subtrochanteric femoral fractures were treated surgically. According to the AO/ASIF Classification, the most frequent fracture type was an 32-A1. They were also classified regarding the Seinsheimer Classification, in which the commonest type was the IIB. Of the 23 fractures, 14 of them had been the result of an unexpected fall, 2 were the result of a high-energy trauma and 7 consisted of pathologic fractures. All the patients were treated using the LTFN device and they all received clinical and radiological follow-ups at least until their fractures were consolidated. The average surgery time, average decrease in haemoglobin in the first 24 hours post- surgery, average need for red blood cell transfusion, postoperative mortality at a 6th month follow-up, time to autonomous deambulation, most frequent destination at the time of discharge, average time for consolidation of the fracture and average follow-up time were reported. Intraoperative and postoperative complications were also recorded. The average surgery time from cut to stitch was 97.45 minutes with the decrease in haemoglobin averaging 26.45 g/L and, on average, the need for red blood cell transfusion was 1.12 concentrates. In the first postoperative week, 57.1% of the total number patients were capable of deambulation. The time to hospital discharge was 12.9 days. After an average follow-up of 13.9 months, total weightbearing was achieved in the 64.7% of the patients. The average consolidation time was 21.6 weeks and none of the patients developed pseudoarthrosis. Technical failures were seen in 4.3% of the cases: 1 patient suffered a migration of the distal locking screw. There were no cases of deep infection, cut-out, bending
Pasiakos, Stefan M; Lieberman, Harris R; McLellan, Tom M
Protein supplements are frequently consumed by athletes and recreationally-active individuals, although the decision to purchase and consume protein supplements is often based on marketing claims rather than evidence-based research. To provide a systematic and comprehensive analysis of literature examining the hypothesis that protein supplements enhance recovery of muscle function and physical performance by attenuating muscle damage and soreness following a previous bout of exercise. English language articles were searched with PubMed and Google Scholar using protein and supplements together with performance, exercise, competition and muscle, alone or in combination as keywords. Inclusion criteria required studies to recruit healthy adults less than 50 years of age and to evaluate the effects of protein supplements alone or in combination with carbohydrate on performance metrics including time-to-exhaustion, time-trial or isometric or isokinetic muscle strength and markers of muscle damage and soreness. Twenty-seven articles were identified of which 18 dealt exclusively with ingestion of protein supplements to reduce muscle damage and soreness and improve recovery of muscle function following exercise, whereas the remaining 9 articles assessed muscle damage as well as performance metrics during single or repeat bouts of exercise. Papers were evaluated based on experimental design and examined for confounders that explain discrepancies between studies such as dietary control, training state of participants, sample size, direct or surrogate measures of muscle damage, and sensitivity of the performance metric. High quality and consistent data demonstrated there is no apparent relationship between recovery of muscle function and ratings of muscle soreness and surrogate markers of muscle damage when protein supplements are consumed prior to, during or after a bout of endurance or resistance exercise. There also appears to be insufficient experimental data
Full Text Available Introduction: Nausea and vomiting after ear, nose and throat (ENT surgery is one of the most common and notable problems facing anesthesiologists in this area. This study was conducted to determine the effect of a pharyngeal pack on the severity of nausea, vomiting, and sore throat among patients after ear, pharynx, and throat surgeries. Materials and Methods: This randomized clinical study was performed in 140 patients (61 men and 79 women; age range, 20–40 years who had undergone nasal surgery in 2010. Patients were divided into two groups: the first group were treated using a pharyngeal pack (case group and the second group were managed without a pharyngeal pack (control group. Statistical analysis was performed using the Chi-square test and the Mann-Whitney U test. SPSS software was used for data analysis. Results: The mean severity of nausea and vomiting in the two groups was 2.057, 1.371 and 1.100, respectively, with no significant differences between groups. However, the mean severity of sore throat was 1.714 in the group with the pharyngeal pack and 1.385 in the group without pharyngeal pack (P=0.010. Conclusion: Not only does a pharyngeal pack in ENT surgery not reduce the extent and severity of nausea and vomiting, but it also increases the severity of sore throat in patients when leaving the recovery room and discharging hospital.
Meamarbashi, Abbas; Rajabi, Ali
Delayed-onset muscle soreness (DOMS) often occurs after unaccustomed eccentric exercise and reduces exercise performance. We aimed to study the preventive effects of saffron and indomethacin on the biochemical and functional indicators of DOMS after 1-session eccentric exercise. A 10-day, randomized, double-blind, placebo-controlled, pretest-posttest design. Controlled research laboratory. Thirty-nine nonactive male university students randomly divided into saffron (n = 12), indomethacin (n = 12), and control (n = 15) groups. Saffron group received 1 capsule containing dried saffron powder (n = 12, 300 mg/d), indomethacin group received 75 mg indomethacin (n = 12, 25 mg thrice a day), and control group (n = 15) received placebo capsules, 1 week before and 3 days after eccentric exercise. Ten days before and 24, 48, and 72 hours after muscle soreness protocol, the maximum isometric and isotonic forces, plasma creatine kinase (CK), plasma lactate dehydrogenase (LDH), perceived pain, knee range of movement, and thigh circumference were measured. Muscle soreness protocol was performed with a weight load equal to 80% of the maximum isotonic force in 4 sessions with 20 repetitions and 3-minute rest in between. This study shows that 10-day supplementation with 300 mg saffron significantly decreased the CK and LDH concentrations (P < 0.0001). In the saffron group, there was no decline in maximum isometric and isotonic forces after eccentric exercise, but a significant decline in the isometric force was observed in the control group (P < 0.0001). No pain was reported in the saffron group, whereas the indomethacin group experienced pain before 72 hours (P < 0.001). Results obtained from the current novel research indicate a strong preventive effect of 10-day supplementation with saffron on the DOMS. The saffron can be used to prevent DOMS and alleviate the DOMS symptoms.
Prior, Mary Jane; Lavins, B Joseph; Cooper, Kimberly
To compare the efficacy of acetaminophen extended release (ER) caplets to placebo in treating muscle soreness after a marathon. This was a randomized, double-blind, placebo-controlled study of participants ≥ 18 years old, who completed a marathon and experienced muscle soreness rated at least 4 on a 0-to-10 numerical rating scale. The intent-to-treat efficacy analysis included 610 participants. Participants were screened for eligibility before the marathon, and reported to the study tent after the marathon. On confirming eligibility, participants were randomly assigned to 4 days of 3-times-daily treatment of either acetaminophen ER 1300 mg (n=307) or placebo (n=303). Participants treated with acetaminophen ER reported a significantly (Psoreness on the day of the marathon (day 1) (-0.79) than did placebo (-0.36). In addition, the adjusted mean average interference with sleep was significantly lower for acetaminophen ER (2.14) than for placebo (2.52, P=0.0046). The adjusted mean overall satisfaction with treatment was significantly higher for acetaminophen ER (5.38) than for placebo (4.64, P=0.0060). Adverse events were reported by 3.7% of participants, with no clinically important difference between treatment groups. No serious adverse events were reported. Acetaminophen ER 1300 mg, a nonprescription drug, was an effective treatment for post-race muscle soreness on the day of the marathon. In addition, acetaminophen ER provided benefit for interference with sleep and overall satisfaction with treatment, and was generally well tolerated.
Oh, Kyung Eun; Song, Ae Ran; Sok, Sohyune R
This study compared and examined the effects of aroma gargling, cold water gargling, and wet gauze application on thirst, halitosis, and sore throat in patients after spine surgery. A quasiexperimental pretest/posttest control group design was employed. Samples were total 70 patients (aroma gargling: 24 samples, cold gargling: 24 samples, and wet gauze: 22 samples) after spine surgery in K Hospital in Seoul, Korea. The aroma gargle solution as an experimental intervention was prepared by blending peppermint, tea tree, and lemon oils at a ratio of 1:2:2. A 60 cc of aroma gargle solution was used 3 times for 15 to 20 seconds. The visual analog scale was used to measure the degrees of thirst and sore throat, and a portable device was used to examine the degree of halitosis. There were significant differences in the degrees of thirst, halitosis, and sore throat according to interaction between group and duration. In the comparison among 3 groups, aroma gargling provided better oral health by decreasing thirst, halitosis, and sore throat for patients with spine surgery. Aroma gargling can be utilized as an effective nursing intervention for decreasing thirst, halitosis, and sore throat for patients with spine surgery in clinical practice. Results suggest, therefore, that health professionals should consider an array of methods including aroma gargling for patients after spine surgery.
Ingham, Stephen A; van Someren, Ken A; Howatson, Glyn
The aim of this study was to examine the effect of concentric warm-up exercise on eccentrically induced changes in muscle strength, range of motion, and soreness of the elbow flexors. Ten resistance-exercise naive participants performed intermittent incremental eccentric actions (42 in total) of the elbow flexor muscles of each arm to induce muscle damage. The arms of each participant were randomly assigned either to a pre-eccentric exercise warm-up involving intermittent concentric exercise (warm-up) or no prior exercise (control). Strength, range of motion, and ratings of soreness were recorded before and 1, 2, 3, 4, and 7 days after exercise. Strength, range of motion, and soreness during muscular movements changed over time (P at most 0.01; Cohen's d at least 0.51, medium). There was an interaction (P soreness was reduced for the warm-up group, while the muscle was flexed, extended, and relaxed compared with control (P soreness after eccentric-exercise-induced muscle damage and might allow higher intensities of training to be performed.
Agten, Christoph A; Buck, Florian M; Dyer, Linda; Flück, Martin; Pfirrmann, Christian W A; Rosskopf, Andrea B
The objective of our study was to assess delayed-onset muscle soreness (DOMS) over time using quantitative MRI and shear-wave ultrasound (US) elastography. Five male (mean age ± SD, 39.6 ± 4.6 years) and five female (30.6 ± 13.5 years) volunteers underwent 1.5-T MRI before and after (15 minutes, 1 day, 3 days, 7 days) performing unilateral eccentric resistance exercise of the elbow flexor muscles. The MRI examinations included fluid-sensitive, DWI, and diffusion-tensor imaging sequences of the distal upper arm. Muscle edema, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were assessed. US of the brachialis muscle was performed before and after (15 minutes, 12 hours, 1 day, 2 days, 3 days, 7 days) exercise to measure mean shear-wave velocity (SWV). Pain and muscle tightness were assessed. For men, muscle edema was moderate and peaked 3 days after exercise; for women, muscle edema was mild and peaked 1-3 days after exercise. ADC was highest 3 days after exercise in men (mean, 1809.22 × 10 -6 mm 2 /s; before exercise, 1529.88 × 10 -6 mm 2 /s) and women (1741.90 × 10 -6 mm 2 /s; before exercise, 1475.80 × 10 -6 mm 2 /s). FA dropped from 361.00 in men and 389.00 in women before exercise to a minimum of 252.12 and 321.28, respectively, 3 days after exercise. Mean SWV increased after exercise in men (before exercise, 3.00 ± 0.30 m/s; peak [15 minutes after exercise], 4.04 ± 0.90 m/s) and women (before, 2.82 ± 0.40 m/s; peak [1 day after exercise], 3.23 ± 0.40 m/s) and subsequently returned to normal. In men, the ADC values of the brachialis muscle positively correlated with mean SWV (r = 0.92, p = 0.028). FA negatively correlated with pain in men (r = -0.993, p = 0.001) Muscle edema outlasted clinical symptoms in most volunteers. FA inversely correlates with pain and may be a useful imaging parameter for assessment of DOMS. Shear-wave US elastography shows a temporary increase of muscle stiffness after DOMS-inducing exercise but does not
Full Text Available Unaccustomed strenuous exercise that includes lengthening contraction (LC often causes tenderness and movement related pain after some delay (delayed-onset muscle soreness, DOMS. We previously demonstrated that nerve growth factor (NGF and glial cell line-derived neurotrophic factor (GDNF are up-regulated in exercised muscle through up-regulation of cyclooxygenase (COX-2, and they sensitized nociceptors resulting in mechanical hyperalgesia. There is also a study showing that transient receptor potential (TRP ion channels are involved in DOMS. Here we examined whether and how TRPV1 and/or TRPV4 are involved in DOMS. We firstly evaluated a method to measure the mechanical withdrawal threshold of the deep tissues in wild-type (WT mice with a modified Randall-Selitto apparatus. WT, TRPV1-/- and TRPV4-/- mice were then subjected to LC. Another group of mice received injection of murine NGF-2.5S or GDNF to the lateral gastrocnemius (LGC muscle. Before and after these treatments the mechanical withdrawal threshold of LGC was evaluated. The change in expression of NGF, GDNF and COX-2 mRNA in the muscle was examined using real-time RT-PCR. In WT mice, mechanical hyperalgesia was observed 6-24 h after LC and 1-24 h after NGF and GDNF injection. LC induced mechanical hyperalgesia neither in TRPV1-/- nor in TRPV4-/- mice. NGF injection induced mechanical hyperalgesia in WT and TRPV4-/- mice but not in TRPV1-/- mice. GDNF injection induced mechanical hyperalgesia in WT but neither in TRPV1-/- nor in TRPV4-/- mice. Expression of NGF and COX-2 mRNA was significantly increased 3 h after LC in all genotypes. However, GDNF mRNA did not increase in TRPV4-/- mice. These results suggest that TRPV1 contributes to DOMS downstream (possibly at nociceptors of NGF and GDNF, while TRPV4 is located downstream of GDNF and possibly also in the process of GDNF up-regulation.