Compartment pressures in children with normal and fractured lower extremities

Abstract

Purpose

Needle manometry is a tool to confirm suspected acute compartment syndrome (ACS). There is scarce evidence of normal pressure values of the lower extremities in children. The aim of this study is to assess the normal compartment pressures in non-injured lower extremities of children.

Methods

This prospective study included children up to the age of 16 years with lower extremity fractures that needed reduction. Between June 2009 and August 2015, 20 children were included. We used needle manometry to measure the pressures in the superficial (SPC), deep posterior (DPC) and in the anterior compartments (AC) on both the lower legs.

Results

On the healthy leg, the mean compartment pressure was 15.15 mmHg in the AC (range 7–30 mmHg), 14.32 mmHg in the SPC (range 8–24 mmHg) and 13.00 mmHg in the DPC (range 4–21 mmHg). On the injured leg, the mean compartment pressure was 24.07 mmHg in the AC (range 5–40 mmHg), 17.21 mmHg in the SPC (range 7–29 mmHg) and 17.13 mmHg in the DPC (range 6–37 mmHg). We found a perfusion gradient (diastolic blood pressure—compartment pressure) < 30 mmHg in at least one compartment of the fractured and healthy leg in 13 patients. Five patients underwent fasciotomy for suspected ACS and their data was excluded for the injured leg.

Conclusion

We could show that children have higher normal compartment pressures than adults in the lower leg. They seem to be able to tolerate higher absolute compartment pressures and lower pressure gradients before ACS occurs. More studies are needed to make a final statement on tolerable compartment pressures in children.

http://bit.ly/2Bktdz5

Die Entwicklung virtueller Realität als Expositionsverfahren

Zusammenfassung

Hintergrund

Virtuelle Realität (VR) wird seit 20 Jahren als Expositionsverfahren in der Verhaltenstherapie von Angststörungen untersucht. Inzwischen liegen mehrere Metaanalysen mit überzeugenden Wirksamkeitsbelegen vor.

Fragestellung

In den letzten Jahren hat eine enorme Weiterentwicklung der VR-Technologie und der damit verbundenen Möglichkeiten stattgefunden, die weiterhin andauert. Vor diesem Hintergrund wird der aktuelle Stand von VR als Expositionsmethode dargestellt.

Material und Methoden

Wir bieten einen narrativen Überblick über aktuelle Forschung zu VR-Expositionstherapie bei Angststörungen und die wichtigsten Entwicklungen in diesem Bereich.

Ergebnisse

Nach einem anfangs fast ausschließlichen Fokus auf spezifische Phobien nimmt die Zahl der Arbeiten zu komplexeren Angststörungen (v. a. soziale Angststörung) zu. Zudem hat sich VR inzwischen als experimentelle Methode etabliert, um psychopathologische Prozesse zu erforschen und die Wirkmechanismen von (VR-)Exposition zu erhellen.

Diskussion

Nach wie vor besteht Forschungsbedarf zur VR-Expositionstherapie, v. a. bei komplexen Angststörungen (z. B. Panikstörung und Agoraphobie, soziale Phobie) und Traumafolgestörungen. Darüber hinaus hat sich VR als Forschungsmethode inzwischen etabliert. Die rasche technische Entwicklung im VR-Bereich lässt eine weitere Zunahme der Forschungsaktivitäten zu VR erwarten – sowohl in der klinischen als auch in der Grundlagenforschung.

http://bit.ly/2MMqdjL

A histocytological and radiological overview of the natural history of intervertebral disk: from embryonic formation to age-related degeneration

Abstract

Purpose

To elucidate the natural history of intervertebral disk (IVD) and characterize its embryonic beginnings and age-related degeneration.

Methods

Coronal sections of embryonic (E13.5-neonatal) and postnatal (4–60-week-old) Sprague–Dawley rat IVD were stained by a series of histological stainings (hematoxylin and eosin, Alcian blue, Picrosirius red, Masson, Periodic acid–Schiff). Growth kinetics within embryonic IVD were evaluated by immunohistochemical staining of Ki67 and proliferating cell nuclear antigen. Postnatal maturation and degeneration of IVD were visualized on radiology by X-ray, CT, and MR imaging.

Results

During the formation of rat IVD, inner annulus fibrosus (AF) and cartilaginous endplate (CEP) shared similar cell density, extracellular matrix, and potential of growth kinetics; notochord provided increased and enlarged cytoplasmic vacuoles to generate nucleus pulposus (NP), part of which was retained within CEP. Postnatally, vacuolated notochord cells were reduced by devacuolation, while chondrocytic NP cells increased; cartilaginous layers of CEP were narrowed by vertebrae growth and secondary ossification; fibrotic portion of AF decreased as cartilaginous matrix accumulated and infiltrated outward. In aged and degenerated IVD, large longitudinal fissures were detected near the boundaries between inner and outer AF, whereas both reduced cellularity and accumulated cell clusters were evident within the dehydrated NP; only part of these histocytological changes could be reported on radiology.

Conclusions

By showing that the natural history of IVD is orchestrated by a dynamic histocytological regulation, our study may facilitate better understanding of the developmental defects, cellular heterogeneity, age-related degenerative mechanisms, and biological regeneration of IVD.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

http://bit.ly/2DTkgyx

Correction to: Measuring nanoparticles in the size range to 2000 nm

The original version of this article unfortunately contained mistakes.

http://bit.ly/2BjcbkO

Gait abnormalities following slipped capital femoral epiphysis treated with in situ fixation

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Brice Henry, Christine Detrembleur, Philippe Mahaudens, Sophie Boulet, Pierre-Louis Docquier

Abstract

Background

Slipped capital femoral epiphysis (SCFE) is a common disorder in adolescent for which no consensus exists regarding management. The aim of the present study was to analyze gait modifications following SCFE treated with in situ fixation (ISF) and to relate it to radiologic stage. Research question. To verify if gait biomechanics are impaired in patients with SCFE and to try to determine a degree of slippage from which gait modifications would appear.

Methods

We evaluated 16 patients treated by ISF for SCFE with slippage ranging from 11° to 61°. Gait variables were compared to normal population according to age and walking speed and were normalized in Z-scores.

Results

Spatiotemporal parameters, mechanical and energetic variables were inferior to |1.5| Z-scores and considered as normal. Kinematics showed increase of pelvic tilt and hip adduction. Kinetic variables showed modifications with increased hip extension moment. There was also a strong increase in power of hip extensor. Hip extension moment and power of hip extensors were significantly correlated to radiologic stage. Analysis of ROC curves showed a cut-off value of slippage about 25°–30° affecting kinematics of pelvis and hip and kinetic variables.

Conclusion

The gait variables were close to normal values. Main modifications were observed in kinematic and kinetic data with a significant increase in extension moment and power generated at the operated hip. This could participate to long-term joint degradation observed in SCFE, even in mild slips. The clinical message is to control regularly SCFE with initial slippage greater than >25–30° to allow for early diagnosis of premature hip osteoarthritis.

from #Audiology via ola Kala on Inoreader http://bit.ly/2DQRaQ9

Movement Variability emerges in Gait as Adaptation to Task Constraints in Dynamic Environments

Publication date: Available online 4 February 2019

Source: Gait & Posture

Author(s): Carla Caballero, Keith Davids, Ben Heller, Jonathan Wheat, Francisco J. Moreno

Abstract

Background

Motor variability has been related to motor control playing a functional role in human adaptive behaviours. However, the direction of the relationship between variability and motor control can be unclear. The specific relations that exist between task constraints and movement (re)organization could explain some of this controversy.

Research question

This study sought to understand whether manipulation of task constraints result in changes in the magnitude or structure of motor system variability observed in a basic walking task. We also investigated the relationship between performance in achieving task goals and the structure of motor variability.

Methods

Twenty volunteers walked around a circular track with binary combinations of 3 task constraints, providing 8 conditions. The manipulated task constraints were: 1) track width; 2) surface stiffness; and 3), walking direction. Performance was analysed using standard deviation (SD) of sacral displacement and its mean velocity (MV). Fuzzy Entropy (FE) and Detrended Fluctuation Analysis (DFA) were used to assess the kinematic variability structure.

Results

Individuals showed lower SD and MV walking on the narrower track. These changes were also followed by higher DFA values, indicating a more auto-correlated structure of variability. The foam surface was also associated with an increase in amplitude, velocity and irregularity (FE) of movement.

Significance

Results of this study describe how specific task constraints, such as the width of the walking track and the surface stiffness, shape emergent movement coordination patterns as participants search for functional information from the environment to regulate performance behaviors. Changes in variability structure could reveal the search for adaptive strategies during walking. Smaller movement fluctuations and higher velocity in gait patterns are related to greater irregularity and lower autocorrelation in the kinematic variability structure, demonstrating that a specific relationship emerges between system variability and movement performance, which is driven by task constraints.

from #Audiology via ola Kala on Inoreader http://bit.ly/2MLZovO

Gait abnormalities following slipped capital femoral epiphysis treated with in situ fixation

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Brice Henry, Christine Detrembleur, Philippe Mahaudens, Sophie Boulet, Pierre-Louis Docquier

Abstract

Background

Slipped capital femoral epiphysis (SCFE) is a common disorder in adolescent for which no consensus exists regarding management. The aim of the present study was to analyze gait modifications following SCFE treated with in situ fixation (ISF) and to relate it to radiologic stage. Research question. To verify if gait biomechanics are impaired in patients with SCFE and to try to determine a degree of slippage from which gait modifications would appear.

Methods

We evaluated 16 patients treated by ISF for SCFE with slippage ranging from 11° to 61°. Gait variables were compared to normal population according to age and walking speed and were normalized in Z-scores.

Results

Spatiotemporal parameters, mechanical and energetic variables were inferior to |1.5| Z-scores and considered as normal. Kinematics showed increase of pelvic tilt and hip adduction. Kinetic variables showed modifications with increased hip extension moment. There was also a strong increase in power of hip extensor. Hip extension moment and power of hip extensors were significantly correlated to radiologic stage. Analysis of ROC curves showed a cut-off value of slippage about 25°–30° affecting kinematics of pelvis and hip and kinetic variables.

Conclusion

The gait variables were close to normal values. Main modifications were observed in kinematic and kinetic data with a significant increase in extension moment and power generated at the operated hip. This could participate to long-term joint degradation observed in SCFE, even in mild slips. The clinical message is to control regularly SCFE with initial slippage greater than >25–30° to allow for early diagnosis of premature hip osteoarthritis.

from #Audiology via ola Kala on Inoreader http://bit.ly/2DQRaQ9
via IFTTT