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Results for “MANIPULATION, ORTHOPEDIC”

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PubMed1980

[Children's mandible fractures (author's transl)].

At Lyon's Maxillo-facial Surgery Center, children's mandible fractures represent 8% treated fractures at admited sick people (35 children for 56 fractures) for 1976-77-78. We insist on the treatment used in our center for articular region fractures: mandibular gymnastic in propulsion and laterality with a good result, orthopedic treatment only in case of gymnastic's failure. The other anatomic types are treated by orthopedic, surgical or mixed method, according to teething age, and fracture's diastasis.

Adolescent↗

PubMed1996

Clinically significant abnormalities in postreduction radiographs after anterior shoulder dislocation.

STUDY OBJECTIVE: To determine the incidence of clinically significant fractures or other abnormalities seen on postreduction shoulder radiographs which were not seen on postreduction should radiographs which were not seen on the prereduction films obtained for anterior shoulder dislocations. METHODS: Retrospective chart review of 131 patients who presented with a total of 175 anterior shoulder dislocations to the emergency department of an urban, university-affiliated, Level 1 Trauma Center with an emergency medicine residency program. All patients had complete medical records, radiographs before and after reduction, and no fractures reported on the prereduction films. RESULTS: There were three avulsion fractures (1.7%; 95% confidence interval [CI], 0% to 4.5%) detected on postreduction radiographs. In all three cases, a radiologist who was blinded to the original interpretations and the purpose of the study also noted the fractures on the prereduction films, although these fractures were not detected on the original interpretations. There were 14 new Hill-Sachs deformities (8%; 95% CI, 4% to 12%). In one case (.6%; 95% CI, 0% to 2.8%), the postreduction radiograph demonstrated a persistent dislocation, which was subsequently reduced in the ED. This was the only postreduction finding that altered acute management. CONCLUSION: Postreduction radiographs rarely reveal any clinically significant abnormality after an anterior shoulder dislocation has been reduced. Emergency physicians and orthopedic surgeons should question whether the time and expense of obtaining routine postreduction films in the ED for anterior shoulder dislocations is justified. A prospective study is needed to validate our findings.

Adult↗

PubMed2004

Computer-aided multimedia training in orthopedic rehabilitation.

OBJECTIVE: To compare a computer-aided training program with a conventional training program in orthopedic rehabilitation. DESIGN: The study was a randomized, nonblinded, controlled trial in which follow-up data were obtained at 6 mos. In an inpatient rehabilitation center, a consecutive sample was taken of patients with first total hip replacements or first total knee replacements 23-42 days after surgery. Indication groups were examined separately. The study population included 189 women and 85 men. Mean age was 69 yrs (38-86 yrs). Patients received either computer-aided training (case group) or conventional training (control group) within the framework of their inpatient rehabilitation program. The main outcome measures were levels of acceptance and effectiveness (Harris Hip Score, Hospital for Special Surgery Score, FIM instrument, and Hanover Functional Ability Questionnaire). RESULTS: Both forms of training showed significant improvements until discharge in scores and items used for the result evaluation independent of patient sex, age, and educational level. The 6-mo follow-up showed that between the groups, there was no statistically significant difference in the level of improvement concerning functional capacity. Furthermore, patients displayed their acceptance of the system by rating it with average values between "good" and "very good." CONCLUSIONS: For patients with total hip replacements or total knee replacements, computer-aided training can be regarded as the equivalent to conventional training in relationship to the results of the rehabilitation program. The system is a new tool in orthopedic rehabilitation. To identify the relative importance of the system, further research is needed.

Adult↗

PubMedDate not supplied

[Displaced fractures of the middle third of the forearm in children. The therapeutic considerations].

There been studied 100 cases of fractures of the middle third of both bones of forearm in child for to assess the correctitude of the therapy, based on the analysis of results. The most correct surgical techniques consist of osteosynthesis with Kirschner wire of the both bones, knowing the particularities of the fracture linea in child and the minimal tissues' damages. In the child younger then 10 years old, the open reduction is rarely necessary. Any displaced fracture of middle third of both bones of forearm, whatever the age of the child would be orthopedically reduced, before performing the surgical therapy. The unstable osteosynthesis such as simple screw "osteosynthesis" with wire or thread are contraindicated.

Adolescent↗

PubMed1997

Fracture of the proximal phalanx of the little finger in children: a classification and a method to measure the deformity.

OBJECTIVE: To develop an improved method for measuring the deformity caused by fracture of the proximal end of the proximal phalanx of the little finger in children. DESIGN: A prospective case study. SETTING: Regional hospitals with an orthopedic service. PATIENTS: Forty-two children with a proximal phalangeal fracture of the little finger and 42 children without a phalangeal fracture, who acted as a control. The type of deformity resulting from the fracture was noted, and the angle of deformity was measured. Rotational deformities were measured clinically in all patients and angulation deformities were measured from radiographs. The deformities were graded and classified. MAIN OUTCOME MEASURES: Measurements of the fracture deformity before and after manipulation. RESULTS: There were 38 ulnar angulation deformities, 26 dorsal angulation deformities, 10 ulnar rotation deformities, 3 palmar angulation deformities, 2 radial angulation deformities and 1 radial rotation deformity. The deformities could be graded into 6 different types. CONCLUSION: The measurements of deformity made it possible to describe and classify isolated deformities and combinations of various deformities.

Adolescent↗

PubMed1996

Rehabilitation and chiropractic practice.

In summary, evaluation attempts to identify mechanical sensitivities and muscle or joint dysfunctions that are responsible for a patient's inability to achieve a demand minimum functional capacity. Basic skills that patients use in their jobs, sports or activities of daily living are evaluated (DOT) to establish those minimum demands for return to work. Typically, examination proceeds from active to passive tests. Inspection of posture, range of motion and basic skills (DOT) may come first. This can be followed by active provocative maneuvers such as McKenzie or orthopedic testing (i.e., Kemps). Muscle strength, coordination or endurance tests would then come. These are followed by passive tests of joint play and muscle length. Finally, passive provocative maneuvers, such as orthopedic tests (i.e., Gaenslen's) or soft tissue palpation (i.e., trigger points), would occur last. The goal of evaluation is to achieve diagnostic triage, monitor outcomes, find key functional pathologies and identify work capacity. All these goals should be met by a chiropractic rehabilitation specialist.

Back Pain↗

PubMed1984

[Spinal fractures in children. Diagnostic and therapeutic problems. Apropos of 67 cases].

Between 1960 and 1980 the authors have observed 67 cases of spinal traumatism for children under 15 years old. Neurological deficit was present for 25 of these patients. At the first examination for 17 and after for 8. 5 children have total paraplegia without osteoligamentary lesions. The cervical traumatisms were without other injuries and were the result of minor trauma. The thoracolumbar traumatisms were accompanied by other injuries and were the result of violent trauma. Most of these lesions have been reduced by orthopedic method; only 4 children were operated because the dislocation was incoercible. The 15 children who presented total paraplegia had no recovery. For all the others, the recuperation was good.

Adolescent↗

PubMed1996

Inferior glenohumeral dislocation (luxatio erecta humeri).

A 67-year-old woman was seen in the emergency department because of severe pain and inability to move her left shoulder after falling on an abducted left arm. The fall was the result of a near-syncopal episode. On examination, the left arm was hyperabducted and elevated approximately 80 degrees from the horizontal plane. Furthermore, the patient was unable to move her left arm. Radiographs of the shoulder revealed an inferior dislocation of the glenohumeral joint. Closed reduction in the emergency department was successful. This rare but classic case of inferior glenohumeral dislocation (luxatio erecta humeri) serves to emphasize that a heightened awareness for this injury is necessary if it is to be recognized and treated appropriately. It is important to obtain orthopedic consultation or follow-up (or both) for this injury, because of the high incidence of accompanying tears of the rotator cuff. Neurovascular compromise is also commonly associated with this dislocation. The neurologic injuries are more common than the vascular injuries but tend to resolve after reduction.

Accidental Falls↗

PubMed1979

Orthopedic manual therapy--an overview. Part II: the spine.

The focus of this article is orthopedic manual therapy for the spine: 1) precautions and contraindications for manual methods of treatment; 2) definitions of general terms for therapeutic techniques of mobilization and traction; and 3) the general concepts and the evaluation, treatment, and aftertreatment procedures of James Cyriax, MD, MRCP; Freddy Kaltenborn, DO, RPT; Geoffrey Maitland, MAPA, FCSP; and John McM. Mennell, MD.

Humans↗

PubMed1997

Physical medicine modalities and trigger point injections in the management of temporomandibular disorders and assessing treatment outcome.

Temporomandibular disorders (TMDs) are principally musculoskeletal, orthopedic, and neurologic in nature. The use of trigger point injections and physical medicine modalities has become commonplace in the management of TMDs. These modalities have a long and successful history in the management of similar disorders in other areas of the body, and it is only natural that they would be included in the management of TMD as well.

Electric Stimulation Therapy↗

PubMed2001

[Acute anterior instability of the shoulder: short- and mid-term outcome after conservative treatment].

PURPOSE OF THE STUDY: We assessed short and mid-term outcome after emergency care for acute anterior instability of the shoulder. MATERIALS AND METHOD: Between October 1990 and May 1996, 233 shoulders (206 anteromedial dislocations, 21 dislocations with spontaneous reduction, and 6 painful shoulders with unknown instability) were treated, mainly orthopedically. The series included 165 men and 68 women, mean age 42 years (range 13-95 years). One hundred fifty-eight practiced sports more or less regularly (73% of the 216 patients) and a sports accident was involved in 121 cases (52.8%). Besides the usual lesions secondary to bone displacement, there were 51 fracture-avulsions of the greater tuberosity, 7 major fractures of the anteroinferior border of the glenoid cavity, 2 fractures of the coracoid process, 10 nerve lesions (6 axillary nerve palsies and 4 partial palsies of the brachial plexus) and 10 rotator cuff tears. Orthopedic reduction was performed in the emergency room in all patients with a dislocated shoulder (82%). Immobilization, elbow to body, was prescribed for 8 to 15 days. Sixteen patients (6.8%) underwent surgery during the days following reduction, 8 for displaced fracture of the greater tuberosity, 7 for important fracture of the glenoid cavity and 1 for avulsion of the rotator cuff. RESULTS: Patient files (n=210) or phone interviews (n=185) were used to assess outcome. Mean follow-up was 38 months (12 - 72 months). All nerve lesions regressed within a few weeks without sequelae. We had 6 cases of retractile capsulitis and 4 cases of reflex dystrophy that regressed totally in 3 to 6 months. Recurrent dislocation was observed in 52 cases (24.7% recurrence rate) with 29 occurring within one year (55.8%). Among the 145 other shoulders, 84 recovered completely (58%), 52 were occasionally bothersome (36%), 8 exhibited repeated subdislocation (5.5%) and one remained pseudoparalytic. Among the factors favoring recurrence, we found patient age (higher risk in younger subjects) and lack of rehabilitation (p<0.05). DISCUSSION: Acute anterior dislocation of the shoulder is frequent, but emergency surgical repair is rarely needed (15 cases in our series, 6.9%). Mid-term recurrence is not as frequent as is often thought, warranting the choice of first intention orthopedic care. Our findings demonstrated that emergency surgery is not indicated in most cases of anterior shoulder instability, even with the arthroscopic approach, especially since the results of this method remain unclear.

Accidents↗

PubMed1988

Isolated dislocation of the tarsal navicular: a case report.

Isolated dislocation of the tarsal navicular is a rare injury that is not mentioned in standard orthopedic textbooks and described only once in the English literature. Because of the rarity of this condition, the best means of treatment has not been established. A patient with this unusual dislocation was recently diagnosed and treated. Open reduction was eventually required, which was followed by the development of ischemic necrosis of the navicular.

Adult↗

PubMed2003

[Simultaneous dislocation of the interphalangeal joints of the index finger].

A crush injury caused simultaneous posterior dislocation of the interphalangeal joints of the index without associated fracture. Orthopedic treatment was used because a stable reduction was achieved without difficulty. The hand was immobilized for three weeks followed by rehabilitation exercises. Complete functional recovery was achieved with pain-free joints. We recommend starting the reduction at the distal interphalangeal level in order to allow relaxation of the deep flexor tendons favoring reduction of the proximal interphalangeal joints.

Finger Injuries↗

PubMed1997

[Retrosternal luxation of the clavicle. Apropos of 4 cases surgically treated using a temporary screwed anterior plate and review of the literature].

The authors report 4 new cases of retrosternal dislocation of the clavicle operated by capsular and ligament restoration, and temporary stabilization by anterior plating. The 4 patients were men with a mean age of 17.5 years. The lesion was caused by a sports injury (football, rugby) in 3 out of 4 cases and was related to an indirect mechanism. Clinical examination allowed the diagnosis, was related to based on painful palpation of a dip over the joint, supported by radiology and computed tomography. CT did not reveal the epiphyseal separation present in two cases. Complications were frequent: 1 case of tracheal compression, 2 cases of temporary paresthesia of the upper limb, 2 cases of venous compression with one case of subclavian and medial jugularis venous thrombosis, 1 hemopneumothorax. Surgical reduction was performed in all 4 cases after 2 failures of attempted orthopedic treatment under general anesthesia. All patients recovered a full range of movement, a painless shoulder and no recurrence has been observed. All complications resolved after reduction. Venous thrombosis responded favourably after 6 months of anticoagulant therapy. One plate breakage was observed with no clinical implications. On the basis of an extensive review of the literature, the authors discuss the epidemiology, pathology and the importance of associated injuries, which are frequent and sometimes serious, justifying urgent reduction. Computed tomography is the most useful radiologic modality, both for diagnosis and for investigation of complications. Orthopedic treatment must be attempted first (especially in children) according to a well systematized technique. One third of attempts fail, and cases of delayed diagnosis and serious vascular complications, then require surgical treatment. The costoclavicular ligament is repaired either by Burrows's ligamentoplasty or by bone suture; the clavicle is stabilized by bone suture or by anterior plating. The authors do not advocate either joint fixation by Kirschner wire, or resection of the medial end of the clavicle.

Accidents, Traffic↗

PubMed1984

Clinical education model for staff training in orthopedic manual therapy.

We designed a clinical education model for training staff orthopedic physical therapists to provide basic skills in orthopedic manual therapy. The program evolved in a health maintenance organization, where a large number of patients with acute and chronic musculoskeletal disorders receive care. As physical therapy became primary in the treatment of these patients, the staff needed to develop specialized clinical skill. We divided the program into four phases: Phase I--Lecture Series, Phase II--Evaluation of Clinical Skill, Phase III--Self-directed Study, and Phase IV--Re-evaluation. This clinical education assures the staff physical therapist of a supportive learning environment. The program enhances clinical development by identifying individual strengths and weaknesses and providing a positive framework for improvement and self-evaluation.

Clinical Competence↗

PubMed1988

Complications of chiropractic treatment for back pain.

Back pain often causes patients great despair, and they expect the primary care physician or orthopedic surgeon to provide a quick, simple solution. Rest and analgesia are the most commonly prescribed treatments, and muscle relaxants, heat, traction, and physiotherapy are also used. If these treatments do not help, the patient may search for relief through faith healing, acupuncture, chiropractic treatment, or other nonconventional forms of treatment. Although chiropractic treatment is a popular alternative, its long-term effect is questionable and the medical literature contains numerous reports of patients whose condition worsened as a result of it. Physicians should be aware of the dangers of chiropractic treatment, particularly in patients with severe spondylitic changes, osteoporosis, fractures, tumors, ankylosing spondylitis, infections, or signs of nerve root pressure.

Back Pain↗

PubMed1997

[Orthopedic treatment of scoliosis: new technique using impression by optic procedure].

The authors present a new procedure for acquiring the whole external trunk shape. The construction of braces starts with corrected a positive mold using computer-assisted design software connected to a digital tooling machine. The computer-assisted design and construction of braces enable the determination, measurement, and modification of a three-dimensional image of the trunk, which allows the positive to be corrected. The outer-trunk can be re-balanced, derotated or rectified in the sagittal or frontal plane and the inner modeling of the spine and chest can be rectified. Moreover, in the case of scoliosis or kyphosis, the software produces automatic correction. This rapid (acquisition time < 2 seconds), non invasive, safe and painless procedure can also be used to detect and follow mild spinal deformities.

Adolescent↗

PubMed1997

[A method of cost evaluation of orthopedic treatment of femoral diaphyseal fractures in school-age children].

PURPOSE OF THE STUDY: Femoral diaphysis fractures are very frequent in children. The objective of this study was to evaluate the cost of orthopaedic treatment for femoral diaphysis fracture in school's age children. MATERIAL AND METHODS: 50 femoral fractures were reviewed at an average of 5 years follow-up with many economic parameters. DISCUSSION: Different treatments are available for this type of fracture. Actually, there is a controversy between orthopaedic and surgical treatment and no one gives better long term results. Therefore economic reasons can help for the choice of the method when the final result is equivalent. The same study should be realized for other available fracture treatments. CONCLUSION: Future studies should use the same methodology in order to obtain the real cost of each treatment.

Adolescent↗