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This study describes the learning curve associated with ArtiSential articulating laparoscopic instruments (ALI) in a simulated environment and the early paediatric clinical implementation of this skill set. The study was performed as a single-centre feasibility study. Baseline performance for a peg board transfer task requiring 3D object translation was established with standard instruments (SI) and ALI. Completion time and number of pegs dropped were recorded. Participants completed 5 h of distributed practice followed by a repeat timed performance. ArtiSential articulating instruments were subsequently used in 3 laparoscopic cases using an iterative learning model and the learning points are described. Median baseline completion time with SI and ALI were not significantly different [7.3 min SI vs 10.5 min ALI (p = 0.138), ALI times significantly improved with 5 h training (10.5 min vs 3.5 min (p = 0.014)]. 19 pegs were dropped using SI, while 7 were dropped with ALI (p = 0.028). Two laparoscopic cholecystectomies and a laparoscopic fundoplication were performed using a hybrid approach with articulating instruments and standard laparoscopic instruments with operating times of 164, 94 and 120 min, respectively. There is a short learning curve with rapid acquisition of the articulating skill set using this training program, with intuitive translation to the clinical setting, permitting increased dexterity and range of movement compared to SI. Limitations including air-leak and loss of angulation during dissection respond to modification of surgical set-up and refining technique.

This paper presents a mechanism for linear movement which could be called threadless screw, in which a roller is pushed toward a rotating plain shaft and rotates with it. The roller moves on a helical path when its axis is not parallel to the axis of the shaft. Therefore, the roller moves in direction of the shaft axis, just as linear movement of a nut on a screw. The lead of this mechanism is not only a function of diameter of the shaft, but also the angle between axes of the roller and the shaft which gives the possibility to change the lead continuously from very fine to very rough leads. On the other hand the accuracy of this mechanism depends on the accuracy of a plain cylindrical surface which can be fabricated very accurately compared with the threads of a screw. Two configurations of this mechanism were designed and fabricated to verify the idea. Coarse and fine positioning speeds are 10 and 0.1 mm/sec over an effective range of 200 mm, respectively. The experimental results show that the fast positioning over wide range of movement with resolution of 10 nm is possible by this mechanism. Further investigation shows that applying thrust loads have considerable effect on the lead of the mechanism.

Most knee osteoarthritis and meniscectomy studies focus on osteoarthritis in the tibiofemoral joint and ignore the patellofemoral joint. This study aims to assess the long-term effects of total meniscectomy on the patellofemoral joint. To our knowledge, this is the only study of osteoarthritis in the patellofemoral joint following meniscectomy that extends to a 40-year follow-up period. Twenty-two patients with osteoarthritis were evaluated at a mean of 40 years post-meniscectomy using standardised weight-bearing radiographs of the operated and non-operated knees. Patellofemoral joint osteoarthritis was diagnosed by the presence of osteophytes and joint space narrowing to less than 5 mm. Kellgren and Lawrence scores were calculated from the radiographs. Patellofemoral joint osteoarthritis and tibiofemoral joint osteoarthritis were correlated with International Knee Documentation Committee scores and range of movement measurements. A significant difference was observed between the operated and non-operated knees in terms of patellofemoral joint osteophyte formation. There was a significant difference in tibiofemoral joint Kellgren and Lawrence scores, International Knee Documentation Committee scores and range of movement measurements between knees with lateral facet patellofemoral joint space of 5 mm. This study shows an association between open total meniscectomy and patellofemoral joint osteoarthritis at 40 years following surgery. There was also an association between patellofemoral joint space narrowing in the lateral facet and tibiofemoral joint osteoarthritis. Possible causes include altered biomechanical loading patterns following meniscectomy as well as global processes within the knee.

We report a case of 8 years old male child with bronchiectasis and pectus excavatum. Although feasibility and safety of VATS become well-established in treatment of benign pathologies [ 1 ], many surgeons would argue that two benign lesions in a small child should be approached through an open approach especially that bronchiectasis usually has thick adhesions due to repeated infections and a small chest cavity may not allow a full range of movement of staplers. Pectus excavatum is the most common congenital chest wall deformity, and the minimally invasive repair of the pectus excavatum (MIRPE) has become the treatment of choice in the last decade [ 2 ]. Bronchiectasis is an airway chronic disease. Thoracoscopic surgery for localized bronchiectasis is gaining more acceptance every day [ 3 ]. Simultaneous open cardiothoracic operations and pectus repair are being used but still lack satisfactory cosmetic results. Few publications report simultaneous multiport VATS and MIRPE [ 4 , 5 ]. Our case is the first reported example of such combined procedures via Uniportal VATS approach reported in an 8 years old child.

The mining space of large mining height coal face is large, the range of movement and caving of rock strata is large and the stability of supports at coal face is low and damage rate of supports is high, which significantly affects the safe and efficient production of coal mines. By similar simulation experiment and theoretical analysis, the mode of fractured roofing structure of large mining height coal face and the method of determination of reasonable support resistance of the support was evaluated. Analysis shows that the structural mode of “combined cantilever beam–non-hinged roofing–hinged roofing” of the large mining height coal face appears at the roofing of large mining height coal face. The supporting factor of caved gangue at the gob is introduced, the calculating equations of the fractured step distance of roofing were derived and conventional calculating method of caved height of roofing was corrected and the method of determination of the length and height of each structural area of the roofing was provided. With reference to the excavating conditions at Jinhuagong coal mine in Datong minefield, the dimensions of structural areas of the roofing of the coal face were determined and analyzed, and reasonable support resistance of the height coal face was acquired. By selecting Model ZZ13000/28/60 support and with procedures of advanced pre-cracking blasting, the safe production of large mining height coal face was assured.

BACKGROUND: Patients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). This may impact treatment decision strategy. The aim was to study whether patients with non-operated traumatic PASD have less shoulder impairment than those with RASD.METHODS: In a cross-sectional study baseline data from patients with PASD and RASD in a randomised controlled trial of non-operative shoulder exercise treatment were used. Shoulder function was self-reported (Western Ontario Shoulder Instability (WOSI), Tampa Scale of Kinesiophobia (TSK), General Health (EQ-5D-VAS), Numeric Pain Rating Scale (NPRS)), and measured (Constant-Murley shoulder Score (CMS total), CMS - Range of Motion (CMS-ROM, CMS - strength, proprioception, clinical tests).RESULTS: In total, 56 patients (34 (28 men) with PASD and 22 (21 men) with RASD) (mean age 26 years) participated. WOSI total was 1064 and 1048, and TSK above 37 (indicating high re-injury fear) was present in 33 (97%) and 21 (96%) of the groups with PASD and RASD, with no group difference. CMS total (66.4 and 70.4), CMS-ROM (28.7 and 31.5), CMS-strength (injured shoulder: 7.6 kg and 9.1 kg), proprioception and clinical tests were the same. Furthermore, 26 (76%) with PASD and 13 (59%) with RASD reported not to have received non-operative shoulder treatment.CONCLUSIONS: Non-operated patients with PASD and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients RASD and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.

Bewegungseinschrankungen des Kniegelenks sind nach komplexen Traumen haufig. Sie beeintrachtigen aus Sicht des Patienten das Ergebnis massiv. Nach Ausheilung des initialen Traumas ist es heute moglich, wesentliche Verbesserungen der Beweglichkeit des Kniegelenks zu erreichen. Dabei ist eine sorgfaltige Diagnostik und Therapieplanung essentiell. Die Ursache der Bewegungshemmung kann in intra- und extraartikulare Faktoren sowie in knocherne und weichteilige Pathologien differenziert werden. Bei knochernen Streckhemmungen kann eine Resektion der Ossifikationen nach entsprechender Vorplanung durchgefuhrt werden. Bei kapsularen Streckhemmungen empfiehlt sich die posteriore Kapsulotomie. Bei extraartikularer Fehlstellung sollte eine extendierende Osteotomie in schliesender Technik erfolgen. Beugehemmungen konnen sowohl durch intra- und periartikulare Ursachen als auch durch Veranderungen des Streckapparats am Oberschenkel entstehen. Die Arthrolyse des Kniegelenks allein ist bei posttraumatischen Zustanden selten erfolgreich. Die haufige Patella infera sollte durch Proximalisierung der Tuberositas tibiae oder durch Verlangerung der Patellarsehne behandelt werden. Fur die komplexeren Beugehemmungen stehen die Vastus-intermedius-Resektion bzw. die Quadrizepsplastik nach Judet zur Verfugung. Der operative Aufwand ist nicht gering, angesichts der massiven Beeintrachtigung der Lebensqualitat der oftmals jungen Verletzten jedoch sicher berechtigt.

A pilot study of uterine and vaginal vault manipulation using a new surgical robot-The ViKY Uterine Positioner™--enrolled 36 cases comprising 31 hysterectomies, two myomectomies, two sacrocolpopexies and one excision of severe endometriosis performed between July 2010 and February 2012 in a tertiary referral District General Hospital in the UK. Mean age was 48 years, body mass index 25.7 kg/m(2) and uterine weight 231 g. Nine cases were foot-controlled and 27 by Bluetooth voice control. ViKY UP™ docking time once V-Care™ was inserted was 4.3 min. The device caused no peri-operative complications. Adequate mobilization, visualization and range of movement was possible in 81, 78 and 61 % of cases, respectively, with most of the problems arising in cases with uterine weight350 g. ViKY UP™ was detached and an assistant was required in three cases, whilst V-Care™ came out of the uterus in one case. The learning curve led to various adjustments including optimizing patient position, increasing the device range of movement and adjusting device sensitivity. As a result, problems were minimized in our last nine cases. Adding robotic uterine manipulation is the obvious next step to give the gynecologist the ultimate control and stability of the uterus during robotic-assisted surgery without having to lift their head from the viewfinder or rely on a remotely situated perineal assistant. ViKY UP™ is the first device to deliver this. Pilot study results did not demonstrate compromised safety, and the device appears to be effective and easy to learn.

The purpose of this study was to evaluate the short-term results after performing a total knee arthroplasty (TKA) using two surgical approaches: the subvastus approach (SV) and the conventional parapatellar approach. It was hypothesized that the SV approach would achieve the best short-term benefits. This is a randomized prospective and double-blind study that includes 104 patients. Evaluations were carried out preoperatively, when discharged (5 days) at one, three, and 12 postoperative months. The SV group showed significantly better range of movement and quadriceps extensor force when discharged. Statistically significant differences were found that showed a distinct improvement in favour of the SV group at one month in terms of extensor force and according to the Barthel Index. No significant difference was found between the two groups at the 12 month evaluation. It was concluded that the SV approach offers superior short-term clinical and functional results and it was shown that this approach also offers a significant advantage to the patient in the immediate postoperative period, although these differences tend to disappear over time following TKA. We strongly recommend the SV approach in the majority of TKA.

In this institution, the management of displaced (Gartland III) supracondylar fractures in children was changed from overhead olecranon screw traction to manipulation and percutaneous wiring in 1996. The purpose of this study was to compare the two methods of treatment and observe whether the decision to change management was justified. A retrospective study of two cohorts; 151 patients between 1986 and 1996 treated with olecranon screw traction and 92 patients between 1996 and 2002 treated with percutaneous wiring. Both sets of patients were followed up clinically and radiologically until the child could demonstrate a satisfactory range of movement and the fracture had united. There were no differences in the clinical outcomes between the two groups. The main difference between the groups was in length of stay, which was a median of 1 day in the wired group and 14 days in the traction group. Outcomes achieved from percutaneous wiring of displaced supracondylar fractures are similar to those from olecranon screw traction. The advantage of percutaneous wiring to both patient and provider is the reduced hospital stay. The decision to change management therefore appears to be justified. However, percutaneous wiring is generally a technically more demanding procedure and olecranon screw traction should remain a possible treatment option for the management of this injury.

In cruciate-retaining (CR) type TKA, the increase in posterior condylar offset (PCO) is considered to be correlated to flexion angle acquired postoperatively according to the article reported by Bellemans (J Bone Joint Surg Br 84:50-53, 2002). However, the significance of PCO seems to differ according to the size of joints. We therefore have defined a new parameter of posterior condylar offset ratio (PCOR) on the lateral view of plain X-ray photographs and studied the relationship between PCOR and postoperative flexion status in posterior-stabilized (PS) type TKA. Flexion status includes two parameters, such as postoperative flexion angle (FA) and flexion achievement rate (AR). The subjects of this study were 160 knees (16 males and 144 females, average 75 years.) with PS type TKA for osteoarthritic knees between 1999 and 2003 at our institution, more than at least 1 year postoperative follow-up. In the study of FA, patients with FA of less than 100 degrees were divided into Group L (n = 28), patients with FA of 130 degrees and greater were divided into Group H (n = 58). In the study of AR, patients with AR of less than 100% were divided into Group P (n = 46), patients with AR of 120% and greater were divided into Group G (n = 22). PCOR was statistically compared in each group, respectively. In FA, PCOR in Group L (0.385) was significantly lower (P = 0.027) than that in Group H (0.428). In AR, PCOR in Group P (0.376) was significantly lower (P = 0.0018) than that in Group G (0.456). We have concluded, though there are many factors influencing the range of movement after TKA, our newly defined PCOR could possibly serve as a parameter of postoperative flexion status of PS type TKA on plain X-ray photographs.

Proximal row carpectomy (PRC) is an established procedure in the treatment of advanced radiocarpal arthritis. The aim of this study was to evaluate the individual, functional and radiological results in relation to the initial diagnosis. Seventeen patients (15 men, two women), who had undergone PRC, were evaluated. Their average age at the time of the operation was 48 years (range 21-70 years). The most frequent diagnosis leading to PRC was scaphoid non-union advanced collapse (SNAC), which was observed in nine patients, while in three cases each the condition treated had been scapholunate advanced collapse (SLAC) and perilunate dislocation, and in two cases, Kienboeck's disease. At the time of the follow-up examination (median 65.41 months), a significant improvement in the range of movement was seen. While only four (36%) of the patients with SNAC had radiological signs of arthrosis of the radiocapitate joint, visible radiological involvement was noted in all patients who underwent PRC due to scapholunate dissociation and perilunate dislocation. The results of this study show that PRC is a good way of achieving long-term improvement of the degree of subjective freedom from symptoms and of the functional range of movement. Interruption of ligamentous structures, as in scapholunate dissociation and perilunate dislocation, seems to influence the radiological outcome.

The implantation of a spacer is common practice after ventral discectomy in the cervical spine. Besides bone or bone cement (Palacos, Sulfix, and Allofix), the surgeon has the choice of a variety of factory-made implants (cages). We report on our experience with the Intromed ZWE [Zwischenwirbel-Ersatzsystem (Intervertebral Replacement System)] implant. The ZWE implant (Intromed Medizintechnik GmbH, 15754, Senzig, Germany), made from titanium 6AL 4V, consists of a flat quadrangular body with a large supporting surface on the bottom and top and a central hole. We report the first 100 cases treated with their 1- or 2-year follow-up completed (mean follow-up, 1.7 years). The mean age was 47+/-9 years (range: 27-73 years). The implantation was performed without filling the central hole. In addition to the clinical investigation of neurological alterations and the range of movement, X-rays were taken, and the clinical result was determined by an independent investigator according to the Odom Scale. After the minimum follow-up of 1 year, 32 patients scored excellent on the Odom scale, 38 patients good, 25 patients satisfactory, and 5 patients bad. In 74 cases, fusion occurred radiologically as bony bridging around the implant. In 21 cases, the cage showed no change and no radiolucency. In five cases, radiolucency around the implant occurred without instability at flexion-extension X-ray views. In CT scans done in two patients with complaints, we confirmed bony bridging inside the centre hole implanted empty. The Intromed-ZWE-System performs well in routine clinical use. Compared to bone or bone cement, the operating time is reduced. The Intromed System offers an easy fusion method for a competitive price.

This study was an attempt to see if patients can detect any change in the range of movement after a knee replacement and how much can the surgeon rely upon the patient’s self-assessment. One hundred and forty-two patients with arthritic knees who were waiting for total knee replacement (TKR) were chosen and range of movement (ROM) of their arthritic knee was measured. All these patients were called back into clinics for regular follow-up after TKR but only 112 attended. Their ROM was measured and all of them were asked whether they felt that the ROM of their knee had improved after replacement. The measurements and their answers were recorded. Of the 112 patients, 78 (70%) felt that ROM had improved, 32 (28%) felt that ROM did not improve and 2 (2%) of them were not sure. Our measurements showed that only 38 (34%) patients had improved ROM whereas 74 (66%) had no improvement, in some cases, decreased ROM after TKR. On comparing the patients’ assessment to our measurements, it was found that only 35 patients (31%) were right in their self-assessment whereas 75 patients (67%) were wrong. We conclude that patients overestimate the change in ROM after knee replacement. An improvement in knee pain following TKR appears to have a positive influence on the patient’s perception of change in knee ROM.

PICCs are increasingly employed in children. Some of their risks relate to the location of the central tip. Despite care when placing lines, they sometimes move.To evaluate the influence of arm movement on the central tip location of PICCs placed in children.The central tip location of PICCs was studied in 85 children, with the arm placed in six positions. The variables of side, vein, site and arm position were examined to measure the direction and range of tip movement.The side, site or vein used did not influence the range of movement of the central tip. Change in position of the arm had a significant influence on the central tip location, moving it an average of 2.2 rib spaces, a maximum of 3.5 ribs. Elbow bending and adduction of the arm caused the central tip to move deeper into the chest, compared to when the arm was straight and abducted 90 degrees .Arm position is the significant variable influencing PICC movement. Side, site and vein do not influence the range of movement significantly. Most PICCs descend deeper into the chest with arm adduction and elbow bending.

The use of skin traction splintage is established in the treatment of phalangeal fractures of the fingers. We report our experience with this technique. Fifty patients with 53 different types of closed displaced proximal and middle phalangeal fractures were included in a 4-year study period. Satisfactory radiological reduction was obtained by 48 traction splints applied (90.56%) while five cases required operative intervention (9.44%). The mean duration of traction splint application was 21 days (range 14–28 days). The mean duration of the physiotherapy required after removal of the traction splint was 19 days (range 5–51 days). The mean follow-up period was 39.2 days (range 14–365 days). Out of the 48 traction splints used, full range of movement was obtained in 45 fingers (93.75%). We recommend the use of this technique, as it is a simple, quick, inexpensive, and noninvasive procedure with excellent results.

To compare a new technique (NT) for positioning the left modified Broncho-Cath™ double-lumen tube (LM-DLT) by fibreoptic bronchoscopy (FOB) to the classic technique (CT). Sixty-one adult patients undergoing elective thoracic surgery with LM-DLT were randomly assigned to the NT orto the CT group. For the NT, the endoscopist confirms the left mainstem endobronchial intubation. The proximal edge of the blue bronchial cuff should not be visualized at the carina. Then, through the left bronchial lumen, by transparency across the wall of the tube, the position of the tube is adjusted so that the carina lies midway between the black radiopaque line and the top of the bronchial cuff. After this, the orifice of the left upper lobe (LUL) bronchus should be clearly seen. For the CT, the endoscopist uses the technique described by Benumof and Slinger. After lateral positioning of the patient, the LM-DLT was repositioned if the top of the endobronchial cuff was above the carina or when the LUL bronchus was obstructed. The incidence of proximal repositioning was significantly less in the NT compared to the CT (16%vs 43%, P=0.007). Using this new technique, the LM-DLT is inserted deeper in the left mainstem bronchus. This new landmark augments the range of movement that can be tolerated without requiring repositioning of the LM-DLT, This NT to position and to assess LM-DLT, by transparency across the wall of the tube with FOB, is better adapted to the LM-DLT and its recent modifications.

Surface area measurements were performed on the articular facets in the human hand joints in order to calculate the area-asymmetry (incongruency) between mutual articular facets in every one of the hand joints, and to learn about the relations between the asymmetry in the joint, the joint's morphology, and the range of movement exhibited by it. Several different trials have led to the conclusion that the asymmetry in a joint is strongly influenced by its morphological type (plane; sellar; condyloid; bicondylar). No such correlation was found between the asymmetry in a joint and its characteristic range of movement. The results contradict the intuitive assumption that the greater the incongruency in a joint, the wider the movement it can perform.

Over the last 7 years 128 latissimus dorsi free flaps have been performed at the BG Unfallklinik in Murnau. Since 1995, the use of a partial latissimus dorsi, sized according to the defect that has to be covered, leaving a functional remnant has continuously increased. We compared the donor site morbidity after standard and after partial latissimus dorsi flap in a small group of 10 patients each (n=20). The mean follow-up time was 18 and 24 months, the mean age of the patient 42.5 and 43.6 years. The evaluation included complaints, subjective loss of strength, scar length, ROM of the shoulder, and measured loss of strength, taking into account the patient’s dominant side. The acceptance of the donor area by the patients was very good in both groups. It was found that the loss of strength after partial latissimus dorsi is less evident than after standard latissimus dorsi. The scar length was independent of the type of flap chosen. There was no loss in range of movement. In both groups it was found that if the flap was taken from the non-dominant side the difference in strength to the dominant side was more than if the flap was taken from the dominant side. We could not see a causal relationship between age and the amount of strength lost. Because of the decreased donor site morbidity we think the partial latissimus dorsi flap should be used instead of the standard latissimus whenever possible.

Aims. A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used observer dependent outcome measures in patients with osteoarthritis (OA). Methods. During a single day, six third-year medical students independently examined six patients with OA in predetermined order using a Latin Square design, before and after viewing a standardized videotape demonstrating 13 examination techniques. Reliability coefficients were calculated based on variance components of the analysis of variance (ANOVA) table. Results. Preslandardization reliability coefficients were

A 63-year-old woman presented with a 3-week history of worsening right knee pain. She was fully unable to bear weight and denied any history of trauma, locking or giving way. On examination, she was systemically well with posterolateral joint line tenderness and a reduced range of movement. Blood tests and a joint aspirate were normal. Radiographs reported no fracture, but suggested a loose body in the lateral gutter of the knee. She was discharged with analgesia and physiotherapy. Subsequent follow-up X-rays demonstrated the opacity in the later gutter to be appearing less dense until it eventually disappeared. This correlated to a progressive improvement in the patient’s pain and range of movement in the knee leading to the diagnosis of acute calcific tendinitis of the popliteus tendon. This case report suggests that calcifying tendinitis of popliteus tendon should be considered in the differential diagnosis of acutely painful knee. The case demonstrates that the natural history of calcifying tendinitis of popliteus is similar to that in supraspinatus and that conservative treatment will eventually resolve the symptoms.

Capitellar fractures are rare. If anatomy is not reconstructed accurately, elbow function is sub-optimal. Various studies have shown good outcome in Type I Hahn–Steinthal fractures. There is only one report of a bilateral capitellar fracture in the English literature so far. We report another case of the same. A 26-year-old mother slipped and fell on level ground. She sustained closed injury to both her elbows. Radiographs revealed bilateral, displaced Hahn–Steinthal fracture of the capitellum. She underwent open anatomic reduction and stabilisation with two partially threaded 4 mm cancellous screws, inserted from posterior to anterior. At 2 months, both fractures united. At final follow-up, 19 months post-operatively, she had full range of movement of both elbows. Anatomic reduction, stable internal fixation and early mobilisation of Type I Hahn–Steinthal capitellar fracture achieves excellent results.

We present a case report of a 69-year-old lady who underwent primary knee replacement for osteoarthritis. She had a non-union of patella which was not diagnosed preoperatively due to lack of signs and symptoms. Partial patellectomy and reshaping the patella yielded a good result with functional range of movement and no extensor lag.

Thirty-two elderly patients with a femoral neck fracture treated by bipolar hemiarthroplasty and 36 patients (matched for age) with an Austin-Moore hemiarthroplasty were followed-up and compared. Bipolar replacement resulted in a higher percentage of satisfactory results, less postoperative pain, greater range of movement, more rapid return to unassisted activity, fewer unsatisfactory results and no acetabular erosion. The device functioned as bipolar in all the cases studied for inner-bearing motion.

Phalangeal fractures can be challenging injuries to manage, and their treatment is frequently complicated by deformity and stiffness. External fixation techniques have a well-established role in the treatment of these injuries. The mini-Hoffman external fixator is a particularly simple apparatus in design and in application. From 1998 to 2001 we used this method to treat 25 patients with phalangeal fractures and prospectively followed their progress. Mean patient age was 34 (range 15–62) years. Mean duration of follow-up was 64 (range36–125) weeks. For all fractures the mean total active range of movement for the injured digit was 205° (range 120–240°). When expressed as a percentage of the noninjured digit, a mean of 80% was achieved. Mean flexion deficit was 16 (range 0–50, median 8) mm. Mean extension deficit was 5.75 (range 0–20, median 0) mm. Grip strength when expressed as a percentage of the noninjured side was 92% with a mean recorded value of 39 (range 28–53) mmHg. All fractures united and there were no infective complications. Mean time to return to work was 5 (range 2–12) weeks.

Following manipulation of frozen shoulders under general anaesthesia, we reviewed 74 shoulders at an average of 3 weeks and again at an average of 33 months following the manipulation. We used an adjusted Constant score by excluding the abduction strength measurement. The maximum score was therefore 75 points. The average pre-manipulation score was 24.7 points. At 3 weeks after manipulation this score improved to 54.9 points. At the last follow-up (average 33 months) the score was 72.4 points. We have shown that manipulation under general anaesthesia speeds up recovery of frozen shoulders, and the range of movement improves rapidly.

Using the KinCom 500H isokinetic dynamometer the first part of this study measured the characteristics of the force velocity relationship curve for the human knee extensors between -1.57 (eccentric) and 3.67 (concentric) rads x s(-1) (-90 and 210 degrees s(1)) for both legs in 4 subjects. A significant increase in force generation was seen in eccentric activity at 0.52 rads x s(-1) (30 degrees s(-1)) but not at 1.57 rads x s(-1) (90 degrees s(-1)) compared to maximum voluntary isometric force (P0.005). This increase was, however, lower than would be expected from the classical force-velocity relationship. The second part of the study examined whether restricting the range of movement was able to further increase the eccentric forces. In a further 6 subjects, the eccentric contractions were repeated during either an 80 degrees (15-95 degrees flexion) and a 50 degrees (45-95 degrees flexion) range of movement. Significant increases in force were seen over the shorter range of movement at 0.52 rads x s(-1) (30 degrees s(-1)) (P = 0.006) and 1.57 rads x s(-1) (90 degrees s(-1)) (P0.001).

Objectives To investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Chinese, to observe the stability and range of movement (ROM) post-operatively. Methods and materials From 2003,12 to 2005,12, Bryan disc prosthesis replacement applied in 83 cases (102 levels) of cervical spondylotic myelopathy (CSM) after anterior decompression in our hospital. Clinical (JOA grade and Odom's scale) and radiological (X-ray of flexion, extension; left and right bending position) follow-up was performed. Systemic radiographic study about stability and ROM of replaced level post operationally were measured. CT or MRI scans were applied in all cases to evaluate the signs of the prosthesis deflexion and hetero-ossification in the replaced levels. Results At least 12 months follow-up were done in 65/83 of these paients. All of 83 patients were improved according to Odsm's scale. JOA score increased from average 8.7 to 15.5. There was no prosthesis subsidence. Replaced segment achieved stability and restored partial of normal ROM 4.73°(3.7°–5.9°) early postoperation and 8.12°(5.8°–13.6°) more than 12 months postoperation in flex and extension position. No obvious loss of lordosis was found. CT or MRI follow-up shows position deflexion of the prosthesis metal endplates ( Conclusion Byran cervical disc prosthesis restored motion to the level of the intact segment in flexion-extension and lateral bending in post-operative images. At the same time, it can achieve good anterior decompression treatment effect and immediate stability in replaced 1 or 2 levels, and which is a new choice for the treatment of CSM.

A prospective randomised study was made of 20 patients who underwent acromioplasty for the chronic impingement syndrome. Ten were operated on by Neer's technique and 10 with a modification where the deltoid origin was spared. Rehabilitation was more rapid with a better range of movement in the latter group. Acromioplasty with this modification offers benefits compared with the standard procedure.

Reconstruction of a resected femoral or tibial condyle using the ipsilateral patella as an autogenous graft is better than conventional resection arthrodesis. Seven cases are reported with a follow up of from 3 to 6 years. Consolidation of the graft and fair stability were obtained. The range of movement was more than 90 degrees in 5 out of the 7 cases.

Mobilization with movement applied to the elbow affects shoulder range of movement in subjects with lateral epicondylalgia [Manual Therapy 2001;6(3):170-7]

Dislocation of the hip is rare and so we regard every hip dislocation as an emergency until it has been reduced. From 1977 to 1996 a total of 82 patients with hip dislocation were treated at the Traumatic Surgery Clinic, University of Vienna, Austria. The average age at injury was 29 years. Some 77 patients had unilateral dislocation of the hip, but only in 5 cases was bilateral dislocation found. Iliac dislocation was most common (54 patients). Our treatment consisted in reduction within 6 h of the injury under general anaesthesia (Bohler) and 14 days bedrest. Then the patients were mobilized with full weight bearing, depending on the pain. Of the patients 29 had no clinical infirmities, 8 patients reported temporarily occurring pain and in 6 patients we found a limited range of movement in the hip joint with occasional pain. In all, 43 patients were followed up after 1/2 to 19 years. Radiological signs were seen in 17 patients and avascular necrosis of the femoral head in 1. So after careful evaluation of the patients and the kind of treatment, we recommend the following: 1. Immediate, gentle reduction of the hip joint; 2. Bedrest for 14 days; 3. Early mobilization with full weight bearing.

Between 1971 and 1985, 461 adult patients were treated by Chiari's pelvic osteotomy with medial displacement. Of these, 161 patients (171 hips) were followed up for an average of 9 years. The average age at operation was 29 years. We describe five groups of painful dysplastic hips in which the operation is indicated. Clinical evaluation by Colton's rating system gave 84% of excellent, good or fair results. Radiographs showed that the secondary osteoarthritic changes were arrested in 73%, improved in 11% and that there was deterioration in 16%. Pain was largely or completely relieved in 87%, the range of movement was maintained in 80% and the gait improved in 77% of our cases. The late results were better in younger patients. We conclude that improved biomechanical conditions are responsible for good congruency of the joint which is preserved for a long time.

A method of determining quantitatively the rotary flexibility of the elbow joint was developed and its reliability tested. Examinations of the left elbow joint of 100 healthy men between the ages of 18 and 72 were performed, consisting of measurements of passive supination effected by a graduated external torque as well as of active supination and pronation. The purpose of the study was to acquire a norm as basis for the functional evaluation of this joint in playing the violin. The investigation produced the following results: 1. The maximum active range of movement consists of about 160‡, the supinatory portion is generally higher than the pronatory, when related to a zero position with the palm of the hand in the sagittal plane. 2. The range of passive movement is non-linearly dependant on the external torque. 3. The variability of passive flexibility increases with decreasing external torque and is generally higher than the variability of active flexibility. Active pronation varies more than active supination. 4. A close positive correlation between active and passive supination is evident only when a higher torque is applied. The correlation between active supination and active pronation is only 0.33. 5. The statistically establishable reduction of flexibility through ageing is not considered to be characteristic of actual conditions. On the other hand, a broader dispersion is clearly recognizeable as the result of ageing, through a drop in the lower limit of deviation.

Recurrent dislocation of the shoulder has long been recognized, and more than 100 techniques for repair of the injury are described. This survey describes 113 patients who suffered from recurrent anterior dislocation of the shoulder and were operated upon in accordance with the Putti Platt technique. The most significant preoperative finding was inadequate immobilization after the primary dislocation (62% of the patients). Postoperative recurrence was uncommon (1%) and a relative increased limitation of motion in the postoperative period improved gradually to almost a full range of movement.

A case of spasmus nutans is described and the points of chief interest are as follows:- 1. The room in which the child lived was exceptionally dark. 2. X-ray examination showed evidence of healing rickets. 3. There was a history of both head-nodding and head-wagging previous to admission, but while the child was in hospital only head-nodding was seen, and this disappeared in less than one week. 4. There was a very fine, rapid, horizontal mystagmus in both eyes, but it was impossible to determine whether it was convergent or conjugate. The range of movement was the same in both eyes. 5. The “ coy ” look, described by Still, when the child turns its head away and looks back out of the corner of its eyes, was a very striking feature in the present case. 6. All the symptoms had disappeared when the child was last examined under a year from the time when symptoms were first noticed.

THIS study was undertaken to assess the outcome of arthroscopic compared with open meniscectomy. Two groups of thirty patients matched for age, sex, site and type of meniscal lesion were included. Economic, socio-economic subjective and objective results were recorded at follow up. Duration of hospital stay and post operative absence from work and sport were significantly shorter than those treated arthroscopically. Symptomatically, the arthroscopic group reported better results. Clinical examination carried out at the time of recall revealed less muscle wasting and greater range of movement in the arthroscopic group. We feel that although arthroscopic meniscectomy can be technically demanding its results are clearly superior to those achieved by open meniscectomy.