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Background: These days there are different types of aftercare following flexor tendon injury. Patients in this study received a dynamic Kleinert protocol and additionally two different postoperative treatments. Both treatment groups were compared to each other and results were put into perspective when compared to other treatment options., Methods: Sixty-two patients presenting with clean lesions of the two flexor tendons in zone 2 received postoperative treatment with a dynamic Kleinert protocol. Patients were randomly divided into either Group I (physical therapy) or Group II (exoskeleton). Range of motion was assessed after 6, 12 and 18 weeks. In addition, we measured the Strickland score and grip strength at the 18-week follow-up. DASH scores were obtained at weeks 12 and 18., Results: Regardless of the received postoperative treatment, range of motion was predominantly limited in the proximal interphalangeal and distal interphalangeal joints after 6 weeks. This deficit decreased with time and almost full range of motion was achieved after 18 weeks. Grip strength measured 75% (Group I) and 78% (Group II) of the healthy hand's level. Good functional outcome was observed in the DASH scores after 12 weeks, which improved further, measuring 7.5 (Group I) and 6.8 (Group II) at the 18-week follow-up. We did not see any clinically relevant differences between the two patient groups., Conclusion: Regarding possible reruptures, the Kleinert protocol delivers a safe treatment regime. The possible disadvantage of flexion contractures with the Kleinert protocol was not seen in our measurements. Additional motion exercises using an exoskeleton delivered comparable results to classic physical therapy.

Objective: Revision ACL reconstruction is becoming more frequent because of a 10% rate of re-ruptures and insufficiencies. Currently, computed tomography (CT) represents the gold standard in detecting and measuring the tunnels of the initial ACL reconstruction. The purpose of this study was to compare measurement results of CT and thin-sliced MRI sequences, which were modified to a high soft tissue-bone contrast., Materials and Methods: Prior to an ACL revision surgery, 16 consecutive patients had an MRI in addition to the standard CT scan. A dedicated 0.25-T Esaote G-Scan (Esaote Biomedica, Cologne, Germany) with a Turbo 3D T1 sequence was used for MRI. Tunnel diameters were measured at 11 defined points of interest. For the statistical evaluation, the Mann-Whitney U test for connected samples was used. Inter- and intraobserver reliability was additionally calculated., Results: All measured diameters showed significant to highly significant correlations between both diagnostic tools (r = 0.7-0.98). In addition, there was no significant difference (p > 0.5) between the two techniques. Almost all diameters showed nearly perfect intraobserver reliability (ICC 0.8-0.97). Interobserver reliability showed an ICC of 0.91/0.92 for only one diameter in MRI and CT., Conclusion: Prior to ACL revision surgery, bone tunnel measurements can be done using a 3D T1-MRI sequence in low-field MRI. MRI measurements show the same accuracy as CT scans. Preoperative radiation exposure in mainly young patients could be reduced. Also the costs of an additional CT scan could be saved.

The purpose of this study was to assess whether there is a universal pattern of movement of the finger joints while performing a cylinder grip. A sensor glove was used to record the finger joint motion of 48 participants. Our observations showed that when examining the fingers, flexion motion began either at the metacarpophalangeal (MP) or proximal interphalangeal (PIP) joints, with the distal interphalangeal (DIP) joints always last to move (p = 0.0052). The sequence of the joints at the end of the gripping motion was different than at the beginning. Here, the only statistically significant observation was that the DIP joints fully flexed only once the MP joints had flexed fully. Apart from that, it was completely variable which joint reached its final position first or last. The analysis also revealed that synchronization of four identical joints (i.e. the four PIP joints) was significantly higher than synchronization of the 12 finger joints. Although synchronization was already high at the beginning of the flexion motion, it increased significantly by the time the joints completed their movement.

The purpose of this study was to analyse motion patterns of the finger joints dynamically while making a fist. 10 subjects were examined using the TUB-sensor glove, which was equipped with 14 joint angle sensors. The median time it takes the finger joints to complete flexion until reaching the state of a closed fist ranges between 0.5 to 1.0 s. A specific pattern can be seen for every finger. The PIP and DIP joints appear to be linked, with the DIP trailing the PIP joint. At the thumb the IP is trailing the MCP joint. The MCP joint shows more variation at the beginning of flexion: while in some cases it initiates movement in a finger, in other cases its flexion falls behind the PIP joint movements. The completion of flexion is achieved by the MCP joints, with the PIP and DIP joints reaching their end of motion first. The range of motion (ROM) at the MCP joints shows a finger-dependent median of 79-97°. At the PIP joints the median lies between 87° and 90°, at the DIP joints between 52° and 68°. At the thumb it is 21° for the MCP and 24° for the IP joint. The linkage between PIP and DIP joints can also be seen when analysing the ROM. The coupling ratio amounts to 0.77 at the index finger, 0.75 at the middle and ring finger and 0.57 at the small finger., (© Georg Thieme Verlag KG Stuttgart · New York.)

The present study analyses force distribution patterns during primary grips. 10 subjects were examined using the TUB-sensor glove, which was equipped with 10 pressure sensors. 5 proximal sensors at the MCP joints and 5 distal sensors at the DIP joints were attached palmarly. 9 different gripping motions were examined: the cylinder grip using 4 different objects, the pinch grip and 4 different kinds of precision grips. The force distribution patterns can be clearly divided into 2 groups. On the one hand there are the "power grips", in which the force is distributed over the proximal and distal sensors. On the other hand there are the "precision grips", which only show a force distribution at the distal sensors. Therefore Napier's concept of the existence of primarily 2 gripping patterns, which is based on visual analysis, can be verified objectively. For the "power grips" the force distribution is shifted further distally with increasing size of the objects. In conclusion, their distribution pattern shifts towards the pattern of the "precision grips". At the small finger the distal sensor is already dominant during the "power grips" of smaller objects. The thumb plays a subordinate role during the "power grip" of smaller objects, since these grips are similar to the "closing fist motion" and the objects can be held between the fingers and the palm of the hand. However, with increasing object sizes the thumb gains more importance, since its opposing movement is now required to accomplish the grip., (© Georg Thieme Verlag KG Stuttgart · New York.)

Extra-articular ulna shortening osteotomy, in principle, is an accepted treatment option for symptomatic degenerative and traumatic triangular fibrocartilage complex (TFCC) tears. Despite the benefits of this surgical approach, potential disadvantages include risk of nonunion, soft tissue irritation, and the need for future hardware removal. A recently introduced low profile ulna shortening system was designed to decrease these potential complications. A single-surgeon prospective study was performed to evaluate this system. Ten consecutive patients undergoing ulna shortening for ulnar-sided wrist pain compatible with TFCC pathology participated in the study. Subjective, objective, and radiographic assessments were performed preoperatively and up to 24 weeks postoperatively. Based on visual analog scale (VOS) ratings (0 to 10), pain scores significantly improved (p < 0.05) and average patient satisfaction was 8.7. DASH and PRWE scores improved at three month follow-up (p < 0.05). Osteotomy healing time averaged 10.3 weeks, and there were no nonunions. Average discomfort associated with palpation of the plate at final follow-up was 3.3 (using VOS), and one patient requested removal of the hardware. In this short-term follow-up study, the assessed ulna shortening system appears effective and, in general, well tolerated.

CT scans of 474 patients with suspected chronic obstructive pulmonary disease (COPD) were retrospectively evaluated by automated software. There was a correlation between the total lung capacity (TLC) and the total lung volume (TLV) (r=.675, P<.001), between the TLC and the total emphysema volume (r=.571, P<.001), as well as between the TLC and the emphysema index (r=.532, P<.001), respectively. The correlation between the TLC and the TLV was dependent on the COPD severity according to the Global Initiative for Chronic Obstructive Lung Disease classification (chi(2)=6.3079, P=.043). The TLC allows a prediction of clinical illness severity.

Objective: To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures: treatment by a physical therapist with 12 sessions and an unassisted home exercise program., Design: Randomized controlled cohort study., Setting: Hospital-based care, primary center of orthopedic surgery., Participants: Volunteers (N=48) with fractures of the distal radius after internal fixation with locking plates. There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol., Interventions: Not applicable., Main Outcome Measures: Evaluation of grip strength using a Jamar dynamometer, range of motion (ROM), and Patient Related Wrist Evaluation (PRWE)., Results: After a 6-week period of postoperative treatment, the patients (n=23) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist. Grip strength reached 54% (P=.003), and ROM in extension and flexion 79% (P<.001) of the uninjured side. Ulnar and radial abduction was also higher in this group. In contrast, patients who were treated by a physical therapist achieved grip strength equal to 32%, and ROM in extension and flexion of 52% of the uninjured side. Patients who were performing the home training after operation recorded an improved wrist function with a nearly 50% lower value (P<.001) in the PRWE score., Conclusions: In the postoperative rehabilitation of wrist fractures, instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment.