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Objective: Primary purpose was to examine the effects of exercise and use of a spinal orthosis on quality of life (QoL). Secondary, to explore the effects of above-mentioned interventions on plasma levels of potential markers of pain: substance P (SP), calcitonin gene-related peptide (CGRP), and interleukin-6 (IL-6)., Design: Randomized controlled trial., Setting: Community-dwelling women in Stockholm., Participants: A total of 113 women aged 60-93 years suffering from back pain and self-reported osteoporosis (n=113)., Interventions: The randomized controlled trial was 3-armed: participation in an equipment exercise group, treatment with an activating spinal orthosis or controls. The intervention time was 6 months., Main Outcome Measures: QoL (QUALEFFO-41 and SF-36), plasma levels of SP, CGRP, and IL-6 measured at baseline and after 6 months in all 3 arms., Results: No improvement of QoL was found. Comparing change in mobility (QUALEFFO-41), the effect in least squares means was lower in the spinal orthosis group compared with controls. In the exercise group, the role emotional score (SF-36) deteriorated during the intervention. Effect size varied between 0.02 and 0.6. There was no change in the levels of CGRP or SP, while IL-6 levels were lower at 6 months in the spinal orthosis group compared with the other groups. At least 1 previous vertebral fracture was verified by X-ray in 46 women., Conclusion: The interventions showed none or negative effect on QoL, which was unexpected. The modest effect size may prompt a cautious interpretation. We found a lowering of IL-6 levels in the spinal orthosis group, but more studies are needed., (© 2023 The Authors.)

Women with osteoporosis and back pain took part in focus group interviews and described their experiences of using and handling an activating spinal orthosis. The women described the back orthosis as being like a "close friend", a support in everyday life and a reminder to maintain a good posture., Purpose: The purpose of this study was to describe and gain a deeper understanding of the views of older women with osteoporosis and back pain seeking primary care regarding their use and handling of an activating spinal orthosis., Method: We chose a qualitative method whereby information was gathered via focus group interviews and analysed using inductive content analysis. Women who previously participated in a randomised controlled trial and wore an activating spinal orthosis for 6 months were asked. Out of 31 women, 18 agreed to participate. Five focus group interviews were conducted., Results: The analysis resulted in an overall theme in which the experiences of wearing the spinal orthosis were described as follows: "A well-adapted spinal orthosis could develop into a long-lasting friendship that provided support and help in daily life". The overall theme was based on three main categories: impact on daily life, individual adaptation and personal relationship. The main categories were well differentiated from each other but had an interdependency. All three categories involved cases in which the spinal orthosis was perceived as relieving symptoms and making daily life easier, as well as when it was perceived as being hard to manage and provided no symptom relief., Conclusion: In older women with osteoporosis and back pain, an activating spinal orthosis could be perceived as being a "close friend" and a support in everyday life. To facilitate acceptance of the spinal orthosis, it was important for it to be well adapted and for follow-ups to be carried out regularly.

Primary arthrodesis is a thoroughly studied treatment option for end-stage pathologic entities of the first metatarsophalangeal joint. It is a commonly accepted treatment of many pathologic conditions, including hallux rigidus, severe hallux valgus, hallux varus, and other conditions pertaining to the first ray. Numerous fixation techniques are available for this procedure. Fixation constructs range from simple crossing Kirschner wires to plate and screw fixation or, even, external fixation. We propose a simple and cost-effective fixation technique using an intramedullary Steinmann pin with crossing Kirschner wires. Similar fixation techniques have been described; however, minimal data are available regarding this type of fixation. We present a series of 64 first metatarsophalangeal joint fusion procedures performed on 60 patients using our technique. A retrospective review with attention to several clinical and radiographic parameters was performed. The mean follow-up time was 27 (range 6 to 56) months. This technique resulted in a fusion rate of 90.6% (58 of 64 procedures). Despite the use of a large intramedullary Steinmann pin across the interphalangeal joint (IPJ), only 6 of the 64 procedures (9%) resulted in hallux IPJ degeneration. Of these, only 3 (4.6%) were symptomatic and required therapeutic measures. This suggests that violation of the IPJ with this form of fixation contributes minimally to postoperative pathologic features and is a viable alternative to traditional Association for Osteosynthesis/Association for the Study of Internal Fixation techniques., (Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)