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Purpose: Metaphyseal corrective osteotomy and fixed-angle volar locking plate fixation have reduced the need for additional bone grafting in symptomatic distal radius malunions. This study evaluated the outcomes of gap versus dorsal opening wedge and locking plate fixation without bone grafts for distal radius malunions and the correlation between the osteotomy defect and the osteotomy’s distance from the articular surface with the union time. Methods: We retrospectively reviewed 62 patients who underwent corrective osteotomy between 2010 and 2021. Gap osteotomy (n = 44) was performed to correct the coronal deformity predominantly, whereas an opening wedge osteotomy (n = 18) was performed to correct the sagittal deformity. No bone graft was used in any patient. Radiological outcomes comprised of correction of radial height, inclination, ulnar variance, volar tilt and the correlation between the osteotomy defect and the distance from the distal radial articular surface with the union time. The functional assessment comprised the disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores. Results: All patients had a union of the osteotomy and statistically significant improvement in the radial height, inclination, ulnar variance, and tilt, irrespective of the osteotomy technique (P < .05). The mean defect length of the osteotomy, the time to the union, and the distance of the osteotomy were 4.7 mm (1–8.3 mm), 11.7 weeks (5–24 weeks), and 13.9 mm (1.6–35.8 mm), respectively. Time taken for union showed a weak positive correlation with the defect length of the osteotomy and no correlation with the distance of the distal osteotomy site from the articular surface. Opening wedge osteotomies took less time than the gap osteotomies. The mean postoperative disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores were 6.89 and 12.18, respectively. Conclusions: Corrective osteotomy and fixed-angle volar plate fixation for distal radius malunion provide satisfactory union rates and clinical and radiological outcomes even without bone graft, irrespective of the osteotomy type, size, or location. However, length of the osteotomy defect influenced the union time. Type of study/level of evidence: Therapeutic IV.

Background Forward Shoulder Posture (FSP) is one of the most common postural deviations of the upper back, which may affect the scapulohumeral rhythm (SHR). This study aimed to investigate changes in scapulohumeral rhythm during scapular plane shoulder abduction between individuals with and without FSP. Methods A cross sectional study with two group comparison. Young adults with FSP (N=39) with a forward shoulder angle ≥ 52°and without FSP(N=40) with a forward shoulder angle < 52° were recruited for the study. Scapular upward rotation was measured with the help of two inclinometers during scapular plane shoulder abduction, at resting shoulder abduction, at 30°, 60°, 90°, 120°, 150°, and at full range of shoulder abduction, and SHR was calculated. The scapulohumeral rhythm was compared between the two groups using an independent t test. Results Data analysis showed a statistically significant difference in scapulohumeral rhythm at 30°(p=0.004), 60°(p=0.013), and 90°(p=0.009) shoulder abduction between the two groups. There were no significant differences in the other ranges of shoulder abduction between the two groups. Conclusion Forward shoulder posture alters the scapulohumeral rhythm between 30 ° and 90°shoulder abduction. Clinicians, trainers, and sports therapists should be aware of this change to intervene at an early stage and prevent the development of pathological conditions around the shoulder.

AbstractThe L5-S1 segment of the spine is highly susceptible to injury, frequently causing low back pain. The segment has gained a lot of scientific interest, leading to many experimental works that can be found describing its biomechanical characteristics. But, there is a lack of work focusing on its computational studies, which can significantly aid its further studies. In the current study, a subject-specific single-segment finite element model of the L5-S1 unit was developed from a T2-mapped MRI scan. This study is mainly intended to probe the requirements for modelling the annulus of the disc and also attempts to understand the role of ligaments exclusive to the L5-S1 spinal unit to establish its validated finite element model. The annulus was represented by two different forms of hyperelastic material models (isotropic and anisotropic) for which the constants were determined from experimental data found in the literature. Their ability to impart the required characteristic was tested for the finite element model to mimic the experimental responses during sagittal and lateral moment loads. A comparison of results with the two material models is also discussed for other valuable parameters like contact pressure at the facets, maximum von-Mises stresses in the vertebrae, ligament strains, and midplane Tresca shear stresses of the annulus. The anisotropic Gasser-Ogden-Holzapfel (GOH) model was observed to deliver a response that consistently showed good compliance with the experimental response and hence, it is recommended for the computational studies of this segment.

The total hip prosthesis is considered one of the greatest advancements in orthopaedic surgery in the early 20th century. In hip implant replacement, the stem is inserted into the femur and femoral head, acetabular cup, and backing cup over the stem. This felicitates the normal range of motion and stability of an individual compared to the natural hip joint. Several different types of biomaterials are used in the total hip prosthesis. Where the combination of UHMWPE, CoCrMo alloy, and Ti-6Al-4 V alloy is widely used due to their superior mechanical properties over the others. In this work, these material combinations are used for the analysis with changes in the femoral head sizes from 24 mm to 48 mm to know the best size with the better material combination. Static structural analyses are carried out using Ansys R-19. Two sets of analyses are performed for two different material combinations between Ti-6Al-4 V, CoCr, and UHMWPE. The circular cross-shaped stem with change in femoral head sizes from 24 mm to 48 mm is used for analysis. The acetabular cup and backing cup thickness are kept constant throughout the study. The size of the acetabular cup and backing cup is considered 6 mm and 4 mm respectively. Loading and boundary conditions are considered as per the ASTM standards. Hip implant with Ti-6Al-4 V for stem and a 4 mm backing cup of CoCr and 6 mm acetabular cup of UHMWPE shown the least stress value of 203.48 MPa over all the other models which are used in the analysis. This work shows the analysis to know the effect of the change in femoral head size and also the change in material combinations used in hip implants. Further experimental work can be carried out to validate the results obtained in the current work.

In replacement surgery of the hip joint, an implant is replaced into the natural femur which recreates the articulation and functionally of a natural joint. Total hip replacement is significantly increasing by the day worldwide and is likely to increase by 174% by 2030. Primary revision is another major concern for total hip replacement with revision rates likely to increase by 137%. The first part of the article states the basic anatomy of the hip joint, different ligaments in the hip, the disorders associated with the joint, and evaluation of total hip arthroplasty. In the second part some of the major works are highlighted followed by a detailed discussion about different design considerations and wear-related issues in hip joints. More emphasis is given to the tribological behavior of implants under different conditions. The design aspects and several parameters which affect the wear rate in implants are summarized. Also, different testing methods which are used both in experimental and numerical techniques are reported to estimate the wear rates in hip implants with the evolution of hip implants since the early 20th century, in terms of different designs, materials and wear hip implant arthroplasty is known as one of the best advancements in healthcare. Further research is needed to establish to improve the life expectancy of hip implants.

Abstract Introduction Mechanical neck pain (MNP) is a commonly occurring musculoskeletal condition that is usually managed using electrical modalities, joint mobilization techniques, and therapeutic exercises, but has limited evidence of their efficacy. Pathology (densification) of the deep cervical fascia that occurs due to the increased viscosity of hyaluronic acid (HA) may induce neck pain and associated painful symptoms of the upper quarter region. Fascial manipulation (FM) and yoga poses are considered to reduce the thixotropy of the ground substances of the deep fascia and improve muscle function. The purpose of this study is to investigate the effect of FM and sequential yoga poses (SYP) when compared to the usual care on pain, function, and oculomotor control in MNP. Methods This FaCe-Man trial will recruit 160 patients with subacute and chronic mechanical neck pain diagnosed using predefined criteria. Participants will be randomized to either the intervention group or the usual care group, using a random allocation ratio of 1:1. Patients in the intervention group will receive FM (4 sessions in 4 weeks) and SYP (12 weeks) whereas the standard care group will receive cervical mobilization/ thoracic manipulation (4 sessions in 4 weeks) and therapeutic exercises (12 weeks). The primary outcome is the change in the numeric pain rating scale (NPRS). The secondary outcomes include changes in the patient-specific functional scale and oculomotor control, myofascial stiffness, fear-avoidance behavior questionnaire, and elbow extension range of motion during neurodynamics test 1. Discussion If found effective, FM along with SYP investigated in this trial can be considered as a treatment strategy in the management of mechanical neck pain. Considering the magnitude of the problem, and the pragmatic and patient-centered approach to be followed, it is worth investigating this trial. Trial registration ClinicalTrials.gov CTRI/2020/01/022934 . Registered on January 24, 2020 with ctri.nic.in. Clinical Trials Registry – India.

Hip implants consist of a stem, femoral head, acetabular cup, and backing cup. There is a wide variety of sizes and lengths. Their adaptability is limited because of the inter-anatomical variations. There is no single fit-for-all implant design that satisfies the orthopedic requirement satisfactorily. In this work, the trapezoidal-shaped stem with three different cross-sections is considered. The femoral head size, acetabular cup thickness, backing cup thickness, and trunnion geometry were varied to arrive at the best possible combination. ANSYS R-19 was used to perform the static analysis. It is found that trapezoidal-shaped profile two has the least amount of stress and total deformation. The von Mises stresses were found to be higher when the femoral head size was between 32 mm to 40 mm in profile two. It was also observed that the femoral head with 24 mm has the least stress compared to higher head sizes. The maximum von Mises stress-induced in profile two was 141.0 MPa, the total deformation of 0.04436 mm and elastic strain of 7.6 × 10−4 mm/mm. Trunnion interface does not have a significant role with respect to the structural strength of the implant. From the findings of this study, it is inferred that profile two shaped stems with the femoral ball size of 36 mm, acetabular cup thickness of 2 mm and backing cup thickness of 1mm is best suited for the hip replacement. The major outcome of this study is the utilization of the DoE method to determine the optimized value of the implant.

Background: The Hip joint is the primary joint which gives stability to the human body. The wear and tear associated with age and other factors, require these joints to be replaced by implants using hip arthroplasty surgeries. Cobalt chromium alloy (CoCr), titanium alloy, stainless steel are some of the most common hip joint materials used for hip implants. The design requirement for hip joint implants are very stringent to avoid revision joint surgeries due to aseptic loosening. There are various choices in shapes and materials used for stem and acetabular designs. This makes it more difficult to make an informed decision on the type of design and material that can be used for hip implants. Methods: Circular, Oval, ellipse and trapezoidal designs with three individual cross sections (defined as profile 1, profile 2 and profile 3) are considered for the study. All models are modeled using CATIA V-6. Static structural analysis is performed using ANSYS R-19 to arrive at the best possible design and material combination for stem and acetabular cup. Results: It was found that, profile 2 of all the four designs has the lowest possible deformation and von Mises stress when compared to profile 1 and profile 3. In general, profile 2 with trapezoidal stem has best outcomes in terms of its mechanical properties. Besides, stem designed with material CoCr and its associated acetabular cup with CoC (ceramic on ceramic) material can produce an implant having better properties and longer durability. Conclusions: CoCr was found to be the preferred choice of material for stem design. It was also observed that, irrespective of material considered for the analysis profile 2 with trapezoidal stem showcased lesser deformation and von Mises stress over the other eleven models. For analysis involving acetabular cups, CoC implants exhibited better mechanical properties over the conventional CoPE (Ceramic on polyethylene) materials such as Ultra-high molecular weight polyethylene (UHMWPE). It is inferred from the findings of this study that, the profile 2 with trapezoidal stem design made of CoCr material and acetabular cup made of CoC material is best suited for hip joint implants.

Background Forward Shoulder Posture (FSP) is one of the most common postural deviations of the upper back, which may affect the scapulohumeral rhythm (SHR). This study aimed to investigate changes in scapulohumeral rhythm during scapular plane shoulder abduction between individuals with and without FSP. Methods A cross sectional study with two group comparison. Young adults with FSP (N=39) with a forward shoulder angle ≥ 52°and without FSP(N=40) with a forward shoulder angle < 52° were recruited for the study. Scapular upward rotation was measured with the help of two inclinometers during scapular plane shoulder abduction, at resting shoulder abduction, at 30°, 60°, 90°, 120°, 150°, and at full range of shoulder abduction, and SHR was calculated. The scapulohumeral rhythm was compared between the two groups using an independent t test. Results Data analysis showed a statistically significant difference in scapulohumeral rhythm at 30°(p=0.004), 60°(p=0.013), and 90°(p=0.009) shoulder abduction between the two groups. There were no significant differences in the other ranges of shoulder abduction between the two groups. Conclusion Forward shoulder posture alters the scapulohumeral rhythm between 30 ° and 90°shoulder abduction. Clinicians, trainers, and sports therapists should be aware of this change to intervene at an early stage and prevent the development of pathological conditions around the shoulder.