Contracture

Contractures constitute a health problem in mobility-restricted geriatric patients. Contractures are clinically important due to their impact on functional outcome. Prophylactic interventions seem to be indispensable. We performed a systematic review studying the interventions used to prevent immobility-related contractures in the geriatric long-term care. The efficacy and safety of preventive methods was assessed. Electronic literature searches covered the databases PubMed, PEDro, CINAHL and the Cochrane Library (May 2010). Eligibility criteria for studies were: Investigation of an intervention aimed to prevent contractures, conducted in a geriatric and long-term care setting, inclusion of participants aged>65 years. The primary search focused on RCTs, systematic reviews und meta-analysis published between 1990 and May 2010 in English or German. The included studies were analysed and evaluated by one author while a second author checked the results. Methodological quality was critically evaluated using internationally accepted criteria. Eight studies met the inclusion criteria. Prophylactic interventions comprise mobility-encouraging and position-supportive interventions. Mobility-encouraging interventions aim to prevent contractures and immobility, for example offering range-of-motion exercises. Position-supportive interventions are transformations of motion and position, which are conducted with nurses' support. Due to limited methodological quality of these studies, the efficacy of certain measures remains unclear. Further studies on contracture prophylaxis investigating patient-relevant outcomes, interventions' adverse effects and costs are required.

Whether a patient with burn injury is an adult or child, contracture management should be the primary focus of burn rehabilitation throughout the continuum of care. Positioning and splinting are crucial components of a comprehensive burn rehabilitation program that emphasizes contracture prevention. The emphasis of these devices throughout the phases of rehabilitation fluctuates to meet the changing needs of patients with burn injury. Early, effective, and consistent use of positioning devices and splints is recommended for successful management of burn scar contracture.

Recent advances in clinical research have increased our understanding of causal pathways, opportunities for primary prevention, and the value of specific intervention strategies in the management of Cerebral Palsy (CP). Despite the increasing popularity of newer treatment alternatives, e.g., Botulinum Toxin and Intrathecal Baclofen, single event multilevel Orthopaedic bony and soft tissue surgery, in the context of a multi-disciplinary rehabilitation team, remains a vital component in the overall management plan. A meticulous clinical examination, augmented in some cases by instrumented gait analysis, allows for a comprehensive treatment plan addressing the entire extremity. This paper provides a critical review of the currently available treatment modalities.

Background Dynamic breast deformity following partial submuscular augmentation is not uncommon. The complication is due primarily to the release of the pectoralis and the true incidence of this complication is not known. The submuscular biplane pocket is a new pocket and is used to correct dynamic breasts following augmentation mammaplasty in the partial submuscular plane. Methods After the first submuscular biplane muscle-splitting augmentation mammaplasty in October 2005, the author has performed 58 secondary augmentation mammaplasties for various reasons. Of these, nine patients showed marked dynamic breast deformity following partial submuscular augmentation and the submuscular muscle-splitting biplane was used to correct this complication. Results Good to excellent results were achieved in all patients with complete elimination of the dynamic breast deformity. Conclusion The submuscular biplane is a new and versatile pocket and is used to correct dynamic breast deformity seen following partial submuscular augmentation mammaplasty.

Background Dynamic breast deformity following partial submuscular augmentation is not uncommon. The complication is due primarily to the release of the pectoralis and the true incidence of this complication is not known. The submuscular biplane pocket is a new pocket and is used to correct dynamic breasts following augmentation mammaplasty in the partial submuscular plane. Methods After the first submuscular biplane muscle-splitting augmentation mammaplasty in October 2005, the author has performed 58 secondary augmentation mammaplasties for various reasons. Of these, nine patients showed marked dynamic breast deformity following partial submuscular augmentation and the submuscular muscle-splitting biplane was used to correct this complication. Results Good to excellent results were achieved in all patients with complete elimination of the dynamic breast deformity. Conclusion The submuscular biplane is a new and versatile pocket and is used to correct dynamic breast deformity seen following partial submuscular augmentation mammaplasty.

The purpose of the study was to assess the effects of hyperbaric oxygen (HBO2) therapy on prosthetic rehabilitation of patients with unilateral lower limb amputation. Narang's scale,the Locomotor Capabilities Index and the two-minute walk test were used to assess functional abilities of amputees on the admission and on discharge from hospital. We also kept records of some clinical parameters whose improvement enables better mobility of patients: thigh and lower leg girth, strength of amputation stump, existence of amputation stump contracture, existence of some other complications on amputation stump, blood oxygenation and pulse palpation. Our results show that hyperbaric oxygenation accelerates prosthetic rehabilitation of lower limb amputees. HBO2-treated patients were discharged from the hospital faster than the controls (hospitalized for 133.2 +/- 54.87 days vs. 158.36 +/- 53.05 days), they had improved arterial Hb saturation (97.40 +/- 3.51% vs. 94.74 +/- 3.28 %) and pulse ...

Trigger thumb of childhood, termed congenital trigger thumb, is a pathology of the flexor pollicis longus tendon with an unknown etiology. In this study, treatment outcomes of 47 trigger thumbs of 36 children were evaluated. There were 18 males and 18 females with a mean age of 34 months (9 months-13 years). Average age of recognition of pathology by the family was 20.5 months (0-8 years). In seven of 11 bilateral cases pathology was recognized simultaneously while in the other four, diagnosis was made at different times. We used conservative treatment for all patients under three years of age, which was unsuccessful. Thus, surgical relase was performed in all cases. In the mean follow-up of seven years (range 5-15), contracture and palpable nodules disappeared. In conclusion, we believe trigger thumb in childhood should be treated surgically and that the term "congenital trigger thumb" should be changed to "developmental trigger thumb".