Recently, several smartphone applications (apps) have been developed and validated for ankle ROM measurement tools like the universal goniometer. This is the first innovative study introduces a new smartphone application to measure ankle joint ROM as a remote solution. This study aimed to assess the correlation between smartphone ROM and universal goniometer measurements, and also report the evaluation of the DijiA app by users. The study included 22 healthy university students (14F/8M; 20.68±1.72 years) admitted to Yeditepe University. Fourty four feet was measured by both the universal goniometer (UG) and DijiA app. The datas were analyzed through using the intraclass correlation coefficient (ICC). The DijiA app was evaluated by usability testing with representative users. Pearson correlation coefficient test showed moderate correlation between the DijiA and UG for dorsiflexion (DF) and plantar flexion (PF) measurements (Pearson correlation coefficient: r=0.323, for DF; r=0.435 for PF 95% confidence interval). The application usability was found as high with 76.5 average score and users liked it. The DijiA app may be a more convenient and easy way to measure ankle DF and PF-ROM than UG. It can be used to evaluate ROM in clinical practice or home using as a personal smartphone

The aim is to investigate if there is a relation between patellar height and knee flexion angle. For this purpose we retrospectively evaluated the radiographs of 500 knees presented for a variety of reasons. We measure knee flexion angle using a computer-generated goniometer. Patellar height was determined using computer generated measurement for the selected ratios, namely, the Insall–Salvati (I/S), Caton–Deschamps (C/D) and Blackburne–Peel (B/P) indices and Modified I/S Ratio. A search of an NHS hospital database was made to identify the knee x rays for patients who were below the age of forty. A senior knee surgeon (DC) supervised three trainee trauma and orthopaedics doctors (HA, JM, ES) working on this research. Measurements were made on the Insall–Salvati (I/S), Caton–Deschamps (C/D) and Blackburne–Peel (B/P) indices and Modified I/S Ratio. The team leader then categorised the experimental measurement of patients’ knee flexion angle into three groups. This categorisation was according to the extent of knee flexion. The angles were specifically, 10.1 to 20, 20.1 to 30, and 30.1 to 40 degrees of knee flexion. Out of the five-hundred at the start of the investigation, four hundred and eighteen patients were excluded because they had had either an operation on the knee or traumatic fracture that was treated conservatively

Total knee arthroplasty (TKA) aims to alleviate pain and restore joint biomechanics to an equivalent degree to age-matched peers. Zimmer Biomet's Nexgen TKA was the most common implant in the UK between 2003 and 2016. This study compared the biomechanical outcomes of the Nexgen implant against a cohort of healthy older adults to determine whether knee biomechanics is restored post-TKA. Patients with a primary Nexgen TKA and healthy adults >55 years old with no musculoskeletal deficits or diagnosis of arthritis were recruited locally. Eligible participants attended one research appointment. Bilateral knee range of motion (RoM) was assessed with a goniometer. A motorised arthrometer (GENOUROB) was then used to quantify the anterior-posterior laxity of each knee. Finally, gait patterns were analysed on a treadmill. An 8-camera Vicon motion capture system generated the biomechanical model. Preliminary statistical analyses were performed in SPSS (α = 0.05; required sample size for ongoing study: n=21 per group). The patient cohort (n=21) was older and had a greater BMI than the comparative group (n=13). Patients also had significantly poorer RoM than healthy older adults. However, there were no inter-group differences in knee laxity, walking speed or cadence. Gait kinematics were comparable in the sagittal plane during stance phase. Peak knee flexion during swing phase was lower in the patient group, however (49.0° vs 41.1°). Preliminary results suggest that knee laxity and some spatiotemporal and kinematic parameters of gait are restored in Nexgen TKA patients. While knee RoM remains significantly poorer in the patient cohort, an average RoM of >110° was achieved. This suggests the implant provides sufficient RoM for most activities of daily living. Further improvements to knee kinematics may necessitate additional rehabilitation. Future recruitment drives will concentrate on adults over the age of 70 for improved inter-group comparability

Plantar fasciitis (PF) is one of the widespread conditions causing hindfoot pain. The most common presenting symptoms are functional limitation and pain (first step and activity) on plantar surface of the foot. The non-operative treatments provide complete resolution of pain in 90% of patients, but functional limitation still remains as a risk factor for recurrency of PF. Although the number of non-operative treatment options showing efficacy on pain and functional limitation are excessive, the evidences are limited for functional limitation. Additionally, Mulligan mobilization with movement (MMWM) in Chronic Plantar Fasciitis has been poorly studied in the literature. According to these findings, the study was aimed to determine effectiveness of Mulligan mobilization with movement on Chronic Plantar Fasciitis. A total of 25 patients (40 feet) with chronic PF were included in the study. The patients were randomly divided into Mulligan concept rehabilitation group (PF-M, n=20 feet) and Home Rehabilitation group (PF-H, n=20 feet). (MMWM), Foot and ankle exercises program were applied to PF-M, twice a week totally 8 week (16 sessions) and foot- ankle exercises as a home program were given for PF-H, 8 weeks. The range of motion (ROM) for dorsiflexion and plantar flexion was measured by using a manual goniometer. Pain, disability and activity restriction were assessed by Foot Function Index (FFI) . The first step morning pain was evaluated by Visual Analogue Scale (VAS) and Kinesiophobia was also reported by using Tampa Scale (TSK). Patients were evaluated at baseline and 8 weeks. FFI, VAS, TSK, ROM values improved in all groups (intragroup variability) at 8th week (P < .05). The other result indicated that ROM values for DF and PF and TSK scores in PF-M had more significant improvement than PF-H (p<.05). To the best of our knowledge this is the first randomised controlled trial for investigating Mulligan Concept efficiancy on chronic PF. Both Mulligan mobilization with movement (MMWM) and exercise protocols are effective for chronic PF. Furthermore, The Mulligan concept seems more effective treatment option in reducing kinesiophobia and improving functional capacity

Background. Severe hallux rigidus can be treated with total or hemi arthroplasty to preserve motion in the 1st metatarsophalangeal joint (MTPJ). Decreased dorsiflexion impairs the rollover motion of the 1st MTPJ and recent studies of patients with 1st MTPJ osteoarthritis show increased plantar forces on the hallux. Objectives. Our aim was to examine the plantar force variables under the hallux and the 1st, 2nd, and 3rd – 5th distal metatarsal head (MH) on patients operated with a proximal hemiarthroplasty (HemiCap) in the 1st MTPJ and compare to a control group of healthy patients. Secondary aims: To examine correlations between the force and the 1st MTPJ range of motion (ROM) and pain. Study Design & Methods. Seventy patients operated with HemiCap were invited. 41 were included, (10 men, 31 women), median operation date 2011(range 2007–2014), age 63(47–78), 37 unilateral and 4 bilateral. Dorsal ROM of the 1st MTPJ was measured by goniometer and by x-ray. Pain evaluated by visual analog scale (VAS 1–10) during daily activities (DA) and during testing (DT). Emed (Novel) Foot Pressure Mapping system was used to measure peak force (N) and force/time integral (N/s) under the hallux, 1st and 2nd and 3–5th metatarsal heads (MH). Statistics: Force variables between operated feet and control group were compared by independent two-sample t-test or Wilcoxon rank sum test. Force variables association to ROM and pain by linear regression models. Results. Median (range) for HemiCap/Control group: Peak force (N): Hallux: 12(1–26)/20(4–30), 1st MH: 17(8–41)/24(14–42), 2nd MH 24(15–37)/28(24–37), 3rd–5th MH: 27(18–36)/30(25–35). Force/time integral (N/s): Hallux: 1(1–4)/4(1–12), 1st MH: 5(2–18)/7(3–11), 2nd MH 8(4–13)/10(7–13), 3rd–5th MH: 9(6–15)/10(8–14). Significant difference between HemiCap patients and healthy controls in peak force and force/time integral was found under the hallux (p<0.01), 1st (p<0.05) and 2nd MH (p<0.05), and max force under the 3–5th MH (p<0.01). Dorsal ROM of the operated feet was 45 degrees (10–75) by goniometer and 41 degrees (16–70) by x-ray. An increase in dorsal ROM decreased the peak force and force/time integral under the hallux (p>0.05) but not under the MHs. Most patients reported no pain (VAS 1: 62% DA, 78% DT), only 2 patients reported VAS>3. No significant correlation between pain and force or force/time integral. Conclusions. A mid-term hemiarthroplasty do not restore the joint motion to normal. The loading patterns are in opposition to AO patients as as assfgjkdfgjkfdgjk the HemiCap patients show a significantly decreased peak force and force/time integral under the hallux compared to the control group and the larger the dorsiflexion achieved postoperatively the smaller the force/time integral becomes. It may reflect a patient reluctance to load the 1st ray and 2nd MH. The plantar forces are not linked to pain. Most report minimal pain, but the pain score is biased by missing numbers and exclusion of revisions

Foot pain and related problems are quite common in the community. It is reported that 24% of individuals older than 45 experienced foot pain. Also, it is stated that at least two thirds of individuals experiences moderate physical disability due to foot problems. In the absence of evaluation of risk factors such as limited ankle dorsiflexion in the early period of the diseases (Plantar fasciitis, Achilles Tendinopathy e.g.) and the lack of mobile systems with portable remote access, foot pain becomes refractory/chronic foot pain, secondary pathologies and ends with workload of 1., 2. and 3rd level healthcare services. In the literature, manuel and dijital methods have been used to analyze the ankle range of motion (ROM). These studies are generally based on placing protractors on the image and / or angle detection from inclination measurement by using the gyroscope sensor of the mobile device. Some of these applications are effective and they are designed to be suitable for measuring in a clinical setting by a physician or physiotherapist. To the best of our knowledge, there is no system developed to measure real-time ankle ROM remotely with collaboration of the patients. In this research, we proposed to develop an ankle ROM analyze system with smart phone application that can be used comfortably by subjects. We present a case of a 22-year-old male with a symptomatic pes planus. The mobile application, which was used for data collection, was designed and implemented for Android devices. Initially, before the mobile application home page is opened, a consent page was submitted to the acceptance of individual within the scope of Law (KVKK) data privacy. Then, the participant was asked to state his sociodemographic characteristics [age, gender, height, weight] and dominant side. No history of foot-ankle injury, trauma, and surgery was recorded. Activity pain of the foot was 6 according to visual anolog scale (VAS) in the mobile application. His ankle dorsiflexion was 15 ° by manuel goniometer. Besides, server was responsible for storing the collected data and ROM measurement. ROM was calculated by processing the foot video which was sent through the mobile application. During the processing phase, a segmentation model was used which was trained with image process and deep learning methods. With the developed system, we obtained the manual goniometric measurement result with 2 degrees deviation. As the application is calibrated, it is expected to approach the actual measurement of ROM. We can conclude that mobile app-goniometer result in dorsiflexion measurement is a novel promising evaluation method for ankle ROM. it will be easy and practical to detect and monitor risk factor of the diseases, decrease medical costs, provide health services in rural areas, and contribution to life quality and to reduce the workload on physicians and physiotherapist

Background. Non-contact anterior cruciate ligament (ACL) injuries occurs with a higher incidence in female athletes compared with males after the onset of puberty. One anatomical factor with clinically observable differences between males and females is lower extremity alignment. The knee joint valgus in the coronal plane, which is associated with ACL injury risk, is composed of rotation of the tibia around the stationary femur and hip rotation combined with knee flexion. The purpose of this study was to prove the difference of hip rotation between female and male handball players with or without history of ACL injury. Methods. Elite collegiate athletes on the varsity handball team (17 females and 24 males) were recruited. Whereas 8 females and 1 male had a history of ACL injury, there were 9 females and 23 males with no history of ACL injury. The 6 measures of hip joint motion [flexion, extension, abduction, adduction, external rotation (ER), and internal rotation (IR)] and the 2 measures of knee joint motion (flexion and extension) were measured with the standard procedure using a goniometer. Results. The range of ER in ACL-injured females (37±7.5) was smaller than in uninjured females (49±8.2). The range of IR in ACL-injured female players (55±9.6) was greater than in uninjured females (41±13). There was no difference in ER+IR between ACL-injured and uninjured females. In the ACL-injured male handball player, ER was dominant to IR. Compared with the uninjured males, the ACL-injured female players showed smaller range of ER, greater ranges of IR and greater ER+IR. Conclusions. ACL-injured female handball players had greater hip IR with smaller hip ER, compared with uninjured counterpart. Hip rotation may be a crucial risk factor for ACL injury in female athletes. Level of evidence. 2b

The management of displaced forearm diaphyseal fractures in adults is predominantly operative. Anatomical reduction is necessary to infer optimal motion and strength. The authors have observed an intraoperative technique where passive pronosupination is examined to assess quality of reduction as a surrogate marker for active movement. We aimed to assess the value of this technique, but intentionally malreducing a simulated diaphyseal fracture of a radius in a cadaveric model, and measuring the effect on pronosupination. A single cadaveric arm was prepared and pronation/supination was examined according to American Academy of Orthopaedic Surgeons guidance. A Henry approach was then performed and a transverse osteotomy achieved in the radial diaphysis. A volar locking plate was used to hold the radius in progressive amounts of translation and rotation, with pronosupaintion measured with a goniometer. The radius could be grossly malreduced with no effect on pronation and supination until the extremes of deformity. The forearm showed more tolerance with rotational malreduction than translation. Passive pronation was more sensitive for malreduction than supination. The use of passive pronosupination to assess quality of reduction is misleading

Summary Statement. The circle theorem is a simple and effective measurement tool for estimating acetabular version after total hip arthroplasty. Introduction. Position of the acetabular cup is a major factor in the range of motion and risk of dislocation after total hip arthroplasty. However, there is no well established technique for accurately and easily estimating acetabular cup version intraoperatively or postoperatively. The objective of this study was to evaluate a recently proposed method for measuring acetabular cup version on a single plain radiograph of the hip, which is based on one of the circle theorems in basic geometry. Patients & Methods. Radiographic version is defined as the angle between the cup face plane and a plane perpendicular to the body coronal plane. Using this definition, a metal hemispheric cup was placed in a pelvic sawbone model at a series of known angles of radiographic version (based on direct goniometer measurement). Cup inclination, pelvic tilt, and pelvic rotation were held constant for all version angles. A single antero-posterior hip radiograph was then obtained and reviewed for each version angle. The acetabular cup version was next estimated by using a compass and protractor in accordance with the circle theorem. Statistical analysis was performed utilizing Student's t-test with an alpha=0.05. Results. 20 known angles of version were evaluated: 11 anteverted angles, 7 retroverted angles, and 2 neutral angles. Mean difference between the circle theorem estimate and the true version was 0.90 degrees (range −2 to 3). There was no statistically significant difference between the circle theorem's estimates and the true version (p=0.84). Similarly, there was no significant difference between the anteverted estimates (mean difference 0.91) and the retroverted estimates (mean difference 0.86)(p=0.95). Discussion/Conclusion. Methods of measuring component position are essential for evaluating surgical technique, monitoring cup stability, and maximizing patient outcomes. Radiographic version of an acetabular cup can be estimated by using the circle theorem. This theorem can provide a quick, easy, and accurate estimate of version with the use of simple instruments (compass and protractor) and readily available plain radiographs

To study the effect of ligament injuries and surgical repair we investigated the three-dimensional kinematics of the ankle joint complex and the talocrural and the subtalar joints in seven fresh-frozen lower legs before and after sectioning and reconstruction of the ligaments. A foot movement simulator produced controlled torque in one plane of movement while allowing unconstrained movement in the remainder. After testing the intact joint the measurements were repeated after simulation of ligament injuries by cutting the anterior talofibular and calcaneofibular ligaments. The tests were repeated after the Evans, Watson-Jones and Chrisman-Snook tenodeses. The range of movement (ROM) was measured using two goniometer systems which determined the relative movement between the tibia and talus (talocrural ROM) and between the talus and calcaneus (subtalar ROM). Ligament lesions led to increased inversion and internal rotation, predominantly in the talocrural joint. The reconstruction procedures reduced the movement in the ankle joint complex by reducing subtalar movement to a non-physiological level but did not correct the instability of the talocrural joint

Objectives

There are various pin-in-plaster methods for treating fractures of the distal radius. The purpose of this study is to introduce a modified technique of ‘pin in plaster’.

Different calcaneal plates with locked screws were compared in an experimental model of a calcaneal fracture. Four plate models were tested, three with uniaxially-locked screws (Synthes, Newdeal, Darco), and one with polyaxially-locked screws (90° ± 15°) (Rimbus). Synthetic calcanei were osteotomised to create a fracture model and then fixed with the plates and screws. Seven specimens for each plate model were subjected to cyclic loading (preload 20 N, 1000 cycles at 800 N, 0.75 mm/s), and load to failure (0.75 mm/s).

During cyclic loading, the plate with polyaxially-locked screws (Rimbus) showed significantly lower displacement in the primary loading direction than the plates with uniaxially-locked screws (mean values of maximum displacement during cyclic loading: Rimbus, 3.13 mm (sd 0.68); Synthes, 3.46 mm (sd 1.25); Darco, 4.48 mm (sd 3.17); Newdeal, 5.02 mm (sd 3.79); one-way analysis of variance, p < 0.001).

The increased stability of a plate with polyaxially-locked screws demonstrated during cyclic loading compared with plates with uniaxially-locked screws may be beneficial for clinical use.

We have investigated the anatomy of the proximal part of the ulna to assess its influence on the use of plates in the management of fractures at this site. We examined 54 specimens from cadavers. The mean varus angulation in the proximal third was 17.5° (11° to 23°) and the mean anterior deviation 4.5° (1° to 14°). These variations must be considered when applying plates to the dorsal surface of the ulna for Monteggia-type fractures. A pre-operative radiograph of the contralateral elbow may also be of value.

The aim of this randomised, controlled in vivo study in an ovine model was to investigate the effect of cylic pneumatic pressure on fracture healing. We performed a transverse osteotomy of the right radius in 37 sheep. They were randomised to a control group or a treatment group where they received cyclic loading of the osteotomy by the application of a pressure cuff around the muscles of the proximal forelimb. Sheep from both groups were killed at four or six weeks. Radiography, ultrasonography, biomechanical testing and histomorphometry were used to assess the differences between the groups. The area of periosteal callus, peak torsional strength, fracture stiffness, energy absorbed over the first 10° of torsion and histomorphometric analysis all showed that the osteotomies treated with the cyclic pneumatic pressure at four weeks were not significantly different from the control osteotomies at six weeks.