BACKGROUND:Traditionally, acute nondisplaced scaphoid fractures have been treated nonoperatively in a cast, and the expected union rate approaches 90%. Internal fixation of nondisplaced scaphoid fr ...

Nonoperative compared with operative treatment of acute scaphoid fractures. A randomized clinical trial.

The Achilles tendon (AT) consists of fascicles that originate from the medial head of the gastrocnemius (MG), lateral head of the gastrocnemius (LG), and soleus muscle (Sol). These fascicles are reported to have a twisted structure. However, there is no consensus as to the degree of torsion. The purpose of this study was to investigate the twisted structure of the AT at the level of fascicles that originate from the MG, LG, and Sol, and elucidate the morphological characteristics. Gross anatomical study of 60 Japanese cadavers (111 legs) was used. The AT fascicles originated from the MG, LG, and Sol were fused while twisting among themselves. There were three classification types depending on the degree of torsion. Further fine separation of each fascicle revealed MG ran fairly parallel in all types, whereas LG and Sol, particularly of the extreme type, were inserted onto the calcaneal tuberosity with strong torsion. In addition, the sites of Sol torsion were 3-5 cm proximal to the calcaneal insertion of the AT. These findings provide promising basic data to elucidate the functional role of the twisted structure and mechanisms for the occurrence of AT injury and other conditions.

The twisted structure of the human Achilles tendon

Abnormal lower limb biomechanics is speculated to be a risk factor for Achilles tendinopathy. This study systematically reviewed the existing literature to identify, critique and summarise lower limb biomechanical factors associated with Achilles tendinopathy. We searched electronic bibliographic databases (Medline, EMBASE, Current contents, CINAHL and SPORTDiscus) in November 2010. All prospective cohort and case-control studies that evaluated biomechanical factors (temporospatial parameters, lower limb kinematics, dynamic plantar pressures, kinetics [ground reaction forces and joint moments] and muscle activity) associated with mid-portion Achilles tendinopathy were included. Quality of included studies was evaluated using the Quality Index. The magnitude of differences (effect sizes) between cases and controls was calculated using Cohen's d (with 95% CIs). Nine studies were identified; two were prospective and the remaining seven case-control study designs. The quality of 9 identified studies was varied, with Quality Index scores ranging from 4 to 15 out of 17. All studies analysed running biomechanics. Cases displayed increased eversion range of motion of the rearfoot (d = 0.92 and 0.67 in two studies), reduced maximum lower leg abduction (d = -1.16), reduced ankle joint dorsiflexion velocity (d = -0.62) and reduced knee flexion during gait (d = -0.90). Cases also demonstrated a number of differences in dynamic plantar pressures (primarily the distribution of the centre of force), ground reaction forces (large effects for timing variables) and also showed reduced peak tibial external rotation moment (d = -1.29). Cases also displayed differences in the timing and amplitude of a number of lower limb muscles but many differences were equivocal. There are differences in lower limb biomechanics between those with and without Achilles tendinopathy that may have implications for the prevention and management of the condition. However, the findings need to be interpreted with caution due to the limited quality of a number of the included studies. Future well-designed prospective studies are required to confirm these findings.

/pdf/lower-limb-biomechanics-during-running-in-individuals-with-5bsob0vrny.pdf

Lower limb biomechanics during running in individuals with achilles tendinopathy: a systematic review

Understanding stability of the distal radioulnar joint through an understanding of its anatomy.

Fractures and dislocations of the carpal bones are more common in young active patients. These injuries can lead to pain, dysfunction, and loss of productivity. Conventional radiography remains the primary imaging modality for evaluation of suspected carpal fractures and dislocations. However, multidetector computed tomography (CT) is playing an increasingly important role, especially in the following situations: (a) when results from initial radiographs are negative in patients with suspected carpal fractures, (b) when initial radiographic findings are indeterminate, and (c) when knowledge of the extent of carpal fractures or dislocations is required before surgical treatment. The advantages of multidetector CT include quick and accurate diagnosis with availability in most emergency centers. Multidetector CT can easily display the extent of carpal fractures and dislocations, often depicting fractures that are occult at radiography. In addition, with multiplanar (two-dimensional) and volumetric (three-dim...

https://pubs.rsna.org/doi/pdf/10.1148/rg.286085511

Multidetector CT of Carpal Injuries: Anatomy, Fractures, and Fracture-Dislocations

ADAPTIVE CARPUS (FIGURE 1)



Fig. 1: 
ADAPTIVE CARPUS-ADAPTIVE DISI: the distal articular surface of the radius is inclined 30° dorsally from an old impacted distal radius fracture. The lunate is tilted dorsally to account for dorsal inclination of the distal radius, while the capitate is in neutral position following the position of the metacarpals with the hand. Changes in the carpal alignment creates a capitolunate angle of approximately 30° and a scapholunate angle of 85°. The increased scapholunate angle creates a DISI (dorsal intercalated segmental instability) configuration.



SYNONYM: none

CLINICAL: NA

RADIOLOGIC: a carpal malalignment usually identified by a dorsal or volar tilt of the lunate caused by an extracarpal osseous abnormality, usually a distal radial malunion without ligament tears

COMMENTS: 1) every carpus must adjust in some way to alterations of the radius articular surface, the ulnar head position, and the shape or size of the carpal bones even if all of its ligaments are intact. Although these alterations of the osseous elements may disrupt the ligament anchorage, may be accompanied by ligament damage, or may secondarily develop ligament attenuation, they often begin as a normal carpus. 2) The carpus may be malaligned between the two rows or remain aligned within itself, while translating at the radiocarpal level to a new position (usually dorsal, sometimes volar, even ulnar or radial). 3) This definition refers to an extracarpal, not an intracarpal, problem. If the malalignment is due to an intracarpal problem, then the case falls into a CID, CIND, or CIC category and would not fit into the category of an adaptive carpus as described here. Any adaptive carpus, by definition, can be solved by an extracarpal intervention that does not require surgery on the carpus. However, with time an adaptive carpus may degenerate to a point that the intrinsic ligaments …

Satoshi Toh

Papers

Wrist terminology as defined by the International Wrist Investigators' Workshop (IWIW)