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Article ; Online: Publisher Correction: The absence of reporting standards and a lack of objective, performance-based outcomes following intramedullary nailing of tibial shaft fractures: findings from a scoping review into 179 articles.

Thwaites, Simon / Abrahams, John / Thewlis, Dominic / Rickman, Mark

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2023 Volume 50, Issue 2, Page(s) 619

Language	English
Publishing date	2023-11-02
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-023-02380-z
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Article ; Online: The absence of reporting standards and a lack of objective, performance-based outcomes following intramedullary nailing of tibial shaft fractures: findings from a scoping review into 179 articles.

Thwaites, Simon / Abrahams, John / Thewlis, Dominic / Rickman, Mark

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2023 Volume 50, Issue 1, Page(s) 59–70

Abstract: Purpose: This scoping review was conducted to summarise the outcome tools reported in the assessment of tibial shaft fractures treated with intramedullary (IM) nailing, with a key focus on knee pain and function, and performance-based outcomes.: ... ...

Abstract	Purpose: This scoping review was conducted to summarise the outcome tools reported in the assessment of tibial shaft fractures treated with intramedullary (IM) nailing, with a key focus on knee pain and function, and performance-based outcomes. Methods: PubMed and Embase databases were searched on May 31, 2023. All study designs and populations were included, including ex vivo studies without fracture. Studies with only open or intra-articular fractures, or other fracture fixation, were excluded. Reported outcome tools and pertinent study characteristics were extracted and summarised. Results: Of 488 articles identified, 179 met the inclusion criteria. For in vivo studies (n = 152), there were 13,705 fractures; the IM nailing approach not described for 30% of these. There were 133 unique patient outcomes, with a binary assessment of knee pain (29% of studies) and Lysholm score (21%) most common. Only 10/152 (7%) in vivo studies included an objective, performance-based measure of knee function. Fracture union was most frequent (52%) of 81 different clinical outcomes. For ex vivo studies (n = 29), there were 408 tibias included, with nail insertion location most prevalent (66% of studies) of 34 reported outcomes. Conclusion: The heterogeneity of outcome tools reported limits comparison between studies and the most commonly reported patient outcomes may not be the most appropriate. Future studies should report the IM nailing approach and consider capturing both patient-reported and performance-based outcomes to help inform surgical decision making.
MeSH term(s)	Humans ; Tibia ; Fracture Fixation, Intramedullary ; Bone Nails ; Tibial Fractures/surgery ; Pain ; Treatment Outcome ; Retrospective Studies
Language	English
Publishing date	2023-08-09
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-023-02338-1
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Zs.A 1221: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Retention of kinematic patterns during a 6-minute walk test in people with knee osteoarthritis.

Millar, Stuart C / Bennett, Kieran / Rickman, Mark / Thewlis, Dominic

Gait & posture

2023 Volume 101, Page(s) 106–113

Abstract: Background: Knee osteoarthritis (OA) is a chronic condition affecting the entire joint and surrounding tissue, resulting in pain, stiffness and impaired movement. Recent studies have suggested the use of physical performance tests, such as the six- ... ...

Abstract	Background: Knee osteoarthritis (OA) is a chronic condition affecting the entire joint and surrounding tissue, resulting in pain, stiffness and impaired movement. Recent studies have suggested the use of physical performance tests, such as the six-minute walk test (6MWT) to assess joint function for those with knee OA. This study assessed lower limb sagittal plane joint angles during a 6MWT for people with mild-moderate knee OA. Methods: Thirty-one participants (18 male, 13 female; 62.9 ± 8.4 years) with knee OA were recruited. Gait data were collected in a single session during which participants completed a 6MWT around a 20 m course. Sagittal plane joint angles for the hip, knee and ankle were calculated during the first and last minute of the 6MWT. Statistical parametric mapping (SPM) was used to investigate changes in kinematic traces over the gait cycle. Results: Mean joint angles for the hip and knee showed no significant differences between the first and last minute of the 6MWT. Ankle joint kinematic traces indicated there to be a decrease in plantarflexion approaching toe-off in the last minute of the test - a 1.5° reduction from the first minute. No significant differences were calculated for walking speed or joint range of motion. Discussion: The lack of significant change in joint kinematic parameters and walking speed suggests the relative fatigue and pain burden to the participant over the duration of the 6-minute period is insufficient to elicit any mechanical changes to walking gait.
MeSH term(s)	Humans ; Male ; Female ; Osteoarthritis, Knee ; Walk Test ; Biomechanical Phenomena ; Walking ; Gait ; Knee Joint
Language	English
Publishing date	2023-02-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2023.02.004
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Article: Investigating and defining outcomes of suprapatellar versus infrapatellar intramedullary nailing of tibial shaft fractures: a protocol for a pilot randomised controlled trial.

Thwaites, Simon / Thewlis, Dominic / Hall, Kelly / Rickman, Mark

Pilot and feasibility studies

2022 Volume 8, Issue 1, Page(s) 110

Abstract: Background: Anterior knee pain is often reported following intramedullary nailing of tibial shaft fractures. The aetiology remains unclear, but the surgical approach may play an important role. To date, no biomechanically validated method exists to ... ...

Abstract	Background: Anterior knee pain is often reported following intramedullary nailing of tibial shaft fractures. The aetiology remains unclear, but the surgical approach may play an important role. To date, no biomechanically validated method exists to assess patient outcomes specific to anterior knee pain in this cohort. The central aims of this study are to (1) evaluate the feasibility of a full-scale randomised controlled trial (RCT) investigating the influence of surgical approach on intramedullary nailing of tibial shaft fractures (suprapatellar versus infrapatellar nailing), (2) explore differences in clinical outcomes between the approaches, and (3) explore the development of a biomechanically validated methodology for assessing post-operative anterior knee pain and knee function specific to intramedullary nailing of tibial shaft fractures. Methods: This pilot study will follow a prospective randomised controlled design at the Royal Adelaide Hospital and The Queen Elizabeth Hospital (South Australia). This study aims to recruit 60 patients between 18 and 60 years old who will be randomly assigned to either the suprapatellar or infrapatellar approach following a decision for intramedullary surgical fixation by the treating surgeon. All nails in this study will be Stryker T2 Alpha nails. Patients will undergo standard radiograph, magnetic resonance imaging, and clinical assessments in-line with their standard operative care, and complete a number of patient-reported and performance-based outcome measures. Performance-based outcome measures will be assessed utilising three-dimensional motion capture techniques. Follow-up time points are 3, 6, 12, and 18 months. Feasibility outcomes include ability to meet enrolment and retention metrics, compliance with all questionnaires and assessment procedures, and the occurrence of any adverse events. The primary clinical outcome is the incidence of anterior knee pain at 12 months after surgery. Discussion: This study will establish the feasibility and inform the design of a large-scale RCT. Evaluation of all clinical data and patient outcomes will lead to the development of a new tool for assessing patient outcomes in this cohort. Limitations of the study include an unpredictable enrolment rate and loss to follow-up, small sample size, and the unknown ability of three-dimensional motion analysis to pick up the effects of anterior knee pain after tibial nailing. Trial registration: This trial was prospectively registered on the 7 February 2020 on ANZCTR, ACTRN12620000109909 .
Language	English
Publishing date	2022-05-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2809935-7
ISSN	2055-5784
ISSN	2055-5784
DOI	10.1186/s40814-022-01057-5
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Article ; Online: Visualising knee loading patterns during kneeling and the development of a laboratory-based adaptation of the Aberdeen Weight-Bearing Test (Knee).

Thwaites, Simon / Rickman, Mark / Thewlis, Dominic

The Knee

2022 Volume 38, Page(s) 201–211

Abstract: Background: Information regarding the loading of key anatomical structures of the knee during kneeling would enhance existing functional tests, yet current visualisation methods are limited and require further development.: Aims: (1) Develop a knee ... ...

Abstract	Background: Information regarding the loading of key anatomical structures of the knee during kneeling would enhance existing functional tests, yet current visualisation methods are limited and require further development. Aims: (1) Develop a knee loading visualisation technique to investigate loading patterns of the knee during kneeling; and (2) determine the utility of the technique in combination with vertical ground reaction forces and centre of pressure data in the lab-based Aberdeen Weight-Bearing Test (Knee) by assessing their reliability. Methods: Fourteen healthy participants conducted kneeling tasks with and without knee pads across two testing sessions. Eight force-sensitive resistors were affixed to the right knee throughout different kneeling tasks: upright kneeling, and reaching forward, back, left, and right. A photo of the force-sensitive resistor configuration was used to generate participant-specific heat maps of knee loading. Two in-ground force platforms were used to measure vertical ground reaction forces and centre of pressure. Results: The inferior patella tendon showed the highest proportion of activation during both bare and knee pad kneeling for all kneeling tasks. Knee pads reduced the repeatability of knee loading patterns. Force-sensitive resistor activation and vertical ground reaction force components of the lab-based Aberdeen Weight-Bearing Test (Knee) were shown to be reliable, whereas the centre of pressure data was unreliable. Conclusion: We have developed a lab-based technique for visualising knee loading using force-sensitive resistors. The combination of force-sensitive resistor activation and vertical ground reaction force data provides valuable insights into both the magnitude and locations of applied loads throughout kneeling.
MeSH term(s)	Humans ; Knee ; Knee Joint/physiology ; Posture/physiology ; Reproducibility of Results ; Weight-Bearing/physiology
Language	English
Publishing date	2022-09-11
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1200476-5
ISSN	1873-5800 ; 0968-0160
ISSN (online)	1873-5800
ISSN	0968-0160
DOI	10.1016/j.knee.2022.08.019
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Article ; Online: Gait biomechanics after proximal femoral nailing of intertrochanteric fractures.

Sivakumar, Arjun / Rickman, Mark / Thewlis, Dominic

Journal of orthopaedic research : official publication of the Orthopaedic Research Society

2022 Volume 41, Issue 4, Page(s) 862–874

Abstract: Proximal femur fractures in the elderly are associated with significant loss of independence, mobility, and quality of life. This prospective study aimed to: (1) investigate gait biomechanics in intertrochanteric fracture (ITF) patients (A1 and A2 AO/OTA) ...

Abstract	Proximal femur fractures in the elderly are associated with significant loss of independence, mobility, and quality of life. This prospective study aimed to: (1) investigate gait biomechanics in intertrochanteric fracture (ITF) patients (A1 and A2 AO/OTA) managed via femoral nailing at 6 weeks and 6 months postoperative and how these compared with similarly aged elderly controls; and (2) investigate whether femoral offset shortening (FOS) and lateral lag screw protrusion (LSP) were associated with changes in gait biomechanics at postoperative time points. Hip radiographs and gait data were collected for 34 patients at 6 weeks and 6 months postoperatively. Gait data were also collected from similarly aged controls. FOS and LSP were measured from radiographs. Joint angles, external moments, and powers were calculated for the hip, knee, and ankle and compared between time points in ITF patients and healthy controls using statistical parametric mapping. The relationship between radiographic measures with gait speed, step length, peak hip abduction, and maximum hip abduction moment was assessed using a Pearson correlation. External hip adduction moments and hip power generation improved in the first 6 months postoperative, but differed significantly from healthy controls during single limb stance. LSP showed a moderate correlation with maximum hip abduction moment at 6 weeks postoperative (r = -0.469, p = 0.048). These results provide new detail on functional outcomes after ITF and potential mechanisms that functional deficiencies may stem from. Lag screw prominence may be an important factor in maintaining functional independence and minimizing the risk of secondary falls after ITF in the elderly.
MeSH term(s)	Humans ; Aged ; Prospective Studies ; Biomechanical Phenomena ; Quality of Life ; Hip Fractures/surgery ; Gait ; Treatment Outcome ; Femoral Fractures/surgery
Language	English
Publishing date	2022-08-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605542-4
ISSN	1554-527X ; 0736-0266
ISSN (online)	1554-527X
ISSN	0736-0266
DOI	10.1002/jor.25427
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Article ; Online: An instrumented walker in three-dimensional gait analysis: Improving musculoskeletal estimates in the lower limb mobility impaired.

Sivakumar, Arjun / Bennett, Kieran / Rickman, Mark / Thewlis, Dominic

Gait & posture

2022 Volume 93, Page(s) 142–145

Abstract: Background: In three-dimensional (3D) gait analysis of individuals requiring a walking frame (walker), acquisition of artefact-free motion and force data is challenging. Without inclusion of handle-reaction forces alongside ground reaction forces, ... ...

Abstract	Background: In three-dimensional (3D) gait analysis of individuals requiring a walking frame (walker), acquisition of artefact-free motion and force data is challenging. Without inclusion of handle-reaction forces alongside ground reaction forces, external forces used in musculoskeletal modelling are incomplete. This may increase dynamic inconsistencies between the model and measured motions and forces, thus, uncertainties in estimates of musculoskeletal load. Research question: To develop an instrumented walker and evaluate the effects of including handle-reaction forces on residual forces during musculoskeletal modelling. Methods: An instrumented walker measuring handle-reaction forces synchronously with motion capture and ground reaction force data was developed. 3D gait analysis was conducted in ten elderly participants recovering from a proximal femur fracture and requiring a walker for ambulation. Joint kinetics and residual forces were calculated between two external load conditions: (1) external loads applied using only force platforms; or (2) external loads applied using force platforms and walker handle-reaction forces. Results: Including handle-reaction forces reduced residual forces and improved estimates of musculoskeletal loads of the torso (P = <0.001). Significance: A wide instrumented walker measuring handle-reaction forces allows for the gait analysis of individuals requiring a walker and improves reliability of musculoskeletal dynamics.
MeSH term(s)	Aged ; Biomechanical Phenomena ; Gait ; Humans ; Lower Extremity ; Reproducibility of Results ; Walkers ; Walking
Language	English
Publishing date	2022-01-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1162323-8
ISSN	1879-2219 ; 0966-6362
ISSN (online)	1879-2219
ISSN	0966-6362
DOI	10.1016/j.gaitpost.2022.01.023
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Article: Reoperation rates after proximal femur fracture fixation with single and dual screw femoral nails: a systematic review and meta-analysis.

Sivakumar, Arjun / Edwards, Suzanne / Millar, Stuart / Thewlis, Dominic / Rickman, Mark

EFORT open reviews

2022 Volume 7, Issue 7, Page(s) 506–515

Abstract: Purpose: The purpose of this study was to investigate differences in aseptic reoperation rates between single or dual lag screw femoral nails,in the treatment of intertrochanteric fractures (ITF) in elderly patients.: Methods: Electronic databases ... ...

Abstract	Purpose: The purpose of this study was to investigate differences in aseptic reoperation rates between single or dual lag screw femoral nails,in the treatment of intertrochanteric fractures (ITF) in elderly patients. Methods: Electronic databases were searched for RCTs and prospective cohort studies treating elderly ITF patients with a single or dual screw femoral nails. Data for aseptic reoperation rates between single screw, dual separated screw and dual integrated screw devices were pooled using a random-effects meta-analysis with 95% CIs. Pooled proportions were compared using a N-1 chi-squared test. Complications contributing to aseptic reoperation rates were extracted, and the contribution of cut-out and periprosthetic fracture as a proportion of reoperations was analysed using a negative binomial regression model. Results: Forty-two (n = 42) studies were evaluated, including 2795 patients treated with a single screw device, 1309 patients treated with a dual separated screw device and 303 patients treated with a dual integrated screw device. There was no significant difference in aseptic reoperation rates between single and dual lag screw femoral nails of both separated and integrated lag screw designs. Moreover, complications of cut-out and periprosthetic fracture as a proportion of reoperations did not differ significantly between devices. Conclusion: The current evidence showed that aseptic reoperation rates were not significantly different between single and dual screw nails of a separated lag screw design. For dual integrated screw devices, due to insufficient evidence available, further high quality RCTs are required to allow for decisive comparisons with these newer devices.
Language	English
Publishing date	2022-07-05
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2844421-8
ISSN	2058-5241 ; 2058-5241 ; 2396-7544
ISSN (online)	2058-5241
ISSN	2058-5241 ; 2396-7544
DOI	10.1530/EOR-21-0067
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Article ; Online: Setting up girls for success in fundamental motor skills: The role of balance in 8-10 year olds.

Tsiros, Margarita D / Shahrin, Suliana / Mackintosh, Shylie / Thewlis, Dominic

Journal of sports sciences

2022 , Page(s) 1–8

Abstract: The purpose of this study was to explore the relationship between postural control and fundamental motor skills in girls. An observational cross-sectional study was conducted in 47 girls, aged 8-10 years. Postural control (postural sway centre of ... ...

Abstract	The purpose of this study was to explore the relationship between postural control and fundamental motor skills in girls. An observational cross-sectional study was conducted in 47 girls, aged 8-10 years. Postural control (postural sway centre of pressure) was evaluated during tandem stance, leading with dominant and non-dominant limbs with eyes open and closed, using an AMTI force platform. Fundamental motor skills were assessed using the Test of Gross Motor Development 2nd Edition, examining total, locomotor and object control scores. Data were analysed using linear regression, adjusted for body mass index percentile and household income. For locomotor skills, significant relationships were found with a number of postural sway outcomes for adjusted and unadjusted analyses (r - 0.287 to r - 0.425, p ≤ 0.042). Total motor skill score was significantly related to postural sway in the tandem dominant eyes closed condition for unadjusted and adjusted analyses (r ≥ -0.294, p ≤ 0.04). In conclusion, our findings indicate that postural control may be important for fundamental motor skill proficiency and movement quality in pre-adolescent girls, particularly for locomotor skills. Our study provides evidence supporting the clinical practice of assessing postural control in girls presenting with motor skill deficits.
Language	English
Publishing date	2022-11-27
Publishing country	England
Document type	Journal Article
ZDB-ID	995528-8
ISSN	1466-447X ; 0264-0414
ISSN (online)	1466-447X
ISSN	0264-0414
DOI	10.1080/02640414.2022.2148051
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Article ; Online: Improvement in postural alignment is associated with recovery of mobility after complex acquired brain injury: An observational study.

Mills, Simon J / Mackintosh, Shylie / McDonnell, Michelle N / Thewlis, Dominic

Physiotherapy theory and practice

2022 Volume 39, Issue 6, Page(s) 1274–1286

Abstract: Purpose: Determine how mobility changes over 6 months in people unable to walk at 8-weeks post-Acquired Brain Injury (ABI); if there is an association over time between postural alignment and mobility post-ABI; and if alignment after ABI becomes closer ... ...

Abstract	Purpose: Determine how mobility changes over 6 months in people unable to walk at 8-weeks post-Acquired Brain Injury (ABI); if there is an association over time between postural alignment and mobility post-ABI; and if alignment after ABI becomes closer to healthy alignment over time. Methods: Fourteen adults with ABI, evaluated over 6 months, and a reference sample of 30 healthy adults were studied. The primary measure for changes in mobility was the Clinical Outcome Variables Scale (COVS). Secondary measures were sit-to-stand, timed standing holding rails, independent walking speed and number of testing conditions achieved. The Functional Independence Measure (FIM) was scored at rehabilitation admission and discharge. To analyze postural alignment, participants were recorded in sitting and standing, each repeated holding rails, and walking if able. Three-dimensional kinematic data were used to quantify whole-body postural alignment, equal to mean segment displacements from the base of support in the transverse plane. Associations between three-dimensional kinematic alignment scores and COVS scores were calculated using Linear Mixed-Effects Models. Results: Participants made significant improvements in COVS scores, most secondary mobility scores, and FIM scores over time (p ≤ .001). Relationships between increasing COVS scores and decreasing sitting and standing mal-alignment scores were statistically significant. Visual analysis of graphed segment positions indicated that sitting and standing alignment became more similar to healthy alignment over time; this was not clear for walking. Conclusion: Improvement in postural alignment may be a factor for improving mobility in people with severe impairments after ABI.
MeSH term(s)	Adult ; Humans ; Brain Injuries ; Hospitalization ; Walking ; Patient Discharge ; Postural Balance
Language	English
Publishing date	2022-02-02
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	1045333-7
ISSN	1532-5040 ; 0959-3985
ISSN (online)	1532-5040
ISSN	0959-3985
DOI	10.1080/09593985.2022.2034197
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