Dóra Maurer: Proportions & Timing

This paper aims at re-evaluating two of Hungarian artist Dóra Mauer’s films, the video work Proportions (1979) and the 16mm film Timing (1973/80). Both films follow a rigid structure. In Proportions, Maurer uses a paper roll to compare her own body measures repeatedly; in Timing, she repeatedly folds a white linen to compare the rhythm of her arm movements. Through her use of paper and the gesture of folding, the two films can be read as references to the very origin of the term format, as coined in early letterpress printing. When the notion of format is understood as a determination of a ratio and, as such, as an indexical reference to given social relationships (Summers, 2003), these films unfold sociocultural and political meanings. The present paper traces this spectrum of meaning through the pointed inclusion of historical discourses surrounding early motion studies, the art scene in socialist Hungary in the 1970s, and early time experiments before the advent of precision clocks.

Multiple ligament anatomic-based reconstructions of the knee: State- of-the-art

Multiple knee ligament injuries are defined as a disruption of any combination of the four main ligament complexes; the cruciate ligaments, posterolateral corner, and posteromedial corner. Evaluation requires consideration of the entire clinical picture, including injury to associated structures, directions and degree of instability, neurovascular compromise and appropriate imaging, and physical examination. Reconstruction is favored over repair and anatomic- based reconstruction techniques have been validated to restore the native biomechanics of the knee and lead to successful patient-reported and objective outcomes. Anatomic-based reconstruction of many knee ligaments simultaneously requires precise knowledge of the relevant anatomical landmarks, careful planning of reconstruction tunnel positions, and orientations to avoid tunnel convergence, and employment of immediate early motion in the post-operative rehabilitation regimen to provide the patient the best chance for relatively normal use of the affected limb.

Outcomes of Accelerated Physical Therapy in Patients with Transtendinous Rotator Cuff Repair (234)

Objectives: Surgical treatment options for the repair of symptomatic partial thickness and minimally retracted full-thickness rotator cuff tears include transtendinous or tear-completion transosseous-equivalent approaches. While transtendinous repairs are associated with superior biomechanical outcomes and lower rates of cuff re-tear, they have been linked to greater stiffness and a slower rate of recovery in comparison to tear-completion transosseous-equivalent repairs, especially in the first three months postoperatively. The purpose of this retrospective matched cohort study was to examine whether expediting a patient’s physical therapy (PT) regimen immediately following transtendinous rotator cuff repair can avert complications of postoperative stiffness and improve range of motion. Methods: After institutional review board approval, the medical records of all patients who underwent arthroscopic rotator cuff repair by the senior author between March of 2015 and May of 2019 were reviewed for inclusion in the study. Inclusion criterion was transtendinous repair. Patients that underwent an accelerated PT regimen were compared to a historical control cohort. The accelerated rehabilitation cohort was allowed passive range of motion (PROM) at 2-4 weeks, active-assisted range of motion (AAROM) at 2-4 weeks, active range of motion (AROM) at 4-6 weeks and strengthening exercises at 6-8 weeks. The historical control cohort received transtendinous rotator cuff repair between February 2005 and February 2015, and subsequently underwent a standard postoperative protocol with no shoulder motion until 6 weeks, PROM at 6-12 weeks, and AROM and strengthening exercises at 3-6 months. These cohorts were propensity matched for age, sex, BMI, and smoking status (with exact matches for sex and smoking status). Medical charts were reviewed for arthroscopic findings, including the tendons repaired (supraspinatus, infraspinatus, subscapularis, or a combination), arthroscopic classification of the tear thickness (partial, high-grade partial, focal full, or full), and presence of a concurrent labral tear. Patient data were analyzed with a mixed effects model to evaluate differences in active ROM at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Forward flexion, abduction, and external rotation were recorded in degrees. Internal rotation was converted from vertebral levels to the Constant Shoulder Score’s numerical ten-point scale for analysis. Finally, re-tear complications were recorded at final follow-up of 6 months and then analyzed with Fisher’s exact test. Results: Sixty-one accelerated PT patients and 61 standard PT controls were included in the study. Mean age (57.02 ±2.70 years [95% confidence interval] vs. 57.45 ± 2.78 years, p=0.83), BMI (28.13 ± 1.13 kg/m2 vs. 28.28 ± 0.99 kg/m2, p=0.84), sex (61.66% female vs. 61.66% female p=1.00), and smoking status (p=1.00) were similar between groups. There were no significant differences between groups in the tendons repaired, the arthroscopic tear thickness, nor the presence of labral tears. (Table 1). The accelerated PT cohort showed significantly increased AROM at 6 weeks and 3 months postoperatively. At 6 weeks, ROM in forward flexion (136.97° vs. 110.52°; p<0.001), abduction (126.08° vs. 100.73°; p=0.003), and external rotation (51.65° vs. 37.90°; p=0.009) were all significantly higher in the accelerated PT cohort. A similar increase was seen at 3 months, with superior forward flexion (147.47° vs. 132.84°; p=0.009), abduction (140.44° vs. 121.91°; p=0.02), and external rotation (57.70° vs. 40.76°; p=0.001) in patients who received accelerated PT. With the exception of forward flexion, which was improved in the accelerated cohort (151.32° vs. 139.11°; p=0.04), there were no other differences in active ROM at 6 months. Internal rotation metrics approached statistical significance at 2 and 6 weeks postoperatively (p=0.07 and p=0.06, respectively). There were no re-tears (0.00%) in the accelerated PT cohort and 1 re-tear (1.64%) in the standard PT cohort (p=1.00). (Table 2). Conclusions: Accelerated PT following transtendinous rotator cuff repair is associated with substantial improvement in AROM at 6 weeks and 3 months when compared to standard PT protocols. Further, the early motion does not seem to result in a higher rotator cuff re-tear rate. Thus, early motion and liberation from obligate sling wear may reduce stiffness and be better tolerated following transtendinous rotator cuff repair surgery.

A STUDY ON STABILIZATION OF COMPOUND SMALL BONE FRACTURES OF HAND AND FOOT WITH JESS FIXATOR

Background : The fractures of small bones of hand and foot should not be more complicated and damaging compared to the damage caused by the injury itself. The goal is to achieve good stability of the bone and joint, which allows early motion without resulting in the residual instability and malunion. These fractures of small bones of hand and foot can be treated with an external xator that allows fracture reduction attaining normal alignment. we took up the study with an aim to access the overall function and complications in treating open small bones of hand and foot with JESS xator. Methods: We performed a prospective study on 20 adult patients (14 males and 6 females) with small bone fractures of hand and foot, who attended outpatient or admitted in inpatient in the department of orthopaedics, government general hospital, Kakinada from October 2017 to august 2019. We excluded closed fractures and severely crushed fractures with neurovascular and tendon injuries. Results: 5 Results are recorded based on Duncan et al. criteria for ngers. For toes, the results are graded based on a total active range of movements. Most of the cases (n=17) showed radiological union within 12 weeks. Two cases took more than 20 weeks to heal. Whatever be the radiological union, the frame is removed mostly by 15 days postop (n=18) and by a maximum period of 21 days (n=6). the results are found to be excellent in 40% of cases, good in 44% cases, fair in 8% and poor results are seen in 8% cases. We had extensor lag as the most common complication (60%, n=15), 2 cases with malunion (8%) and one case (4%) with supercial infection. Conclusion: Hand serves many functions of precise movement, grip, grasp, touch etc. though these are small bones their fracture are not to be neglected and should be managed with utmost care. Jess is simple to operate, cheap, easily available, and has less complication rate. It makes the postoperative management simple and effective. It allows early mobilization, which prevents joint stiffness. Removing the frame at end of second postoperative week allows good functional results and doesn't compromise the stability of fracture.

Coracoclavicular Ligament Augmentation at Clavicle Distal-Third Fracture Treatment

Background. Type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. Material and methods. 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range 12–40 months). Results. Bony union was achieved at a mean follow-up of 8 weeks (range 6–10 weeks). The mean Constant score was 97 (range 92–100). There were no complications or no need to second operation. Conclusions. The augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options.

Functional Outcome Following Hand and Wrist Level Replantation: A Retrospective Review

Objective: Amputations of fingers and significant parts of upper limbs are common following industrial injuries. This study was aimed at assessing the functional outcome in patients with hand replantation following amputation at the level of distal forearm or wrist. Methods: Patients presenting with amputation at the level of wrist and forearm between Jan 2015 and December 1018, with adequate follow up were included. The function in terms of total active motion at the fingers and wrist, sensory recovery, and patient satisfaction and DASH scores at the final follow up were noted. Results: Four cases of replantation at the level of wrist and one replantation at distal forearm level were included in the study. A total of 3 patients were excluded for various reasons. The average follow-up period was 38 months. The average total active motion of fingers achieved was 212○ . All patients recovered protective sensations. Conclusion: Replantation of amputated major upper limb parts restores useful function and should be attempted. Minimizing ischaemia time, secure fixation, primary repair of structures and early motion are determinants of reasonable functional outcome. Level of evidence: IV.

Insula cortex gates the interplay of action observation and preparation for controlled imitation

Perceiving, anticipating and responding to the actions of another person are fundamentally entwined processes such that seeing another’s movement can prompt automatic imitation, as in social mimicry and contagious yawning. Yet the direct-matching of others’ movements is not always appropriate, so this tendency must be controlled. This necessitates the hierarchical integration of the systems for action mirroring with domain-general control networks. Here we use functional magnetic resonance imaging (fMRI) and computational modelling to examine the top-down and context-dependent modulation of mirror representations and their influence on motor planning. Participants performed actions that either intentionally or incidentally imitated, or counter-imitated, an observed action. Analyses of these fMRI data revealed a region in the mid-occipital gyrus (MOG) where activity differed between imitation versus counter-imitation in a manner that depended on whether this was intentional or incidental. To identify broader cortical network mechanisms underlying this interaction between intention and imitativeness, we used dynamic causal modelling to pose specific hypotheses which embody assumptions about inter-areal interactions and contextual modulations. These models each incorporated four regions - medial temporal V5 (early motion perception), MOG (action-observation), supplementary motor area (action planning), and anterior insula (executive control) – but differ in their interactions and hierarchical structure. The best model of our data afforded a crucial role for the anterior insula, gating the interaction of supplementary motor area and MOG activity. This provides a novel brain network-based account of task-dependent control over the integration of motor planning and mirror systems, with mirror responses suppressed for intentional counter-imitation.

Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review

Proximal phalangeal fractures have traditionally been fixed via either Kirschner wires or dorsal plating. Concerns regarding lack of compression and potential for infection with wire fixation, and adhesion formation and stiffness with plating, have lead to alternative fixation methods, such as intramedullary screw fixation. However, the literature regarding this modality is limited. Methods: A systematic review was performed to review the literature regarding intramedullary screw fixation for proximal phalangeal fractures. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. 4 studies were eligible for inclusion, with a further 3 studies assessing proximal and middle phalanges analysed separately. Total active motion was greater than 240° in all proximal phalangeal studies; mean post-operative DASH was 3.62. 6% of patients sustained a major complication. Intramedullary screw fixation of proximal phalangeal fractures is safe, providing stable fixation to allow early motion.