No description available.

Alignment of the above-knee prostheses is one of the important factors affecting the success of patient/prosthesis matching. It has been found that the prosthetist and the patient can accept a number of alignments which produce different intersegmental loads and it has been suggested that it is possible to obtain an 'optimal' alignment satisfying certain criteria. In order to enhance the efficiency of the alignment procedure, it is necessary to understand how alignment affects the amputee's gait and the patient compensations for changes in the alignment. Biomechanical gait tests on above-knee amputees were conducted in which the alignment of the prosthesis was changed systematically. The Strathclyde television-computer system was used to record the kinematic data of the amputee, and the ground reactions were measured by two Kistler forceplates. An 8-segment biomechanical model of the above-knee amputee was developed and implemented by a suit of FORTRAN computer programs to analyze and present 3-D kinematic and kinetic data obtained. The effects of alignment changes on the above-knee amputees' gait were studied in terms of the temporal-distance parameters, angular displacements of the lower limbs and the trunk, ground reactions and intersegmental moments. It was found that the angular displacement at the hip joint on the prosthetic side showed compensatory actions of the amputee for the alignment changes. The ground reaction force was sensitive to alignment changes, and in particular, the changes in the characteristics of the fore-aft ground force could be related to the alignment changes. The antero-posterior intersegmental moments about the prosthetic ankle and knee joints were evidently influenced by alignment.

Background: Rugby injuries are a common phenomenon. The aim of medical professionals is to treat these injuries to the best of their abilities, and if possible, to help prevent their occurrence. Bahr and Holme (2003) argue that sports participation carries with it a risk of injury, with the even more weighty issue that it might later even lead to physical disability. Junge, Cheung, Edwards and Dvorak (2004) recommends the development and implementation of preventative interventions to reduce the rate and severity of injuries in Rugby Union. The Medical and Risk Management Committee of USA Rugby (2003) also reports that the key to preventing injuries in any sport is identifying and addressing the risk factor associated with it. Various studies have identified weakness in plyometric strength, proprioception arid balance as - of lower leg and ankle injuries (Margison, Rowlands, Gleeson arid Eston, 2005; Stasiwpoulos, 2004; Verhagen, Van der Beck, Twisk, Bahr and Mechelen, 2004; Baltaci & Kohl, 2003; Mlophy, Conaoly and Beynnon, 2003; Moss, 2002; Anderson). Aims: ThE aim of this study was to investigate the influence of proprioception, balance and plyometric strength on the occurrence of lower leg injuries in schoolboy rugby players. A further aim was to develop a preventative training programme to address these variables, should they prove to have an influence on lower leg injuries. The possible inclusion of these tests in talent identification test batteries will also be examined. Design: A prospective cohort study. Subjects: A group of 240 schoolboys in U/14, U/15, U/16 and U/18 age groups in two schools (Hoër Volkskool Potchefstroom ("Volkskool") and Potchefstroom Boys High School ("Boys High")) in the North West Province of South Africa was used as the test cohort. Method: At the beginning of the 2006 rugby season all players were tested for proprioception, balance and plyometric strength. These tests were conducted using a computerised tilt board for proprioceptive testing; Star Excursion Balance Test for Balance and an electronic timing mat for plyometric strength. During the season, weekly injury clinics were held at both schools to document all injuries that occurred following the preceding weekend's matches. A statistical analysis was done on all the data collected from the test batteries and injury clinics. Descriptive statistics (means, standard deviation, minimum and maximum) were used as well as practical significant differences (d-values) (Cohen, 1988). The ratios for left and right leg plyometric strength to bilateral plyometric strength (L+R/Bil) and individual left and right leg plyometric strength to bilateral plyometric strength (L/Bil and R/Bil) were also calculated. Results: A profile of proprioception, balance and plyometric strength was compiled for schoolboy rugby players using the test data The U/18 players generally bad the best test results of all the age groups, outperforming U/14, U/15 and U/16 players with most tests. U/15 players outperformed both U/14 and U/16 players. Backline players performed better than loose forwards and forwards in plyometric tests in most age groups. Loose-forwards also outperformed tight-forwards with plyometrics at most age groups. At U/15 and U/16 level, tight-forwards slightly outperformed loose-forwards with Star Excursion Balance Tests. Generally, A-teams performed better than B-teams with all the tests except L+R/Bil; L/Bil and R/BiI. The difference between the teams, however, only had a small to medium effect and cannot be considered practically significant. At U/14 and U/15 levels, there were more practically significant differences between the A- and B-teams, with A-teams outperforming B-teams. The tests could have some value for talent identification at this age level. A rugby epidemiological study was done on the data collected in the weekly injury clinics. This study recorded 54 injuries at the two schools involved during the 2006 season from April to July. Two hundred and forty players were involved in 10890 hours of play. Eight thousand nine hundred and ten of these player hours were practices and 1980 were match hours. These injuries occurred at a prevalence rate of 4.96/1000 player hours. Match injuries accounted for 77.78% of all injuries with training sessions resulting in the remaining 22.22% of injuries, with a match injury rate of 1 injury per individual player every 3.14 matches. U/14 players showed an overall match injury rate of 11.11/1000 match hours. U/15 players showed a rate of 2.47/1000 match hours. The low rate may be attributed to underreporting of injuries by the U/15 players. U/16 players showed a late of 22.33/1000 hours, while U/18 players showed an exceptionally high rate of 45/1000 match hours. The tackle situation was responsible for the highest percentage of injuries (57.14%). Boys High presented with more injuries (57.4%) than Volkskool at a higher prevalence rate (5.60/1000 player hours). In a positional group comparison, backline players presented with 51.85% of injuries. Since backline players only present 46.7% of players in a team, this shows that backline players have a higher risk of injury. A-team players presented with 66.6% of injuries at a prevalence rate of 6.37/1000 player hours. B-team players had an injury rate of 3.43/1000 player hours. The test values for the players suffering lower leg injuries were compared to those for uninjured players. There were eight players with nine lower leg injuries: one player had injuries of both legs. Six of the injuries were intrinsic of nature and two players had extrinsic injuries. Test values for all five tested players with intrinsic injuries were weaker by a high practically significant margin for the L+R/Bil ratio. Conclusion: L+R/Bil proved to be the test result with the most influence on the occurrence of intrinsic lower leg injuries. When the individual test results for the players with intrinsic injuries are compared to the percentiles for all players, it becomes visible that the injured players fall in the 20th percentile for both L+R/Bil and Injured leg/Bil ratios. These 20th percentile values could thus be used as a standard for determining the possible occurrence of intrinsic lower leg injuries. These 20th percentile values are 1.012 for R+L/Bil ratios; 0.483 for L/Bil ratios and 0.492 for R/Bil ratios. This study shows that plyometric ratios for L+R/Bii, L/Bil and R/Bil have an influence on lower leg injuries in schoolboy rugby players. Proprioception and balance did not have any practically significant effects on the occurrence of these injuries. A preventative training programme was also designed following a study of the literature, combined with these results. The tests could also possibly be integrated in talent identification test batteries at U/14 and U/15 level. / Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2007

Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2007.

Background: Rugby injuries are a common phenomenon. The aim of medical professionals is to treat these injuries to the best of their abilities, and if possible, to help prevent their occurrence. Bahr and Holme (2003) argue that sports participation carries with it a risk of injury, with the even more weighty issue that it might later even lead to physical disability. Junge, Cheung, Edwards and Dvorak (2004) recommends the development and implementation of preventative interventions to reduce the rate and severity of injuries in Rugby Union. The Medical and Risk Management Committee of USA Rugby (2003) also reports that the key to preventing injuries in any sport is identifying and addressing the risk factor associated with it. Various studies have identified weakness in plyometric strength, proprioception arid balance as - of lower leg and ankle injuries (Margison, Rowlands, Gleeson arid Eston, 2005; Stasiwpoulos, 2004; Verhagen, Van der Beck, Twisk, Bahr and Mechelen, 2004; Baltaci & Kohl, 2003; Mlophy, Conaoly and Beynnon, 2003; Moss, 2002; Anderson). Aims: ThE aim of this study was to investigate the influence of proprioception, balance and plyometric strength on the occurrence of lower leg injuries in schoolboy rugby players. A further aim was to develop a preventative training programme to address these variables, should they prove to have an influence on lower leg injuries. The possible inclusion of these tests in talent identification test batteries will also be examined. Design: A prospective cohort study. Subjects: A group of 240 schoolboys in U/14, U/15, U/16 and U/18 age groups in two schools (Hoër Volkskool Potchefstroom ("Volkskool") and Potchefstroom Boys High School ("Boys High")) in the North West Province of South Africa was used as the test cohort. Method: At the beginning of the 2006 rugby season all players were tested for proprioception, balance and plyometric strength. These tests were conducted using a computerised tilt board for proprioceptive testing; Star Excursion Balance Test for Balance and an electronic timing mat for plyometric strength. During the season, weekly injury clinics were held at both schools to document all injuries that occurred following the preceding weekend's matches. A statistical analysis was done on all the data collected from the test batteries and injury clinics. Descriptive statistics (means, standard deviation, minimum and maximum) were used as well as practical significant differences (d-values) (Cohen, 1988). The ratios for left and right leg plyometric strength to bilateral plyometric strength (L+R/Bil) and individual left and right leg plyometric strength to bilateral plyometric strength (L/Bil and R/Bil) were also calculated. Results: A profile of proprioception, balance and plyometric strength was compiled for schoolboy rugby players using the test data The U/18 players generally bad the best test results of all the age groups, outperforming U/14, U/15 and U/16 players with most tests. U/15 players outperformed both U/14 and U/16 players. Backline players performed better than loose forwards and forwards in plyometric tests in most age groups. Loose-forwards also outperformed tight-forwards with plyometrics at most age groups. At U/15 and U/16 level, tight-forwards slightly outperformed loose-forwards with Star Excursion Balance Tests. Generally, A-teams performed better than B-teams with all the tests except L+R/Bil; L/Bil and R/BiI. The difference between the teams, however, only had a small to medium effect and cannot be considered practically significant. At U/14 and U/15 levels, there were more practically significant differences between the A- and B-teams, with A-teams outperforming B-teams. The tests could have some value for talent identification at this age level. A rugby epidemiological study was done on the data collected in the weekly injury clinics. This study recorded 54 injuries at the two schools involved during the 2006 season from April to July. Two hundred and forty players were involved in 10890 hours of play. Eight thousand nine hundred and ten of these player hours were practices and 1980 were match hours. These injuries occurred at a prevalence rate of 4.96/1000 player hours. Match injuries accounted for 77.78% of all injuries with training sessions resulting in the remaining 22.22% of injuries, with a match injury rate of 1 injury per individual player every 3.14 matches. U/14 players showed an overall match injury rate of 11.11/1000 match hours. U/15 players showed a rate of 2.47/1000 match hours. The low rate may be attributed to underreporting of injuries by the U/15 players. U/16 players showed a late of 22.33/1000 hours, while U/18 players showed an exceptionally high rate of 45/1000 match hours. The tackle situation was responsible for the highest percentage of injuries (57.14%). Boys High presented with more injuries (57.4%) than Volkskool at a higher prevalence rate (5.60/1000 player hours). In a positional group comparison, backline players presented with 51.85% of injuries. Since backline players only present 46.7% of players in a team, this shows that backline players have a higher risk of injury. A-team players presented with 66.6% of injuries at a prevalence rate of 6.37/1000 player hours. B-team players had an injury rate of 3.43/1000 player hours. The test values for the players suffering lower leg injuries were compared to those for uninjured players. There were eight players with nine lower leg injuries: one player had injuries of both legs. Six of the injuries were intrinsic of nature and two players had extrinsic injuries. Test values for all five tested players with intrinsic injuries were weaker by a high practically significant margin for the L+R/Bil ratio. Conclusion: L+R/Bil proved to be the test result with the most influence on the occurrence of intrinsic lower leg injuries. When the individual test results for the players with intrinsic injuries are compared to the percentiles for all players, it becomes visible that the injured players fall in the 20th percentile for both L+R/Bil and Injured leg/Bil ratios. These 20th percentile values could thus be used as a standard for determining the possible occurrence of intrinsic lower leg injuries. These 20th percentile values are 1.012 for R+L/Bil ratios; 0.483 for L/Bil ratios and 0.492 for R/Bil ratios. This study shows that plyometric ratios for L+R/Bii, L/Bil and R/Bil have an influence on lower leg injuries in schoolboy rugby players. Proprioception and balance did not have any practically significant effects on the occurrence of these injuries. A preventative training programme was also designed following a study of the literature, combined with these results. The tests could also possibly be integrated in talent identification test batteries at U/14 and U/15 level. / Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2007

The foot/ankle complex (particularly the hindfoot) is frequently injured in a wide array of debilitating events, such as car crashes. Numerical models have been used to assess injury risk, but most are minimally validated and do not account for variations in ankle posture that frequently occur during these events. The purpose of this study was to develop an accurate finite element (FE) model of the foot and ankle that accounts for these positional changes. The bone positions and load path in the foot and ankle were quantified throughout its natural range of motion. CT scans were taken of a male cadaveric leg in five postures in which fractures are commonly reported, while strains were recorded by strain gauges attached to the hindfoot bones in response to quasi-static, sub-failure loading. Substantial variations in bone displacements, rotations and strains were observed for all postures tested, highlighting the need for an FE model that accounts for these positional changes. The CT scans were used as the basis of an FE model of the foot and ankle that was developed using TrueGrid® and LS-Dyna® software. The model met rigorous mesh quality criteria, and its properties were optimized to best represent the experimental plantar tissue compression and surface strains. The model was evaluated by comparing its bone position and strain responses to the experimental results in each posture. The fracture thresholds and locations in each posture were estimated and were similar to those reported in the literature. The least vulnerable posture was neutral, and the talus and calcaneus exhibited the lowest fracture thresholds in all postures. This work will be useful in developing improved injury limits for the ankle and postural guidelines to minimize injury. The model can be used to evaluate new protective systems to reduce the occurrence of lower leg injuries. / Thesis / Master of Applied Science (MASc) / Ankle fractures are common occurrences that can lead to severe disability. Safety evaluations of the lower leg are often performed using computer models in a neutral ankle posture, which may underestimate the fracture tolerance in altered postures. The purpose of this study was to develop a computer model of the ankle that accounts for these changes. A cadaveric leg was used to determine how the locations of and strains in the bones of the foot and ankle varied as ankle posture was adjusted. A computer model of the lower leg and ankle was developed, and its accuracy was evaluated by comparison with the experimental results. The least vulnerable posture was neutral, and the hindfoot bones were the most likely to experience fracture in all postures. This model can be used in the future to evaluate new protective systems and develop comprehensive injury criteria for these altered postures.

This thesis seeks to simulate the impact on the human foot on the car bumper. The opening section deals with requirements as to the current passive safety features aiming to mitigate the consequences of such impact. The thesis also describes the construction of a human foot impactor, its certification via both static and dynamic tests, a simulation of the cash test and its evaluation. The designed model as well as the simulation procedure have been led according to the current Euro NCAP specifications.

Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage. Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores. Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year. Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

No description available.

Lower leg injury is an important issue in frontal car crash. Although safety in cars has been improved by developments such as seat belts and airbags, lower leg injuries have not been reduced. These injuries are not life threatening but can result in long term disability and cost a lot to society. This study focused on the passenger occupant in offset frontal crashes and aimed at understanding and finding ways to reduce the injury criteria for the lower leg: tibia index. A finite element model was simplified to introduce parameters which influence on tibia index was investigated with a multivariate analysis. The model simplification consisted in removing irrelevant parts and replacing other parts by simple foam blocks. More than 1300 simulations were run with different parameter values. The results were then analysed by calculating correlations and effects of the parameters on tibia index. It was concluded that the presence of a knee bolster decreased tibia index. The results also showed a decrease of tibia index when the toe pan was angled towards the legs of the passenger. Moreover, a correlation between tibia index and the movement of the feet during the crash was found. It was concluded that restrained lower legs also presented decreased tibia indices compared to unrestrained ones. Most of the results proved to be also valid on the initial, unsimplified finite element model. / Underbensskador är ofta förekommande vid frontalkrock. Även om fordonssäkerheten har förbättrats i och med utveckling av bland annat säkerhetsbälte och krockkudde, har antalet underbensskador inte minskat. Denna typ av skada är inte livshotande men kan resultera i långvariga besvär och kan leda till stora kostnader för samhället. Detta examensarbete fokuserar på passageraren vid frontalkrock (offset) och syftet var att skapa förståelse kring skadekriteriet för underben: tibia index, samt hitta lösningar på hur tibia index kan minskas. En finit elementmodell förenklades och parametrar introducerades. Parametrarnas påverkan på tibia index undersöktes med en multivariat analys. Modellen förenklades genom att eliminera några delar och ersätta andra delar med enkla block. Simuleringar med olika värden på parametrarna skapades och ungefär 1300 kördes. Värdena från simuleringarna analyserades genom att beräkna korrelation och effekt på tibia index. Resultaten visade att implementering av ett slags mjukt knäskydd påverkar tibia index positivt. De visade också att tibia index förbättrades när den främre delen av golvet vinklades mot passagerarens ben. Vidare, fanns en korrelation mellan tibia index och fötternas förflyttning under krockförloppet. Slutsatsen var att kontrollerade underben förbättrar tibia index i jämförelse med okontrollerade ben. De flesta resultaten stämde även för den ursprungliga modellen.