Löpning är en av de största fysiska aktiviteterna runt om i världen. Det räknas med att 37-56 % av alla som löper någon gång drabbas av en skada i samband med löpningen. Studiens syfte är att undersöka effekten av olika dämpningsmaterial, drop samt motion-kontroll av löparskor på skadefrekvens i samband med pronation och supination under löpning. Studien gjordes som en litteraturstudie där 11 vetenskapliga artiklar ingick i studien. Resultatet visar att motion-kontroll skor rekommenderas till pronerande löpare och neutrala skor till supinerande eller neutrala löpare. Minskat drop leder till minskad skaderisk. Framfotslöpning är att föredra jämfört med häl till tå löpning. En mjuk sula är bättre vid kortdistans och en hårdare sula vid långdistans. EVA material visade på en bättre återhämtningseffekt än TPU.

In 20 humanen, osteoporotischen Unterschenkeln wurde versucht eine Lauge-Hansen Supination-Eversions-Verletzung Stadium II zu reproduzieren. In 15 der 18 auswertbaren Proben waren Außenknöchelfrakturen induzierbar. Die Voraussetzung für die erfolgreiche Frakturinduktion war eine Mindestknochen- und Spongiosadichte des Außenknöchels gemessen mit pQCT an Innen- und Außenknöchel. Ansonsten kam es nur zu ligamentären fibularen oder tibialen Avuslionen. Entscheidend, ob eine Außenknöchelfraktur auf Höhe der Syndesmose oder distal entstand, war eine effektive, lateral gerichtete talofibulare Kraft. Jeweils sechs der 15 Außenknöchelfrakturen wurden mit winkelstabilen und nicht winkelstabilen Konturenplatten versorgt und biomechanisch getestet. Mit p kleiner 0,05 konnte signifikant gezeigt werden, dass zum Versagen der winkelstabilen Konturenplatte ein höheres Drehmoment und ein größere Außenrotation nötig waren, als für die nicht winkelstabilen Konturenplatte. Neben der biomechanischen Überlegenheit der winkelstabilen Konturenplatte konnte gezeigt werden, dass ihr Versagen im Gegensatz zur nicht winkelstabilen Konturenplatte unabhängig ist von der Knochendichte des Außenknöchels. / A Lauge-Hansen supination-external rotation fracture (LH SER II) was succeful reproduced in 15 of 18 human cadaveric ankles. The observed fracture pattern was a result of more than a simple external rotation deforming force applied to the supinated foot. It also depend on the presence of al laterally directed talofibular force an a BMD of the ankle over 90,6 mg/ccm. Otherwise you receive only ligament damage. Six fibular fractures were stabilized wiht conventional plates. Other six fibular fractures were stabilized with locking plates and biomechanical tested. Torque to failure (Nm) and angle at failure (degrees) were significantly greater on the side with locked plate than on the side with conventional plate. Our findings clearly demonstrate that the locking plate has greater biomechanical fixation properties than the conventional plates. In contrast to the failure of conventional plating the failure of locked plating was independent of the ankle BMD.

Ankle sprains are one of the most common type of sports injury. They occur most frequently when the foot is in a supine or inverted position. Recovery from an ankle sprain can take from one and up to 26 weeks depending on the severity of the injury. During that period the individual will be unable to participate in any meaningful sports activity and as such it is important to be able to prevent the occurrence of such injuries. Prevention of ankle sprain injuries would require a better understanding of the risk factors of this injury. Several studies attempted to assess such risk actors by inducing foot inversion or supination however the platforms used in these studies were shown to be limited. Hence the main aim of this project is to develop a system that can be used to assess the effect of sudden foot and ankle inversion/supination on the musculoskeletal system of dynamic subjects (e.g. walking, running, jumping, etc.). For this purpose a three degrees of freedom (DOF) rotating platform has been designed, manufactured and installed in the Institute of Motion Analysis and Research (IMAR) Sports Laboratory. The platform rotates around 3 different axes allowing inversion or supination of the foot and ankle of dynamic subjects. The degree of rotation around each axis can easily be set by the researcher/operator. A strain gauge was used to detect foot strike to the platform. As a safety measure laser emitter/receivers check that the entire foot is on the footplate before the platform rotates. Optical encoders provide essential feedback of rotation angles, speed and acceleration. The necessary software and user interface for controlling the platform were also written and tested. The platform was synchronised with a bilateral four-channel EMG (electromyography) system and a 12 camera Vicon® MX-13 system thus allowing measurement of muscle activity and kinematic data during the supination of the foot. A set of software modules were written to allow automated management and processing of the data generated by the new system. The new system was then implemented in a study to validate it and to assess the role of shoes in ankle sprains. In this study, subjects would walk in three different foot conditions: barefoot, and with two different types of sports shoes, along the walkway of the Sports Laboratory where the platform was fitted. When a subject steps on the embedded platform, it rotates causing the subject's foot to supinate. At the same time, the EMG data from the peroneus longus, tibialis anterior, and lateral gastrocnemius muscles are recorded, along with the kinematics of the subject's whole body. The obtained results demonstrated the validity of the newly developed system. Data from the validation study also revealed increased muscle activity following induced foot supination in shod conditions compared to barefoot. Muscle activity of the rotating platform step was found to be significantly higher than the steps before and after. The platform rotation was also found to have an observable effect on body kinematics. The newly developed system is hoped to help provide a better understanding of the risk factors of ankle sprain injury and how to prevent this injury. The system can be used to help improve the design of current footwear and identify which footwear provides better protection against ankle sprain injury. The system can also be used to assess the effectiveness of different ankle injury rehabilitation schemes and different training programs that aim to reduce ankle sprain injuries. The new system can be utilised to identify individuals who are at risk of sustaining an ankle sprain injury. The system can also be utilised in studies outside the scope of ankle sprain injuries.

Objective To investigate the effect a supination splint would have on upper limb function of cerebral palsy children for six months after receiving Botox® injections. Design Ten children attending weekly therapy enrolled in this prospective Quasi-experimental design where each child acted as his own control. Intervention was a supination splint and stretch massage. Assessment was based on pre- and post-intervention records of Modified Ashworth Scale, goniometry, Quality of Upper Extremity Skills Test (QUEST), and an independent panel assessment of videotaped records of hand function. Results Results show that spasticity declined in the forearm pronators, wrist flexors and thumb adductors. Active movement improved significantly in forearm supination and wrist extension. The QUEST demonstrated a significant change. Improvement in the hand function assessment was evident from the second month. Conclusion Findings support the premise that the supination splint is effective in improving upper limb function of cerebral palsy children after Botox® injections. / Dissertation (M (Occupational Therapy))--University of Pretoria, 2007. / Occupational Therapy / M (Occupational Therapy) / unrestricted

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

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Abstract Isolated lateral malleolar supination-external rotation (SER) -type ankle fractures without incongruity on the standard radiographs can be either stable or unstable depending on the status of the deep deltoid ligament. Neither clinical signs of injury on the medial aspect of the ankle nor the displacement of fibular fracture on mortise radiographs seem to predict stability. Therefore, stress testing has been adopted in clinical use. No “gold standard” method exists but the manual external rotation (ER) stress test is the most extensively studied. The ER stress test has some disadvantages, and other methods—such as gravity stress radiography and magnetic resonance imaging—have been suggested instead. However, the evidence to support the use of these methods is still insufficient. The aims of this dissertation were to assess the roles of (1) morphological factors from standard radiographs of 286 patients, (2) clinical findings on the medial side of the ankle and gravity stress radiography of 79 patients, and (3) MRI of 61 patients in evaluating the stability of the ankle mortise in patients with unimalleolar SER-type fractures with no talar shift on standard radiographs. The ER stress test result was considered to be the reference for stability throughout these studies. We found that a fracture line width < 2 mm in lateral radiographs, only two fracture fragments, and female sex are independent factors predicting a stable ankle mortise. Neither clinical signs on the medial side of the ankle nor gravity stress radiography alone predict the stability of the ankle mortise accurately. According to our MRI findings, total tears of the deep deltoid ligaments are rare, and partial tears are common in this this patient group. The reliability of the MRI assessment is only moderate. In conclusion, patients with non-comminuted fractures and < 2 mm displacement on lateral radiographs have stable ankle mortises and need no further stress testing. The gravity stress radiography is an accurate test for the evaluation of the ankle mortise stability only if the clinical signs indicate a similar result with the gravity stress radiographs. The use of MRI provides no additional benefit compared to ER stress testing for stability evaluation of an SER-type ankle fracture. / Tiivistelmä Supinaatio-ulkokiertomekanismilla syntyneet isoloidut ulkokehräsluun murtumat ilman röntgenkuvassa näkyvää telaluun siirtymää voivat olla joko vakaita tai epävakaita nilkan sisemmän nivelsiteen syvän lehden tilasta riippuen. Kliinisessä tutkimuksessa todettujen nilkan sisäreunan vamman merkkien tai röntgenkuvauksella todettavan ulkokehräsluun murtuman virheasennon ei ole osoitettu ennustavan nivelhaarukan mahdollista epävakautta, joten nilkkaa kuormittaen tehtäviä röntgenkuvauksia on otettu kliiniseen käyttöön. Mikään näistä kuvausmenetelmistä ei ole niin sanottu kultainen standardi, mutta ulkokiertovääntötestiä (ER-testi) on tutkittu laajimmin. ER-testin käyttöön liittyy kuitenkin ongelmia, joiden vuoksi niin sanottua painovoimakuvausta tai muun muassa magneettikuvausta (MRI) on ehdotettu käytettäväksi sen sijaan. Näiden menetelmien käyttöä tukeva tieteellinen näyttö on kuitenkin vielä riittämätöntä. Tämän väitöskirjatyön tarkoituksena oli tutkia (1) 286 potilaan tavallisista kuormittamattomista röntgenkuvista morfologisten tekijöiden, (2) 79 potilaan nilkan sisäreunan kliinisen tutkimuksen ja painovoimakuvauksen sekä (3) 61 potilaalla MRI:n merkitystä ja tarkkuutta arvioitaessa supinaatio-ulkokiertomekanismilla syntyneiden ulkokehräsluun murtumien vakautta. ER-testin tulosta käytettiin referenssinä nivelhaarukan vakaudelle kaikissa osatöissä. Sivukuvasta mitattuna ulkokehräsluun murtuman leveys < 2 mm, vain kahden kappaleen murtuma ja naissukupuoli ovat itsenäisiä vakaata nivelhaarukkaa ennustavia tekijöitä. Kliininen tutkimus tai painovoimakuvaus eivät yksinään pysty ennustamaan nivelhaarukan vakautta riittävän tarkasti. MRI:n perusteella sisemmän nivelsiteen syvän lehden täydelliset repeämät ovat tässä vammatyypissä harvinaisia mutta osittaiset repeämät ovat hyvin tavallisia huolimatta ER-testin tuloksesta. MRI:n tulkinnan luotettavuus on ainoastaan kohtalainen. Yhteenvetona voidaan todeta, että ilman ilmeistä telaluun siirtymää röntgenkuvassa yksinkertaiset supinaatio-ulkokiertomekanismilla syntyneet ulkokehräsluun murtumat ovat vakaita eikä nivelhaarukan vakauden testaaminen ole tarpeen, jos murtumaraon leveys sivukuvassa on < 2 mm. Painovoimakuvaus on luotettava, mikäli sen tulos on sama ulkoisten vamman merkkien kanssa. Magneettikuvauksesta ei ole hyötyä arvioitaessa tämän nilkkamurtumatyypin vakautta.