Background: The prevalence of patients with end stage renal disease (ESRD) in Taiwan has risen to the first in the world in recent years. Non-traumatic lower extremity lesion is a common disease of diabetic and ESRD patients. Many studies have found that the prevalence of non-traumatic lower extremity lesion in diabetic patients with ESRD is higher than normal diabetic patients. Prevention the incidence of lower extremity lesions in patients with ESRD may prevent patients from further amputation. Objectives: This study explored the prevalence of ESRD with Non-traumatic lower extremity lesion. We focused on demography status, comorbidities, dialysis therapies and utilization of health care to define the risk factors of disease. Methods: This study conducted secondary data analysis with administrative data from Bureau of National Health Insurance (HV_CD data) for four years (2000, 2002, 2004 and 2006). In total, there were 57021, 75711, 76750, and 86902 for years 2000, 2002, 2004, and 2006, respectively. To attain the research purposes, descriptive analyses and logistic regression were performed. Result: The prevalence of ESRD with non-traumatic lower extremity lesion for the four years were 1.30%, 1.44%, 2.71% and 2.45%, respectively. ESRD patients with and without non-traumatic lower extremity lesion were significant difference between comorbidities (OR for the four years were 2.06, 1.98, 1.86 and 1.83), dialysis therapies (hemodialysis / peritoneal dialysis, OR for the four years were 17.1, 16.79, 15.12 and 9.23) and duration of dialysis (1-5 years / 5 years and more, OR was 1.39 in 2002).There were significant differences in regions of hospital organizations (compared with the north, OR were 0.67 in the center in 2000, 1.47 in the east in 2002 and 0.87 in the center in 2006), class of hospital organizations (compared with Academic Medical Centers, OR were 1.40 in Regional Hospitals, 1.50 in District Hospitals and 0.36 in Physician Clinics in 2000, 0.18 in Physician Clinics in 2002, 0.76 in Regional Hospitals, 0.78 in District Hospitals and 0.23 in Physician Clinics in 2004, 0.66 in Regional Hospitals, 0.75 in District Hospitals and 0.26 in Physician Clinics in 2006 ) and outpatient visits ( positive correlation in all years except 2000). Conclusion: The risk factors of suffering non-traumatic lower extremity lesion in ESRD patients are comorbidities, dialysis therapies and duration of dialysis. In the part of regions of hospital organizations, the east region has higher and the center region has lower probability of suffering the disease, comparing with the north region. Academic Medical Centers has the highest probability to find ESRD patients with non-traumatic lower extremity lesion. We also found the numbers of outpatient visits were increasing with the disease. Based on the results, we highly suggest that caregivers from dialysis units have to pay great attention in taking care of the ESRD patients with non-traumatic lower extremity lesion to prevent from the further amputation.

Osteoarthritis (OA) of the knee affects between 5.4% and 38% of older adults and this prevalence is increasing as the population ages and becomes more obese. As health costs rise, it is important to have accurate and cost-effective methods to assess knee OA and the risk for OA. One risk factor for progression of knee OA is lower extremity (LE) frontal-plane malalignment. The first goal of this thesis was to assess the suitability of knee radiographs and LE photographs for the estimation of frontal-plane LE alignment. In the first study, several versions of the femoral shaft-tibial shaft (FS-TS) angle, assessed from knee radiographs, were compared to the hip-knee-ankle (HKA) angle, assessed from full-length radiographs. We concluded that the FS-TS angle is not a recommended substitute for the HKA angle, because the association between the two measures differs depending on alignment, OA severity and the method of determining the FS-TS angle. In the second study, the hip-knee-ankle angle determined from a pelvis-to-ankle photograph (HKA-P) was assessed for its ability to estimate the HKA angle. The HKA-P angle was reliable and highly correlated to the HKA. It therefore shows promise as an accurate and cost-effective assessment tool for the estimation of LE alignment. Commonly-used grading scales for the severity of knee OA seen on a radiograph emphasize just one feature of OA; therefore the second goal of this thesis was to assess the psychometric properties of the unicompartmental osteoarthritis grade (UCOAG), a composite scale which grades several features of OA in the tibiofemoral (TF) compartment. In the third and fourth studies, the reliability, validity and sensitivity to change of the UCOAG scale was assessed and compared to two commonly-used scales (Kellgren-Lawrence and Osteoarthritis Research Society International joint space narrowing). The UCOAG scale showed moderate to excellent reliability. All three scales demonstrated comparable validity and sensitivity to change. The UCOAG is therefore recommended for the assessment of OA severity and change over time. This research provides evidence for the use of accurate and cost-effective measures to assess LE alignment using photographs, and TF OA severity using radiographs, for clinical assessment and research purposes. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2013-09-26 13:21:06.097

Background and purpose of research: The number of individuals playing rugby union is increasing every year particularly amongst adolescence at a school level. With the increase in participation an increase in injuries arises. The purpose of this study was to document the lower limb injuries previously sustained in the 2009 rugby season as well as the injuries sustained over a six week period in 2010 and to identify the risk factors associated with these injuries. Method: A prospective cohort design was used. Sixty-five participants from three high schools on the West Rand completed an injury questionnaire and participated in pre-season testing of lower limb muscle length, muscle strength and balance. Lower limb injuries were documented throughout the season. Descriptive statistics were used to describe the data and a univariate analysis was done to determine if there were any associations between various risk factors and sustaining an injury. Results: Six lower limb injuries were documented in 2010. Knee and ankle injuries accounted for 25 out of the 35 (71%) injuries sustained over the 2009 and 2010 rugby seasons. The risk factors for lower limb injuries included good flexibility of the hamstring muscle group and logistic regression also showed an association between a right lower limb injury and right sided muscle strength of the ankle dorsiflexors (p=0.04) and knee extensors (p=0.05). Conclusion: The risk factors associated with these lower limb injuries were good flexibility of the hamstring muscle group as well as right sided quadriceps and tibialis anterior muscle strength.

With American football becoming increasingly popular in the United States, more efforts have been made on technology and advancements to reduce the number of injuries sustained by athletes. However, few studies have been conducted to evaluate how the field type, field condition, and shoe type interact with each other to induce injuries. To fill in the gap in the literature, this thesis used epidemiological methods to investigate the effect of field condition and shoe type on lower extremity injuries, specifically knee and ankle injuries, using real player data from the 2008, 2009, and 2010 football seasons from The University of Iowa. Results showed that over three seasons, 189 athletes experienced approximately 38,000 football exposures in 312 days. The athletes endured 250 injuries, in which 129 (51%) occurred in the lower extremity. Of all injuries, 34 (14%) involved the knee and 30 (12%) involved the ankle. Most of the lower extremity injuries, specifically knee injuries and ankle injuries, were of the joint (non-bone) and ligament type. Practices contributed to 73% of exposures, 11% for games, and 16% for other over the three sessions studied. 65% of all exposures occurred on an artificial surface, compared to 36% of all exposures that occurred on a natural surface. Most games were played on a natural surface (56%), while most practices occurred on an artificial surface (56%). For surface condition, 89% of all exposures were categorized as a normal condition compared to the 11% categorizes as a not normal condition. Most athletes used shoes with 9-12 cleats compared to shoes with 7, more than 12, or no cleats. In addition, most athletes used shoes with a high top at the shoe opening compared to a low top and shoes with short cleat lengths compared to long cleat lengths. The field condition variable (not normal vs. normal) was the only unadjusted GLM with significant results for all lower extremity injuries (Chi-square p-value=0.0307) and ankle injuries specifically (Chi-square p-value=0.0253). When the predictor variables were adjusted for team activity (i.e., games and practices) only the playing surface model was significant for all terms, including team activity (Chi-square p-value=0.0018), surface (Chi-square p-value=0.029), and the interaction term (Chi-square p-value=0.0189). This model was further analyzed for practice and games separately, and it was found that surface was significant in predicting lower extremity injuries in a game setting (Chi-square p-value=0.005). For all lower extremity injuries, the odds of having a lower extremity injury on an artificial surface in a game setting was 2.89 times more likely than on a natural surface. For the condition, top height, and number of cleat models, only the team activity term was found significant (Chi-square p-value=0.0143, <.0001, and 0.0038, respectively). When these models were further analyzed for practice and games separately, only field condition was found to be significant in a practice setting. For all lower extremity injuries, the odds of having a lower extremity injury in a not normal condition in a practice setting was 2.04 times more likely than in a normal condition. The cleat length model was not found to be significant when adjusting for team activity. The results of this analysis provide a foundation for future studies to understand why several extrinsic risk factors may be associated with lower extremity injuries.

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand Gauteng, 2017 / Background Soccer is a sport that is gaining in popularity in the elite and non-elite populations worldwide. As a result, the number of injuries in soccer is increasing. Hamstring injuries in particular, with a reported incidence rate as high as 63%, are of significant concern. Most hamstring injuries tend to occur during the swing phase of sprinting when hamstring activity is at its highest. As the speed of sprinting increases, greater mobility in the lumbo-pelvic area is required to maximise sprinting efficiency. Any abnormal or dysfunctional lumbo-pelvic movement during this phase could induce pain and hamstring injury. Lumbo-pelvic movement control dysfunction may therefore indirectly link abnormal lumbar spine movement to lumbo-pelvic pain and hamstring injury. The first aim of this study was to compare the performance of the erector spinae, gluteus maximus, hamstrings (biceps femoris) and quadriceps (rectus femoris) muscles in soccer players, with and without recent hamstring injuries, while performing isometric contractions, a functional squat and sprinting. The study’s second aim was to compare lumbo-pelvic movement control in soccer players with and without recent hamstring injuries. Method Thirty soccer players were selected to participate in this study. Fifteen were assigned to the injured group and 15 to an uninjured group. The injured group comprised players who had sustained a hamstring injury six months prior to the research and who had partially returned to training, and the uninjured group comprised players with no recent hamstring injuries and who were actively involved in full training. Players were matched in respect of age, height, weight and playing position. All players gave informed written consent, completed the physical activity, training and injury questionnaire, and the Oslo hamstring injury questionnaire. Physical tests, which included isometric contraction of the erector spinae, gluteus maximus, hamstrings (biceps femoris) and quadriceps (rectus femoris) muscles, a functional squat and a thirty-metre sprint were done. Muscle activity during these tests was recorded via electromyography (EMG). To determine the lumbo-pelvic movement control of the players, the dorsal pelvic tilt, waiter’s bow, one leg stand and prone knee bend tests were used. Cohen's d (parametric) and Spearman’s correlation coefficient (nonparametric) were used to calculate the effect size, and the Chi-square test and Fisher’s exact to analyse the lumbopelvic movement control data. To establish a statistical significance, the p-value of the study was set at p<0.05. Results EMG muscle activity during isometric contractions was lower in the erector spinae muscles (p=0.04) and biceps femoris muscle (p=0.02) of the injured group. Both these findings were statistically significant. There was no statistically significant difference in muscle activity during the functional squat between the study and uninjured groups. The results of the EMG activity in the thirty-metre sprint were determined to be significant as they demonstrated that the hamstring muscle (p=0.01) activation in the injured group was decreased in comparison with the uninjured group. During the performance of the lumbo-pelvic test, no association was found between the two groups in the dorsal pelvic tilt and one leg stand. The performance of the waiter’s bow (p=0.01) and prone knee bend (p=0.004) revealed statistically significant differences between the study and uninjured groups. The majority of the players in the injured group performed both of these functional tests incorrectly (WB n=10; PKB n=14). Conclusion The study found that the hamstring muscle is at great risk of injury during eccentric contraction of the hamstring muscles. This can be associated with poor lumbo-pelvic movement control, as the load on the hamstring muscle is increased to provide intersegmental stability around the neutral zone, the area of high spinal flexibility. / MT2017

ABSTRACT Common lower extremity injuries in female high school soccer players in Johannesburg east district Mtshali P.T.S. Background and purpose of research As the number of females participating in sports has increased, so has the necessity of understanding the effect of female growth and development in participation, athletic ability and injury patterns. Soccer is one of the sports where South Africa has seen an increase of youth and adult females’ participation. Aim: To establish the prevalence of and extrinsic risk factors contributing to injuries in the lower extremity in female high school soccer players in the Johannesburg east district. Method: A retrospective descriptive questionnaire – based study of 103 first team high school female soccer players in the Johannesburg east district was conducted. This was to determine point and one year prevalence of injuries, profile of injuries that affect female soccer players, associations between injuries and player position, age, use of equipment, frequency of play, and training duration and also to identify possible risk factors that contribute to injuries. Results: The one year prevalence of injured players was 46.1% and point prevalence was 37.8%. Knee injuries (18.6%) and ankle injuries (17.6%) were reported for one year prevalence and for point prevalence knee injuries were 13.3% and ankle injuries 18.9%. An extended duration of skills (p=0.0001) and fitness (p=0.02) training in this population reduced the likelihood of incurring an injury and the older (p=0.01) the players, the more chances of sustaining injuries. The players who wore shin guards were less prone to shin/leg injuries (p=0.01) and the relative odds were 0.35 (CI 0.16-0.79). The midfielders had more foot and toe injuries (p = 0.05). Starting age (p=0.78), frequency of play (p=0.83) wearing of shoes (p=0.54) and stretching had no influence on injury. Conclusion: The knee and ankle were the main locations of injury with defenders and midfielders mostly being injured. The increased duration of training for both skills and fitness and not wearing shin guards are risk factors for injury in female soccer players in high school.

Every year, millions of people are killed or injured in motor vehicle accidents in the United States. Although recent improvements to occupant restraint systems, such as seatbelts and airbags, have significantly decreased life threatening injuries, which usually occur to the chest or head, they have done little to decrease the occurrence of lower extremity injuries. Although lower extremity injuries are not usually life threatening, they can result in chronic disability and high psychosocial cost. Of all lower extremity injuries, injuries to the knee-thigh-hip (KTH) region have been shown to be among the most debilitating. This project used a finite element (FE) model of the KTH region to study injury. A parametric investigation was conducted where the FE KTH was simulated as a vehicle occupant positioned to a range of pre-crash driving postures. The results indicate that foot contact force and knee kinematics during impact affects the axial force absorbed by the KTH region and the likelihood of injury. The results of the study could be used to reevaluate the lower extremity injury thresholds currently used to regulate vehicle safety standards. Also, the results could be used to provide guidelines to vehicle manufacturers for developing safer occupant compartments.

No description available.

Differences in gait biomechanics have been observed between obese and healthy weight adults. It is possible that body segment parameters, particularly the thigh, contribute to the differences in knee biomechanics observed during gait between obese and healthy weight adults. The purpose of this study was to determine if increases in thigh circumference and/or mass associated with obesity alter walking biomechanics in healthy weight males and females. Thigh mass and circumference were increased proportional to a 10 unit increase in body mass index. Frontal and sagittal plane knee angles and moments, and temporospatial variables were recorded. For all dependent variables no main effect for gender was observed. Peak knee flexion angle was similar across conditions with no interaction. There was an interaction for peak internal knee extension moment however post hoc comparisons did not reveal differences in condition among males or females. A main effect for condition was observed for peak knee adduction angle, however post hoc comparisons did not reveal differences among conditions. Peak internal knee abduction moment was similar across conditions with no interaction. Stance time and step width increased during the experimental conditions compared to the control. A interaction was observed for stance time. Females had a longer stance time during the circumference only condition compared to the control condition. A greater step width was observed in conditions that increased thigh circumference. Overall, thigh segment parameters altered gait temporospatial variables. Increases in stance time and step width in obese adults compared to healthy weight adults could be a result of their larger thigh segment parameters.

Orientador: Bruno Livani / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T12:14:39Z (GMT). No. of bitstreams: 1 Carvalho_JoseAndre_D.pdf: 5523749 bytes, checksum: 5c534ff80bb87a60f0d6051a9ccc279b (MD5) Previous issue date: 2012 / Resumo: A escolha do nível de amputação e da técnica cirúrgica a ser adotada nas amputações dos membros inferiores deve ser avaliada com muita atenção, pois influenciará diretamente na reabilitação física e na protetização do amputado. A preservação da articulação do joelho permitirá ao amputado uma marcha mais fisiológica e o processo de reabilitação mais funcional. Em situações específicas como nos traumas ortopédicos com lesão grave do membro inferior, a opção por uma amputação transtibial realizada imediatamente abaixo da tuberosidade tibial com manutenção da inserção do tendão patelar, pode resultar em cotos extremamente curtos, porem cotos funcionais. Amputados com cotos transtibiais extremamente curtos, com comprimento ósseo médio de 4,4cm, ao final do tratamento encontravam-se plenamente adaptados as próteses e satisfeitos com a qualidade de marcha após a reabilitação. Em situações eletivas, a indicação de amputações transtibiais clássicas podem ser substituídas por amputações com periosteoplastia tibio-fibular ou amputações com o uso do retalho plantar neuro-vascular pediculado e com fusão do calcâneo à tíbia. Os pacientes submetidos à técnica de periosteoplastia apresentaram grande capacidade na realização de descarga distal sem dor, durante a utilização de suas próteses. Pacientes submetidos às amputações transtibiais com uso do retalho plantar neuro-vascular pediculado e com fusão do calcâneo à tíbia, apresentaram como resultado um coto ósseo distal bastante estável, com maior área terminal para descarga de peso e fixação do próprio soquete protético, contribuindo muito no processo de reabilitação. Nestas três situações distintas, realizadas com técnicas cirúrgicas não convencionais, como nos cotos transtibiais extremamente curtos, na perioplastia tibio-fibular e com uso retalho plantar neuro-vascular pediculado e fusão do calcâneo à tíbia; excelentes resultados puderam ser observados no processo de reabilitação e na confecção customizada das próteses, quando comparada com as amputações transtibiais clássicas / Abstract: The choice of the level of amputation and surgical technique to be adopted in lower limb amputations should be assessed carefully, because it will influence directly on the fitting and physical rehabilitation of the amputee. The preservation of the knee joint renders the amputee a more physiological gait and a more functional process of rehabilitation. In specific situations, such as orthopedic trauma with severe lower limb injury, the option for a transtibial amputation performed just below the tibial tuberosity, with maintenance of the insertion of the patellar tendon, can result in extremely short, stumps, but functional stumps. Transtibial amputees with stumps extremely short, with an average bone length of 4.4cm, were fully adapted to the prostheses and satisfied with the quality of gait after rehabilitation. In elective situations, the classical transtibial amputations can be substituted by amputations with tibio-fibular periosteoplasty or the use of a neuro-vascular pediculated plantar flap graft, with fusion of the calcaneous to the tibia. Patients undergoing periosteoplasty technique presented a painless and high capacity terminal discharge during use of the prostheses. Patients submitted to a neuro-vascular pediculated plantar flap graft with fusion of the calcaneous to the tibia, presented a stable distal bone stump with a larger distal bearing area and better fixation of the prostheses, contributing positively to the rehabilitation process. In these three different situations, that made use of no convencional surgical techniques, as in the extremely short leg stumps, tibio-fibular periosteoplasty and the use of a neuro-vascular pediculated plantar flap graft, with fusion of the calcaneous to the tibia; excellent results may be achieved in the rehabilitation process and in the fitting of custom prostheses, when compared with traditional transtibial amputations / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências