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Restoration of motion is an important component of success in digital replantation. This is achieved only with rigid bony fixation that allows early post-operative mobilisation. In addition, the technique used should be simple and avoid excessive soft tissue stripping. These aims are difficult to achieve in amputations near the base of the proximal phalanx with existing bone fixation techniques. We describe a modification of the perpendicular loop wiring technique, where one wire loop is intra-articular, which satisfies the above criteria, and describe its application and results in two clinical cases.

The objective of this study was to compare the clinical results of unstable distal radius fractures treated with ORIF with plate and screws compared to EF. Patients with unstable distal radius fractures treated with ORIF or EF from January 2005 to December 2010 were reviewed in terms of the Modified Mayo Wrist Score, range of motion, pain, grip strength, and radiologic parameters. Results showed that there was no difference in the Modified Mayo Wrist Score between ORIF (17 patients) and EF (11 patients) (p = 0.07). The ORIF group had better wrist flexion, wrist extension, pronation and supination compared to the EF group (p < 0.05). There were no significant differences in terms of radial and ulnar deviation, grip strength, pain and postoperative radiologic parameters (p < 0.05). Better wrist flexion, wrist extension and forearm rotation can be expected in ORIF compared to EF in the management of unstable distal radius fractures.

The purpose of our study is to retrospectively compare the use of tension band (TB) wiring and dorsal plating (DP) for the fixation of fifth metacarpal (MC) neck fractures. A retrospective study of patients who had surgical treatment of 5th MC fractures from 2009 to 2013 was performed. Data including patient demographics, mechanism of injury, pre and postoperative pain score, range of motion (ROM), duration of follow-up and whether implants were removed were documented. Three radiological parameters: angulation (in degrees), radial-ulnar displacement (in millimetres) and MC height ratio were measured. There were a total of 84 patients with isolated closed 5th MC neck fractures, of which 41 underwent DP and 43 underwent TB. Patients who underwent DP demonstrated better improvement in fracture angulation, radial-ulnar displacement, MC height ratio and final ROM compared to those who underwent TB. This study has shown that DP is a viable surgical treatment option for 5th MC neck fractures.

Background: Hook plate fixation of closed mallet fractures was first described in 2007, but there has subsequently been a lack of studies examining the outcomes and complications of this technique.

Methods: This paper aims to assess the clinical outcomes of hook plate fixation of closed mallet fractures by retrospectively reviewing 31 closed, bony mallet injuries that were surgically fixed with a hook plate between 2002-2011.

Results: Patients who underwent hook plate fixation had a median time to radiographic union of 83 days. Pre-operative median distal interphalangeal joint (DIPJ) extensor lag was 20°, with a post-operative extensor lag of 0°. Median DIPJ flexion was 60°, with 58% of all cases achieving greater than 50° of DIPJ flexion. There were 4 instances of minor complications (i.e. transient nail deformity and marginal skin flap ischaemia), with 3 cases of major complications (i.e. fracture redisplacement).

Conclusions: Our results show that the hook plate technique has satisfactory functional outcomes and an acceptable complications rate compared to other treatment modalities in the existing literature. Nevertheless, the outcomes of this technique in our sample population were not as excellent as initially reported.

Level of Evidence: Level IV: Retrospective case series, Therapeutic Studies

Introduction: Posterior cruciate ligament (PCL) is the stronger of the two cruciate ligaments of the knee and is a constraint to posterior dislocation of the knee in 90 degrees of flexion. Damage to PCL due to bony avulsion if not treated can lead to chronic pain and patellar degeneration due to posterior subluxation of the tibia. Various modalities are there to treat PCL bony avulsion fracture, including the conservative method (in undisplaced or <5 mm displaced bony piece) and open methods, including the midline posterior approach, Burks and Schaffer approach, and Arthroscopic approach with the help of sutures and screws.

The purpose of this study was to objectively evaluate the results after Burks and Schaffer’s approach to tibial PCL avulsion fractures using cannulated cancellous (cc) screws with or without a washer.

Methodology: This is an observational study of PCL bony avulsion fractures of 30 patients in the age group of 15–45 years admitted to Dr. S.N. Medical College and Associated Group of Hospitals, Jodhpur who were followed up for six months and were classified under Modified Meyers and Mckeever classification. Patients with associated vascular injuries and severe comorbidities were excluded. Through Burks and Schaffer’s approach, PCL bony avulsion fractures were fixed with a 4 mm partially threaded cc screw with or without a washer. Their functional outcome was assessed using the Lysholm scoring system.

Results: In our study, 30 patients are treated with the Burks and Schaffer method out of which excellent surgical outcomes were found in 23 (76.67%) patients and good outcomes in seven patients (23.33%).

Conclusion: PCL bony avulsion fracture treated with screw fixation through the Burks and Schaffer approach has excellent clinical outcomes due to the ease of performing it with fewer complications during exposure and fixation with an easily available and affordable implant. With this method, patients reported stable knees with a good range of motion and functional outcomes.

Background: Stroke rehabilitation in inpatient setting requires high intensity of manpower and resources. Early stratification of patients with stroke could facilitate early discharge plan and reduce avoidable length of stay (LOS) in hospital. Stratification of patients with stroke in clinical setting is usually based on functional scores which are quite time-consuming and require a special training to complete the full score.

Objective: The objective of the study was to explore whether Modified Functional Ambulation Category (MFAC) can serve as a stratification tool of patients with stroke in inpatient rehabilitation.

Methods: This was a retrospective, descriptive study of the demographic, functional outcomes of patients with stroke in an inpatient rehabilitation center. A total of 2,722 patients completed a stroke rehabilitation program from 2011 to 2015 were recruited. The patients were divided into seven groups according to their admission MFAC. The between-group difference in LOS, functional outcomes at admission and discharge including Modified Rivermead Mobility Index (MRMI) and Modified Barthel Index (MBI) as well as MRMI gain, MRMI efficiency, MBI gain, and MBI efficiency were analyzed.

Results: Subjects with admission categories of MFAC 2 and 3 had a highly significant ($p<0.001$) MRMI gain (6.2 and 6.6, respectively) and subjects with admission categories of MFAC 3 to 5 had highly significant ($P<0.001$) MRMI efficiency (0.34, 0.40, and 0.39, respectively). The subjects with admission categories of MFAC 2 to 5 had a highly significant ($p<0.001$) MBI gain (9.7, 10.2, 9.3, and 7.0, respectively) and the subjects with admission categories of MFAC 4 to 5 had a highly significant ($p<0.001$) MBI efficiency (0.70 and 0.72, respectively). The subjects with admission categories of MFAC 1 and 2 had a highly significant ($p<0.001$) LOS (27.7 and 26.6, respectively). MFAC profile was also established to represent the distribution of discharge MFAC of subjects according to their admission MFAC. The chance of subjects with admission categories of MFAC 1 and MFAC 2 progress to any kind of walker (MFAC $>$ 2) is 12.7% and 58.2%, respectively. The chance of subjects with admission MFAC 3, MFAC 4 and MFAC 5 progress to independent walker (MFAC $>$ 5) is 6.7%, 14.8%, and 50.3%, respectively. Both admission MFAC and admission MBI had strong correlations with discharge MFAC ($r=0.84$, $P<0.0001$ and $r=0.78$, $P<0.0001$, respectively), discharge MRMI ($r=0.82$, $P<0.0001$ and $r=0.78$, $P<0.0001$, respectively) and discharge MBI ($r=0.78$, $P<0.0001$ and $r=0.94$, $P<0.0001$, respectively).

Conclusion: This study showed that patients on admission with moderate disability in term of MFAC had the greatest mobility gain and basic activities of daily living (ADL) gain from inpatient stroke rehabilitation. Admission MFAC could be a stratification tool of patients with stroke in inpatient rehabilitation.

Objective: To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program.

Methods: Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals.

Results: A total of 56 participants were allocated to the experimental group $(n=27)$ and control group $(n=29)$. There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain.

Conclusion: The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.

Background: A clinical quality improvement programme named Accelerated Stroke Ambulation Programme (ASAP) was piloted in Physiotherapy Department of Tai Po Hospital from 1st October 2019 to 30th September 2020 and executed as a standard practice afterwards. The goal of ASAP was to facilitate early maximal walking ability of stroke patients in early rehabilitation phase. ASAP featured (1) proactive outcome monitoring and standardised process compliance monitoring by a patient database — Stroke Registry; (2) standardised mobility prediction by Reference Modified Rivermead Mobility Index (MRMI) Gain and (3) standardised intervention database — Stroke Treatment Library. Objective: To investigate the effectiveness of ASAP in an inpatient rehabilitation setting for stroke patients in terms of functional outcomes. Methods: The design was a retrospective comparative study to analyse the difference in functional outcomes of Pre-ASAP Group (1st October 2018 - 30th September 2019) and Post-ASAP Group (1st October 2020–30th September 2021). The primary outcome measures were MRMI, Berg’s Balance Scale (BBS), Modified Barthel Index (MBI), MRMI Gain, BBS Gain, MBI Gain, MRMI Efficiency, BBS Efficiency and MBI Efficiency. Results: There 348 subjects in Pre-ASAP Group and 281 subjects in Post-ASAP Group. Both groups had highly significant within-group improvement in MRMI, BBS and MBI ($p<0.001$). The MRMI Gain of Pre-ASAP Group and Post-ASAP Group was 6.32 and 7.42, respectively; and the difference was significant ($p<0.05$). The BBS Gain of Pre-ASAP Group and Post-ASAP Group was 8.17 and 9.70, respectively; and the difference was in margin of significance ($p=0.069$). The MBI Gain of Pre-ASAP Group and Post-ASAP Group was 10.69 and 11.96, respectively; but the difference was non-significant ($p=0.280$). The MRMI Efficiency, BBS Efficiency and MBI Efficiency of Post-ASAP Group were higher than Pre-ASAP Group but the difference was non-significant. The results of this study reflected that stroke rehabilitation programme with proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database was practical in real clinical practice with better functional outcomes than traditional physiotherapy practice which were dominated by personal preference and experience of therapists. Conclusion: Proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database may enhance the effectiveness in terms of functional outcomes of stroke rehabilitation programme.

Background: We aimed to evaluate the effectiveness of our novel operation technique that included radial shaft shortening plus supination producing osteotomy and transfer of the biceps brachii tendon to the brachialis tendon in patients with chronic radial head dislocation secondary to brachial plexus birth injury (BPBI).

Methods: Fourteen patients with chronic radial head dislocation resulting from BPBI were included in this study, with a minimum 1-year postoperative follow-up period. All patients underwent the same surgical procedure. The range of motion of affected elbow was measured with a standard goniometer. The Mayo Elbow Performance Score (MEPS) was used to measure for evaluation of functional result of these patients. The affected elbow radiograph also obtained in the last visit for evaluation of compatibility of the radiocapitellar joint.

Results: Fourteen patients (10 males and 4 females) were included in the study. The average age at the time of surgery was 7.2 (5–8) years and average follow-up was 73.2 ± 19 (36–131) months. Although the forearm active–passive pronation decreased, active–passive supination significantly improved postoperatively (p < 0.001). Ten patients had excellent MEPS results (90 and above), two patients with good results (75 and 80), one patient with fair (65) and one patient with poor result (55). Radiocapitellar reduction was achieved in 78.5% (11/14) of the patients.

Conclusions: The novel surgical techniques that included radial shaft shortening plus supination producing osteotomy and transfer of the biceps brachii tendon to the brachialis tendon improved the functional outcomes of patients with chronic radial head dislocation secondary to BPBI.

Level of Evidence: Level IV (Therapeutic)