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Living systems use catalysis to achieve chemical transformations to comply with their needs in terms of energy and building blocks. The pH is a powerful means to regulate such processes, which also influences synthetic systems. In fact, the pH sensitivity of artificial photocatalysts, such as bismuth vanadate, bears the strong potential of flexibly influencing both the motion pattern and the speed of catalytic microswimmers, but it has rarely been investigated to date. In this work, we first present a comprehensive view of the motion behavior of differently shaped bismuth vanadate microswimmers, discuss influences, such as shape, pH, and conductivity of the solutions, and find that the motion pattern of the swimmers switches between upright and horizontal at their point of zero charge. We then apply an immobilizable hydroxypyrene derivative to our substrates to locally influence the pH of the solution by excited-state proton transfer. We find that the motion pattern of our swimmers is strongly influenced by this functionalization and a third motion mode, called tumbling, is introduced. Taking other effects, such as an increased surface roughness of the modified substrates, into account, we critically discuss possible future developments.

The authors present the procedure and results of five years of arthroscopic treatment of wrist radiocarpal and midcarpal ganglia. Thirty cases of dorsal ganglia and seventeen cases of volar ganglia were operated on arthroscopically. The technique was easy to perform in all the radiocarpal ganglia, not easy in midcarpal dorsal ganglia and very difficult in midcarpal volar ganglia. The results were recorded with a mean follow-up of 15 months. Twenty-seven cases of dorsal ganglia and twelve cases of volar ganglia had excellent results with active motion recovery, no complications, absence of scars and no recurrence. Two cases had a recurrence. There were four complications: a case of injury of a radial artery branch, a case of extensive haematoma, and two cases of neuropraxia. In three cases the procedure was converted into open surgery: they had a longer time of healing and a residual scar. The arthroscopic resection has been in our experience effective and safe for the treatment of all radiocarpal ganglia. Good results have been obtained also in the treatment of dorsal midcarpal ganglia. Concerning the uncommon cases of volar midcarpal (STT) ganglia, an open approach seems still indicated.

A technique is presented for rapid evaluation of the extent of orthopedic or neurologic injury. Consistent use of the method, a combination of active motion against resistance and standard neurologic tests, has helped avoid unnecessary radiation and costs while correlating well with physical and radiographic findings in the awake, cooperative, injured individual.

The chief advantages of this method are the ability to impact the fracture before the bolts are tightened, and the fact that the fixation ∗ is so rigid that plaster immobilization is not necessary. Experiments on the cadaver and in the operating room prove the immobilization so rigid that manipulation of the extremities fails to disrupt the fracture reduction and impaction. Because of this, plaster of Paris need not be used. The joints above and below the fracture site are left free for active motion.

“Compression sprain” of the foot is described as a typical injury, as it is initiated by compression of the foot in its long axis, elevating the longitudinal arch sufficiently to cause a severe sprain of all of the joints in the middle of the foot with chip fractures into these joints. This is particularly true regarding the bases of the metatarsal bones. The disability in such cases, both in length and severity, has been far out of proportion to the fractures suffered. Heretofore, too much emphasis has been placed on the fractures, but in the future, these cases will be treated primarily as those of sprain. Active motion and vigorous physical therapy should be instituted with immobilization of the length of time for that of sprains. Success in treatment depends on limiting the period of complete immobilization.

ObjectiveTo determine intra- and inter-raters reliabilities of a stepped clinical assessment in chronic spastic paresis for upper and lower limbs in adults.MethodsEighteen adult subjects (age: 50±14 years, women: 21%) with upper and lower limbs chronic hemiparesis were evaluated by four raters (3 PMR, 1 physiotherapist, age 47±11 years; experience in spastic paresis 14±9 years). This assessment involves performing a passive muscle stretch at 2 velocities, very slow and very fast, followed by an active maximal movement by the patient against the tested muscle and then a 15-second series of active movements of maximal amplitude of which only the last one is measured. Eight muscles were tested: shoulder extensors, elbow flexors, wrist flexors, fingers flexors, gluteus maximus, rectus femoris, soleus and gastrocnemii. Five parameters were collected: maximal range of passive motion XV1, angle of catch XV3, spasticity grade Y, maximal range of active motion XA, and residual range of motion XA15 after 15seconds of rapid alternating movements. Each patient was evaluated on two occasions by each rater one week apart. After the first 9 patients, a 2-hour training was organized before assessing the last 9 patients. Main outcome measures were intra-class correlation coefficient (ICC) and its 95% confidence interval (CI95%) for quantitative data and agreement frequencies for ranges of movement (ordinal data).ResultsBefore training, intra- and inter-reliabilities were excellent: intra-rater ICCs by parameter all muscles taken together: XV1 0.90 [0.60–0.98], XV3 0.84 [0.45–0.96], XA 0.92 [0.68–0.98], XA15 0.90 [0.68–0.98] and inter-raters ICCs, XV1 0.90 [0.72–0.97], XV3 0.83 [0.56–0.95], XA 0.95 [0.87–0.99], XA15 0.95 [0.86–0.98]. After training, both reliabilities improved: intra-rater ICCs, XV1 0.91 [0.65–0.98], XV3 0.92 [0.66–0.98], XA 0.94 [0.67–0.99], XA15 0.93 [0.64–0.99] and inter-raters ICCs, XV10.91 [0.74–0.98], XV3 0.91 [0.75–0.97], XA 0.94 [0.85–0.99], XA15 0.96 [0.87–0.99] (P

The techniques of tension band fixation are applied in the treatment of metacarpal and phalangeal fractures. The technique uses standard, readily available materials. The variability of the fixation techniques allows for secure fixation of virtually any long bone fracture in the hand, even when other methods are not applicable. Nonunion, malunion, loss of fixation, infection, or tendon rupture have not occurred. The technique allows for early active motion and return to full activity usually within for to six weeks. Most patients achieve full painless motion in that time.

Of fifteen patients who had shoulder hemiarthroplasty between 1979 and 1984, eleven had acute four-part proximal humeral fractures, three had avascular necrosis, and one had osteoarthritis. Ten Designed After Natural Anatomy (DANA) and five Neer prostheses were implanted. Four complications occurred. The mean follow-up period was just under three years (range, 13-69 months). Pain relief was excellent but return of function was less consistent. Postoperative active flexion averaged 99 degrees (range, 20 degrees-150 degrees), abduction averaged 99 degrees (range, 50 degrees-150 degrees), and rotation arc averaged 95 degrees (range, 60 degrees-160 degrees). The results were better for patients with avascular necrosis (AVN) than for patients with shoulder trauma. Pain relief was uniformly excellent for patients in both categories, but only AVN patients consistently regained excellent active motion in their shoulders following hemiarthroplasty.

Prosthetic implant arthroplasty of the proximal interphalangeal (PIP) joint has a limited role in the reconstruction of the rheumatoid hand. Ninety-three PIP joint arthroplasties, including 56 Flatt, 30 Swanson, and seven Niebauer implants, were reviewed with postoperative follow-up periods averaging 6.2 years. The average maximum extension/flexion for the prostheses were Flatt, 28 degrees/45 degrees; Swanson, 1 degree/40 degrees; and Niebauer, 3 degrees/26 degrees. The average active ranges of motion for the prosthetic groups were Flatt, 15 degrees; Swanson, 37 degrees; and Niebauer, 19.5 degrees. Analysis of active motion at intervals of up to ten years indicated gradually decreasing active motion for each prosthesis. Comparison of preoperative motion with motion three years after operation indicated a decrease in the Flatt prosthesis group, from 35 degrees to 20 degrees. Radiographically, cortical perforation by the prosthesis was common with the Flatt prosthesis (80%), and recurrent swan-neck deformity was frequent with the Swanson spacer (27%). Despite suboptimal clinical results, patient satisfaction was high, and the ability of patients to perform activities of daily living was acceptable.

Ninety-ninety intraosseous wiring has been used in more than 150 cases over the last 4 years to obtain skeletal stability. This technique has been effective for the internal fixation of replanted parts, arthrodeses, transverse fractures, and elective free-tissue transfers. All osteotomies and fractures healed promptly, usually within 6 weeks. There have been no instances of nonunion, malunion, or implant failure. Only one wire had to be removed due to its prominence. Ninety-ninety intraosseous wiring is an expeditious, straightforward, and very stable method to secure rigid internal fixation and allow early active motion of the digital skeleton.

Fractures of the capitellum can involve a significant portion of the articular surface, rendering the elbow joint unstable. In this situation it is desirable to reduce and internally fix the capitellar fragment, because this restores the articular surface and augments joint stability. A 35-year-old woman sustained a posterolateral dislocation of the left elbow associated with a capitellar fracture. Fixation of the capitellar fragment with Herbert screws stabilized the joint, allowed anatomic reduction, and gave good fixation. Active motion was possible at three weeks. When the patient was evaluated at one year, the fracture had united and there was no evidence of avascular necrosis.

This paper describes a method of treatment for impaired function when pain is the factor responsible for the loss of motion or power. The treatment is the application of a surface anesthetic (ethyl chloride spray) combined with active motion. DEVELOPMENT OF THE TREATMENT In 1933 a gymnastic teacher—Heinz Kowalsky— suggested that treatment of sprains and pulled muscles by immobilization was not satisfactory to active sportsmen. He said that professional sportsmen had found by experience that immediate active motion after any such injury provided the quickest cure. He further told me that he usually advised his pupils to rub their injured joints with alcohol and expose them to live steam for a time. Numbness of the joint was said to result, and active motion was started as soon as this numbness set in. The result of this treatment was said to be satisfactory and superior to treatment by immobilization. I tried

Fracture of the upper end of the humerus is a common injury and accounts for about 2.2 per cent of all bony injuries. 1 It includes definite clinical types, and, when properly treated, good results can be obtained in the great majority of cases. It is my purpose in this article to present an analysis of ninety-six cases of injuries to the upper end of the humerus (table 1), to discuss their treatment, and to show the advantage in certain cases of a simple form of fixation and the importance of early active motion. These cases include only those fractures at or above the level of the surgical neck of the humerus. Fractures occurring at or below the insertion of the internal rotators of the arm present special problems and are essentially shaft fractures. The data which are used here were gathered from the records of the fracture service at

The orthodiagram has been a disappointment to those clinicians who had hoped to find an accurate estimation of the size of the heart of vise in diagnosis. Particularly in the field of cardiac neurosis and early myocarditis, in which the ordinary diagnostic methods fail to show any enlargement, evidence of a slight enlargement might be expected to have diagnostic or prognostic import. The roentgenogram does not give us such evidence because of the magnification of the cardiac shadow by the divergent rays and because of the lack of definition at the margin, since the heart is in active motion while the exposure is being made. The orthodiagram, however, gives perfectly definite images of a moving organ, allows of the observation of any anomaly of motion, and depends only on the skill of the operator in the interpretation of the images viewed. In addition it leaves a permanent record of

1. 1. A new method of digital skeletal traction is described, which is atraumatic and permits motion at the interphalangeal joints. 2. 2. Application of this method has been made with fingers in extension and in flexion. It has been observed that while the rate of return of function is the same for either position, flexion is preferable since the usefulness of the hand is much greater during the period of rehabilitation. 3. 3. The indications for digital traction are reviewed. 4. 4. Three pertinent cases are presented.