scholarly journals Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients

2021 ◽  
Author(s):  
Charlotte Reinke ◽  
Sebastian Lotzien ◽  
Emre Yilmaz ◽  
Yannik Hanusrichter ◽  
Christopher Ull ◽  
...  
Keyword(s):  
External Fixator ◽  
Demographic Data ◽  
Joint Destruction ◽  
Salvage Procedure ◽  
Aofas Score ◽  
Ilizarov External Fixator ◽  
Tibiocalcaneal Arthrodesis ◽  
Ilizarov Fixator ◽  
Lost To Follow Up

Abstract Introduction Salvage of joint destruction of the tibiotalar and subtalar joint with necrosis or infection of the talus in compromised hosts is a challenging problem. In these cases, tibiocalcaneal arthrodesis using the Ilizarov external fixator represents a possible alternative to amputation. This retrospective study presents the results and complications of this salvage procedure. Materials and methods Between 2005 and 2015, 19 patients were treated with tibiocalcaneal arthrodesis using the Ilizarov external fixator. Ten patients received tibiocalcaneal arthrodesis due to an acute or chronic infection with joint destruction. The other nine patients presented posttraumatic necrosis of the talus or Charcot arthropathy. In addition to demographic data, the time spent in the fixator, the major and minor complications and the endpoint of the consolidation were evaluated retrospectively. Furthermore, clinical outcomes were measured using the modified American Orthopedic Foot and Ankle Society (AOFAS) score. Results The average time spent in the fixator was 22 (range 14–34) weeks. The average follow-up in 17 patients was 116 (range 4–542) weeks. Two patients were lost to follow-up. Complete osseous consolidation was achieved in 14 out of 19 patients. One patient presented partial consolidation, and in four patients, pseudarthrosis could be detected. The mean modified AOFAS score at the final follow-up was 53 out of 86 possible points. Conclusion Tibiocalcaneal arthrodesis using the Ilizarov fixator is a possible salvage procedure even in compromised hosts. However, the healing rates are below the rates reported in the literature for tibiotalar arthrodesis in comparable clinical situations.

scholarly journals Simultaneous septic arthrodesis of the tibiotalar and subtalar joints with the Ilizarov external fixator—an analysis of 13 patients

2021 ◽  
Author(s):  
Charlotte Cibura ◽  
Sebastian Lotzien ◽  
Emre Yilmaz ◽  
Hinnerk Baecker ◽  
Thomas Armin Schildhauer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Demographic Data ◽  
Joint Destruction ◽  
Case Series ◽  
Fistula Formation ◽  
Chronic Infections ◽  
Ilizarov External Fixator ◽  
Tibiocalcaneal Arthrodesis ◽  
The Mean

Abstract Purpose Treatment of joint destruction of the tibiotalar and subtalar joints caused by acute or chronic infections in compromised hosts is a challenging problem. In these cases, simultaneous septic arthrodesis with the use of the Ilizarov external fixator represents a possible alternative to amputation. This case series presents the results and complications of patients with acute or chronic infection of the tibiotalar and subtalar joints. Methods Between 2005 and 2015, 13 patients with acute or chronic infections were treated by simultaneous single-stage debridement/arthrodesis of the tibiotalar and subtalar joints. In seven patients, there was a florid infection with fistula formation and soft tissue defects, and in six patients, there was chronic osteomyelitis with closed soft tissue. In addition to the demographic data, the time spent in the fixator, the major and minor complications and the endpoint of consolidation were reviewed. Results The mean time spent in the fixator was 18 (min 15, max 26) weeks. The mean follow-up time for nine patients was 100 (min 3, max 341) weeks. Complete osseous consolidation of both the tibiotalar and subtalar joints was achieved in 10 patients (77%). In three (23%) patients, there was complete consolidation of one of the joints and partial consolidation of the other joint. Conclusion The Ilizarov external fixator allows for simultaneous arthrodesis of the tibiotalar and subtalar joints in septic joint destruction. However, the healing rates are below the rates reported in the literature for isolated tibiotalar or tibiocalcaneal arthrodesis in comparable clinical situations.

Correction of Ankle and Hindfoot Deformities by Supramalleolar Osteotomy

2003 ◽  
Vol 24 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Cengiz Sen ◽  
Mehmet Kocaoglu ◽  
Levent Eralp ◽  
Murat Cinar
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Aofas Score ◽  
Ilizarov External Fixator ◽  
Surgical Interventions ◽  
Supramalleolar Osteotomy ◽  
Osteotomy Technique ◽  
Hindfoot Deformities ◽  
The Mean

Ankle and hindfoot deformities in 11 patients with a mean age of 15 (range, four to 35) have been gradually corrected by an Ilizarov external fixator. In all patients, supramalleolar osteotomy was utilized by percutaneous drilling and osteotomy technique. The patients were evaluated clinically by the AOFAS scoring system and radiologically by malorientation and malalignment tests described by Paley. The purpose of the current study is to evaluate the efficacy of supramalleolar osteotomy and correction by an Ilizarov device in treating hindfoot and ankle deformities. The mean external fixation period was five (2.5 to eight) months. The mean interval between the operation and last follow-up examination was 19 (13 to 26) months. The patients improved an average of 30 points after the operation regarding to AOFAS score. A plantigrade foot was achieved in the whole group. Radiologically, no malalignment or malorientation was measured. Equal leg lengths were achieved in all nine patients with one exception. Complications were graded after Paley as minor problems in 11 patients and as obstacles requiring surgical interventions in four patients. Sequelae remained in only one patient. Ankle and hindfoot deformities caused by various etiologies are complicated by poor soft tissue condition and a short foot. A supramalleolar osteotomy and Ilizarov external fixator can safely and effectively correct these deformities.

Treatment of refractory Aspergillus otomycosis with voriconazole: case series and review

2014 ◽  
Vol 128 (6) ◽  
pp. 547-551 ◽  
Author(s):  
Hsu-Chueh Ho ◽  
Shih-Hsuan Hsiao ◽  
Cheng-Yung Lee ◽  
Chen-Chi Tsai
Keyword(s):  
Medical Records ◽  
Therapeutic Option ◽  
Demographic Data ◽  
Local Treatment ◽  
Case Series ◽  
Surgical Debridement ◽  
Underlying Diseases ◽  
Lost To Follow Up

AbstractBackground:Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.Method:We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.Results:In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.Conclusion:This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.

scholarly journals The axial load-share ratio in vivo as a supplemental assessment for the external fixator safe removal

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Qiyu Jia ◽  
Feiyu Cai ◽  
Kai Liu ◽  
Xingpeng Zhang ◽  
...  
Keyword(s):  
External Fixation ◽  
Clinical Experience ◽  
External Fixator ◽  
Axial Load ◽  
Mechanical Test ◽  
Statistical Significance ◽  
Demographic Data ◽  
Ratio Test ◽  
Ilizarov External Fixator

Abstract Background: Timing the fixator removal is vital for a successful external fixation treatment. The purpose of this study was to determine the effectiveness of axial load-share ratio in vivo as a supplemental decision support tool for the safe removal of an Ilizarov external fixator.Methods: This prospective observational study consists of 83 patients undergoing tibial or femoral lengthening with Ilizarov circular external fixation in our institution, from January 2011 to October 2019. In group Ⅰ (38 patients), the external fixator was removed based on the surgeon’s clinical experience and radiographs from January 2011 to June 2015. In group Ⅱ (45 patients), from July 2015 to October 2019, the supplemental axial load-share (LS) ratio test was accomplished without the knowledge of the clinical results by another medical team. When the LS ratio < 10% was consistent with the conclusion (dense bone formation was achieved in the distraction zone) drawn from the corresponding routine radiographs by the treating surgeon, the external fixator was removed.Results: There was no statistical significance in demographic data between the two groups (P>0.05). In group Ⅰ, 4 of the 38 patients suffered refracture (the refracture rate was 10.5%) after fixator removal, and bone union was finally achieved with further intervention by intramedullary nail. In group Ⅱ, 36 patients terminated the external fixation after the first mechanical test, and another 9 patients terminated the external fixation at the subsequent test. None of the 45 patients in group Ⅱ suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (P<0.05).Conclusions: Adequate assessment of bone regenerate is crucial before removing an external fixator to prevent deformation or refracture. The axial load-share ratio in vivo is a practically quantitative method to supplement radiography and clinical experience for the assessment of regenerate healing, and the axial load-share ratio dropped below 10% is a safe limit for the Ilizarov external fixator removal.

scholarly journals Outcome of Core Out Fistulectomy and the Ligation of Anal Fistula Tract: A Single Center Experience in Malaysia

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
M Salehudin C.Z ◽  
Azmi M. Nor ◽  
R Mohd Rus
Keyword(s):  
Demographic Data ◽  
Cross Sectional Study ◽  
Fistula Tract ◽  
Cross Sectional ◽  
Single Center Experience ◽  
The Mean ◽  
Lost To Follow Up ◽  
Benign Anorectal Disease ◽  
Primary Healing

Introduction: Fistula-in-ano is a benign anorectal disease which always poses a big dilemma to the surgeons because of their significant recurrent rate following surgery. Materials and Methods: A cross-sectional study involving 42 patients undergoing core out fistulectomy in the Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia were included in this study. Demographic data of patients were assessed. Endoanal ultrasound (EAUS) was done prior to the surgery to determine types of fistula and classified using Park’s classification. Follow up was made post-operatively at 4th week, 2nd month, 3rd month, 4th month, 5th month and 6th month to look for the duration of healing or recurrence. Results: 5 out of 42 patients were lost to follow up leaving 37 patients available for the analysis. Mean age of the patient was 38.4 (13.8) years old. Transphincteric and intersphincteric type of fistula accounted for 54.5% and 40.1%, respectively. 62.2% (n=23) of patients achieved primary healing after the procedure. The mean for healing duration was 3.7 (3.1) months. Recurrence of the disease was seen only in 37.8% (n=14) of the patients. Conclusions: Even though we managed to achieve significant success rate cumulatively, recurrence of fistula still impose a significant challenge toward patient’s management. Therefore, further prospective study with a bigger sample size is recommended to look into this method to reduce recurrence of fistula.

Arthrodesis of the Infected Knee Joint with the Ilizarov External Fixator: an Analysis of 13 Cases

2019 ◽  
Vol 158 (01) ◽  
pp. 58-74
Author(s):  
Charlotte Reinke ◽  
Hinnerk Bäcker ◽  
Sebastian Lotzien ◽  
Thomas A. Schildhauer ◽  
Dominik Seybold ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Knee Joint ◽  
External Fixator ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Salvage Procedure ◽  
Soft Tissue Infections ◽  
Knee Arthrodesis ◽  
Ilizarov External Fixator ◽  
Iliac Crest Bone Grafting

Abstract Background Knee joint infections with pronounced joint destruction, soft tissue and bone involvement are serious diseases in which not only the joint but also the entire extremity are directly endangered. What results can be achieved with the Ilizarov external fixator for septic knee arthrodesis? Patients and Methods Between 2005 and 2017, 13 patients (4 women and 9 men, mean age 46 years) with acute joint and concomitant bone and soft-tissue infections were treated with Ilizarov knee joint arthrodesis. In addition to demographic data, the time spent in the fixator, major and minor complications were retrospectively evaluated. Results The average time spent in the Ilizarov external fixator was 27 weeks (min. 13, max. 68). Arthrodesis and infection repair were primarily achieved in 12 out of 13 patients. In one patient, a delayed healing of the arthrodesis zone could be cured by iliac crest bone grafting, so that eventually a bony knee arthrodesis was achieved in all patients. Pin infects as a minor complication during the time spent in the fixator were common and could be treated by stab incision and antibiotics. Major complications occurred in 3 cases (2 femoral fractures peri-implant, 1 nonunion in the arthrodesis area), which were treated by dilatation of the Ilizarov external fixator and finally plate osteosynthesis or by resection of the pseudarthrosis and iliac crest bone grafting. Conclusion The knee joint arthrodesis with the Ilizarov external fixator is a salvage procedure for limb preservation in fulminant knee joint and concomitant soft tissue infections. The advantages lie in the possibility of osteosynthesis in the acute infection and/or chronic osteomyelitis and the direct full load capacity. Disadvantages are long and complicated treatment times in the fixator with limited patient comfort.

Tibiocalcaneal Arthrodesis

1995 ◽  
Vol 16 (7) ◽  
pp. 401-405 ◽  
Author(s):  
Roger A. Mann ◽  
Loretta B. Chou
Keyword(s):  
Significant Risk ◽  
Salvage Procedure ◽  
Leg Length ◽  
Surgical Indications ◽  
Previous Surgery ◽  
Tibiocalcaneal Arthrodesis ◽  
And Function ◽  
Time Of Operation ◽  
Average Position

A review of eight patients who underwent nine tibiocalcaneal arthrodeses was performed. The surgical indications were failed previous surgery, posttraumatic talar avascular necrosis, and rheumatoid arthritis. The average age at the time of operation was 54 years. The average time of follow-up was 40 months after the operation. Fusion was achieved in all nine feet, with an average time of fusion of 5 months. Results were excellent in three feet, good in four feet, fair in one foot, and poor in one foot. The average leg length discrepancy was 2 cm. The average position of fusion was 6° of valgus and 2° of plantarflexion. All patients stated that they had improvement of pain and function. Seven of the eight patients stated that they would have the procedure done again. Complications were local infection in two patients, malunion in two patients, wound slough in one patient, and a prominent fibula in one patient. Tibiocalcaneal arthrodesis should be reserved as a salvage procedure because it is technically difficult and has a significant risk of complications.

scholarly journals Ankle arthrodesis using computer assisted external fixator in patients with end-stage ankle arthrosis

2021 ◽  
Vol 6 (2) ◽  
pp. 116-120
Author(s):  
Bulent Karslioglu ◽  
◽  
Ali Cagri Tekin ◽  
Esra Tekin ◽  
Ersin Tasatan
Keyword(s):  
External Fixator ◽  
Inflammatory Diseases ◽  
Ankle Arthrodesis ◽  
Deep Infection ◽  
Bony Union ◽  
Computer Assisted ◽  
Aofas Score ◽  
The Mean ◽  
End Stage

Objective. Ankle arthrosis is an end stage disease for the ankle that happens because of posttraumatic arthropathies or inflammatory diseases. Ankle arthrodesis is the gold standard for ankle arthritis. We present the functional outcome for a mid-term follow up study of the patients who underwent trans fibular ankle arthrodesis fixated with hexapod type external fixator through a distal fibular grafting technique. Materials and Methods. A number of 18 patients with trans fibular ankle arthrodesis were included in this study, out of which 6 were female and 12 were male. The mean age at surgery was 57.6 (ranging from 45 to 73). All the patients underwent follow up for a mean follow up period of 27.5 months (ranging from 24 to 35 months). One of the patients had undergone ankle-related surgery for 9 times. The others had undergone 4 or more ankle-related surgeries. Results. Ankle fusions resulted in bony union within postoperative 4.1 months (ranging from 3 to 6 months). None of our patients had superficial or deep infection, soft tissue problems or problems about the external fixator. The mean preoperative AOFAS score was 52.4, and the postoperative AOFAS score was 78.2. We had 7 excellent (38.8%), and 11 (61.1%) good results. We had two cm shortening in 2 patients, 1.5 cm shortening in 1 patient and 1 cm in 5 patients. Conclusions. We have found this method to be useful to be applied to patients, especially to those who undergo lots of surgeries and for whom amputation is a last option.

scholarly journals THE STATUS OF THE UNAFFECTED EYE IS A PREDICTOR OF SHORT-TERM RECOVERY IN A CROATIAN COHORT OF PATIENTS WITH MONOCULAR OPTIC NEURITIS

2021 ◽  
Vol 65 (2) ◽  
Author(s):  
Marija Jelić Vuković ◽  
◽  
Suzana Matić ◽  
Josip Barać ◽  
Dubravka Biuk ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Clinical Presentation ◽  
Demographic Data ◽  
Short Term ◽  
Severe Attack ◽  
Fellow Eye ◽  
Male Ratio ◽  
The Status ◽  
Lost To Follow Up

Aim: To define the clinical profile of patients with unilateral optic neuritis (ON) presented to our clinic and to identify baseline clinical features and demographic data associated with one-month visual acuity (VA) outcome. Methods: Patients with suspected ON referred to our clinic were consecutively assessed for inclusion between February 2017 and November 2019. VA was measured using Snellen charts. Clinical and demographic, baseline and after one-month follow-up data were analyzed in a multivariate model. Results: Overall, 71 patients were included, of which six were considered lost to follow-up. The median age was 50 years old (interquartile range 37-57 years old) and the female to male ratio was 3:1. 14.1 % had a severe attack and 83.1 % recovered completely one month after the diagnosis. Multivariate analysis of data from 65 patients showed that baseline VA of the affected eye (P=0.011) and fellow eye (P=0.015) were factors associated with VA of the affected eye at follow up. Conclusion: Our cohort was older, had a higher female to male ratio and on average, a less severe ON clinical presentation compared to reports from other countries. Baseline VA of both the affected and fellow eye are predictors of one-month VA recovery

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