scholarly journals The application of an allogeneic bone screw for osteosynthesis in hand and foot surgery: a case series

2021 ◽  
Author(s):  
Klaus Pastl ◽  
Wolfgang Schimetta
Keyword(s):  
Healing Process ◽  
Case Series ◽  
Clinical Importance ◽  
Fusion Rate ◽  
Surrounding Tissue ◽  
Allogeneic Bone ◽  
Foot Surgery ◽  
Bone Screw ◽  
Transplant Failure

Abstract Introduction The allogeneic bone screw transplant is a new osteosynthesis device making the use of foreign fixation material obsolete for various kinds of indications. Moreover, it is integrated into the recipient bone by natural bone remodeling without harming the surrounding tissue. The aim of this study was to determine the efficacy and safety of the transplant for osteotomy and arthrodesis in hand and foot surgery and to evaluate the clinical importance of the device. Materials and methods A single-surgeon case series of 32 patients who had undergone hand or foot surgery with the application of an allogeneic bone screw with an average follow-up time of 1 year is reported. Clinical data were reviewed to evaluate the pain levels and satisfaction of the patients and the frequency and type of complications occurring during the healing process. Routine radiography and computed tomography were reviewed to determine the fusion rate, the ingrowth behavior of the transplant and the possible occurrence of transplant failure. Results High patient satisfaction was paired with low postoperative pain levels and a low complication rate. 97% of the patients were free of pain at the timepoint of the second follow-up examination, the mean time of recovery of full mobility was 50.1 ± 26.1 days after surgery. Wound healing disturbance occurred only in two cases. Bony consolidation of the osteotomy or arthrodesis gap as well as osseointegration of the transplant was seen in all cases. No transplant failure or transplant loosening occurred. Conclusions The application of the allogeneic bone screw resulted in a 100% fusion rate while the patient burden was low. The transplant is safe and suited for various kinds of osteosynthesis in hand and foot surgery.

scholarly journals Extracorporeal irradiation of tumorous calvaria: a case series

2015 ◽  
Vol 122 (5) ◽  
pp. 1127-1130
Author(s):  
Daryoush Tavanaiepour ◽  
William C. Broaddus ◽  
Theodore D. Chung ◽  
Kathryn L. Holloway ◽  
Michelle A. Proper ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Case Series ◽  
B Cell Lymphoma ◽  
Bone Flap ◽  
High Dose ◽  
Allogeneic Bone ◽  
Who Grade ◽  
Extracorporeal Irradiation

OBJECT When intracranial tumors invade the overlying skull, gross resection typically includes removal of the involved bone. Methods used to repair the resulting structural defect in the cranium include artificial prostheses, allogeneic bone grafts, and autoclaving the autologous graft. The authors have previously reported a case involving high-dose extracorporeal ionizing radiation to treat the tumorous calvaria intraoperatively, followed by reimplantation of the treated bone flap. In this paper the authors report the long-term follow-up of that case, as well as results of using extracorporeal irradiation of tumorous calvaria (EITC) for an additional 20 patients treated similarly. METHODS The decision to undergo EITC was typically anticipated preoperatively, but determined intraoperatively, if upon inspection the bone flap was invaded by tumor. The bone flap was then delivered to the radiation oncology department, where a total dose of 120 Gy was delivered, using a clinical linear accelerator, over a period of approximately 15 minutes. After the intracranial tumor resection was completed, the irradiated craniotomy bone flap was reimplanted and the wound was closed in a standard fashion. A retrospective review of patients who had undergone EITC was performed for evidence of calvarial tumor recurrence or other complications. RESULTS Since the originally reported case, 20 additional patients have received EITC during craniotomy for invasive tumors. Eighteen (86%) of 21 patients were diagnosed with meningioma: 12 (67%) with WHO Grade I, 5 (28%) with WHO Grade II, and 1 with WHO Grade III (6%). The remaining 3 patients presented with dural-based B-cell lymphoma with extensive adjacent bone invasion (n = 2) and metastatic adenocarcinoma of the lung (n = 1). Follow-up of the 21 patients ranged from 1 to 132 months, with a mean of 41 months and a median of 23 months. No patients have experienced tumor recurrence, infection associated with the treated calvaria, or evidence of bone flap resorption. CONCLUSIONS Calvaria reconstructions represent an important component in structural and cosmetic outcome following craniectomy for tumorous bone. The authors' long-term experience with EITC has been excellent with no local tumor recurrence or complications. Therefore, EITC represents an excellent and efficient option for cranial reconstruction in such patients.

scholarly journals Outcome of Unstable Thoracolumbar Fracture Following Long Segment Posterior Fixation

2021 ◽  
Vol 39 (2) ◽  
pp. 114-122
Author(s):  
Abdullah Al Mamun Choudhury ◽  
Md Shah Alam ◽  
Abul Kalam Azad ◽  
Kohinoor Akhter
Keyword(s):  
Functional Outcome ◽  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Fusion Rate ◽  
Spine Injury ◽  
P Value ◽  
Posterior Fixation ◽  
Thoracolumbar Region

Introduction: Fractures of the thoracolumbar region are the most common injuries of the vertebral column and burst fractures are the most frequent. The purpose of this study was to see the radiological and functional outcome after long segment posterior fixation in unstable thoracolumbar spine injury with incomplete neurological deficit. Methods: A total of 146 cases were included in this prospective case series from January 2014 to December 2018 through non randomized purposive sampling. All the patients were operated with long segment posterior fixation and postero-lateral fusion by Autogenous cancellous bone graft. Postoperative functional outcome was assessed both clinically by ODI, VAS, ASIA and radiologically by Bridwell criteria. Postoperative follow up was conducted at 2nd, 6th,12th and finally 6 monthly. Results: The mean Cobb angle at pre-operative was 21.5 ±8.9 and at final follow-up was 11±4.57 in this study (p-value<0.05). At final follow up 1 grade improvement occurred in 116(79.5%) patients and 2 grade improvement in 36 (20.5%). Regarding ODI and VAS, moderate disability (25%) with mild pain (16%) was found at final follow up with a Bridwell fusion grade II (48%). Conclusion: Long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit is an effective method of treatment. This method enhances neurological and functional recovery with an acceptable fusion rate J Bangladesh Coll Phys Surg 2021; 39(2): 114-122

scholarly journals Outcomes of Nitinol Compression Staples in Tarsometatarsal Fusion

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142094490
Author(s):  
Carissa C. Dock ◽  
Katie L. Freeman ◽  
J. Chris Coetzee ◽  
Rebecca Stone McGaver ◽  
M. Russell Giveans
Keyword(s):  
Patient Satisfaction ◽  
Case Series ◽  
Fusion Rate ◽  
Perioperative Outcomes ◽  
Wound Complications ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Satisfaction Score ◽  
Foot Function

Background: Tarsometatarsal (TMT) arthrodesis is commonly performed in the management of midfoot arthritis, trauma, or deformity. The purpose of this study was to collect aggregate data (demographic, surgical, and perioperative outcomes) on patients who previously had a TMT fusion with BME compression staples. Methods: Sixty-six patients underwent TMT fusion with BME compression staples. Outcomes included demographics, surgical information, the Veterans Rand VR-12 Health Survey, Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), Revised-Foot Function Index (FFI-R), Ankle Osteoarthritis Scale (AOS), patient satisfaction survey scores, radiographic fusion rate, level of pain reduction, and complications. Sixty-six patients (68 feet) were analyzed (59 females) with an average age of 64 years (range, 18-83). The mean latest follow-up was 35.9 (range, 6-56.6 months). Results: The average surgical time was 38.1±14.3 minutes (range, 11-75). All outcomes improved significantly ( P < .001) from preoperative to latest follow-up except for the VR-12 Mental and Physical score. The average time to fusion determined by radiographs was 8.4 weeks (range, 6.1-46.1 weeks). Wound complications were not seen. Indications for subsequent surgeries (26.5%, 18/68 feet) in this current study included pain (n = 14), broken staples, and nonunion (n = 3). Conclusions: The fusion rate in this study, 89.7%, was similar to values reported in the literature. The patient satisfaction score of 81.9 at latest follow-up is consistent with patient satisfaction for other methods of fusion. Level of Evidence: Level IV, retrospective case series.

Secondary Subtalar Joint Osteoarthritis Following Total Ankle Replacement

2019 ◽  
Vol 40 (10) ◽  
pp. 1122-1128 ◽  
Author(s):  
Marc Sokolowski ◽  
Nicola Krähenbühl ◽  
Chen Wang ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Fusion Rate ◽  
Total Ankle Replacement ◽  
Time Interval ◽  
Level Of Evidence ◽  
Joint Fusion ◽  
Ankle Replacement ◽  
Cystic Changes

Background:An advantage of total ankle replacement (TAR) compared to ankle fusion is that by maintaining motion, the occurrence of hypermobility of adjacent joints may be prevented. This could affect the development of symptomatic subtalar joint osteoarthritis (OA). The aim of the study was to determine the incidence of subtalar joint fusion and the progression of subtalar joint OA following TAR.Methods:Secondary subtalar joint fusion rate was determined from a cohort of 941 patients receiving primary TAR between 2000 and 2016. The indication for fusion, the time interval from primary TAR to fusion, and the union rate were evaluated. To assess the progression of subtalar joint OA, degenerative changes of the subtalar joint were classified in 671 patients using the Kellgren-Lawrence score (KLS) prior to TAR and at latest follow-up.Results:In 4% (37) of the patients, a secondary subtalar joint fusion was necessary. The indication for fusion was symptomatic OA in 51% (19), hindfoot instability in 27% (10), osteonecrosis of the talus in 19% (7), and cystic changes of the talus in 3% (1) of the patients. Time from primary TAR to subtalar joint fusion due to progressive OA was 5.0 (range, 0.3-10) years and for other reasons 1.6 (range, 0.2-11.6) years ( P = .3). In 68% (456) of the patients, no progression of subtalar joint OA was observed.Conclusion:The incidence of secondary subtalar joint fusion was low. The most common reason for subtalar joint fusion following TAR was symptomatic OA.Level of Evidence:Level IV, case series.

Tectonic Eccentric Penetrating Sclerokeratoplasty à chaud as Treatment for Peripheral Perforated or Predescemetal Corneal Ulceration

2021 ◽  
Author(s):  
Markus Kohlhaas ◽  
Edita Zey ◽  
Georgios Perdikakis ◽  
Vastardis Iraklis ◽  
Gürol Gökel ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Healing Process ◽  
Hand Movement ◽  
Case Series ◽  
Wound Healing Process ◽  
Corneal Ulceration ◽  
Finger Counting ◽  
Corneal Transplants ◽  
Superficial Wound

Abstract Background Tectonic eccentric sclerokeratoplasty à chaud is a very complex corneal operation and aims to preserve the eyeball and possibly to improve visual acuity in patients with peripheral corneal ulcerations or perforating corneal trauma. Methods 1650 eyes received corneal transplants in our clinic between 2006 and 2019. 14 of these 1650 eyes (0.8%) had a perforated or predescemetal peripheral corneal ulceration and these were treated between 2006 and 2019 with a tectonic eccentric sclerokeratoplasty à chaud. The mean age of the 8 women and 6 men included in this case series was 63 years (22 – 91 years). Results In the postoperative follow-up period, most complications and reoperations occurred in the first 6 months. Re-ulceration was observed in 2 cases as well as early suture loosening in 12 patients. These 2 cases were treated with a partial conjunctival flap. Additionally, prolonged superficial wound healing process was shown in 12 patients. Therefore 27 amniotic membrane transplantations, 12 suture replacements, and 6 partial conjunctival flaps were performed in total. No re-keratoplasties were required in this case series. All eyes could be stabilised through the sclerokeratoplasty as well as subsequent operations and intensive local or even systemic treatment. After removal of the corneal suture, the best-corrected visual acuity improved only insignificantly to hand movement in 1 case, finger counting in 3 cases, 0.1 in 5 cases, 0.2 in 4 cases and 0.5 in 1 case. Preservation of the eyeball with pain relief was achieved in all 14 eyes. Conclusions Eccentric sclerokeratoplasty is a very demanding surgical procedure and is extremely rarely performed. The goal is to preserve the eye.

scholarly journals Early Outcomes of an Anterior Ankle Fusion Plating System with rhPDGF-BB Beta Tricalcium Phosphate Graft

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0017
Author(s):  
Donald J. Covell ◽  
Ryan McMillen
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Clinical Results ◽  
Fusion Rate ◽  
Osteoporotic Bone ◽  
Ankle Arthritis ◽  
Partial Weight Bearing ◽  
Ankle Fusion ◽  
Partial Weight

Category: Ankle; Ankle Arthritis Introduction/Purpose: Ankle fusion offers a reliable and effective treatment for end-stage ankle arthritis. Biomechanical studies have shown that plating systems may offer an advantage to ankle fusion patients with significant bone loss, bone deformity, or osteoporotic bone by providing a stiffer construct. One potential downside to plating systems is that they have been associated with soft tissue irritation due to their profile height. The objective of this case series was to assess the early patient clinical and radiographic outcomes of an anatomically designed, lower profile anterior ankle fusion plate used in combination with an autograft alternative, recombinant human protein derived growth factor (rhPDGF-BB). Methods: All ankle fusions performed between May 2018 and August 2019 at two centers were retrospectively evaluated. All patients received an anatomically designed, low profile anterior ankle fusion plate (ORTHOLOC 3Di, Wright Medical Group, Memphis, Tennessee, USA) through an anterior surgical approach. All patients also received rhPDGF-BB as part of the surgical procedure. Patients were non-weight bearing for 6 to 8 weeks in a splint or short leg cast, before transitioning to protected partial weight bearing for another 6 to 8 weeks. Patient demographics, time to radiographic fusion, length of follow-up, and adverse events were collected as part of the review. Results: There were 20 patients (12 male, 8 female) included in the analysis. The average age was 60.9 years (range, 42-90) and the average BMI was 31.6 kg/m2 (range, 21-52). There were eight diabetics, four smokers, and two patients who had preoperative ulcers. The average follow-up time was 7.8 months (range, 3-18). The fusion rate was 90%, with two nonunions. One nonunion patient was an obese, diabetic, neuropathic, smoker with a preoperative ulcer and a previous ankle fracture. She was treated with a bone stimulator and showed increased bony consolidation. The second nonunion patient was a neuropathic, diabetic who had previous hindfoot Charcot reconstruction. Her nonunion was stable and fibrous, which allowed her to ambulate pain free without bracing or assistive devices. Conclusion: This case series presents the first clinical results for this anatomically designed anterior ankle fusion plate. Outcomes were positive with a 90% fusion rate despite being used in a series of patients with a high incidence of risk factors and comorbidities. Additional complications were minor as related to wound healing. Further study is needed to confirm these promising initial results.

scholarly journals Efficacy of Biocage in treating single-segment lumbar degenerative disease in patients with high risk of non-fusion: a prospective controlled study with at least 2 years’ follow-up

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052094550
Author(s):  
Yang Li ◽  
Yang Yu ◽  
Tian-yong Hou ◽  
Ze-hua Zhang ◽  
Jun-chao Xing ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Efficacy ◽  
Fusion Rate ◽  
Degenerative Disease ◽  
Controlled Study ◽  
Allogeneic Bone ◽  
Intervertebral Foramen ◽  
Lumbar Degenerative Disease ◽  
Single Segment

Objective To evaluate the clinical efficacy of an allogeneic bone cage (Biocage; Beijing Datsing Bio-Tech Co., Ltd., Beijing, China) for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion. Methods From January 2013 to December 2016, 67 patients who underwent lumbar fusion were divided into the Biocage group (n = 33) and polyether ether ketone (PEEK) group (n = 34). The patients were followed up for 24 to 48 months. The mean intervertebral height of the fusion level, fusion rate, height of the intervertebral foramen, visual analog scale score, and Oswestry disability index were compared. Results The PEEK group had a lower fusion rate than the Biocage group (88.24% vs. 90.91%), although the difference was not statistically significant. During follow-up, the height of the intervertebral space was similar between the Biocage and PEEK groups (12.88 ± 0.45 and 12.84 ± 1.01 mm, respectively). The height of the intervertebral foramen was larger in the Biocage than PEEK group (20.67 ± 1.34 vs. 20.00 ± 2.05 mm). Good clinical efficacy was achieved in both groups. Conclusion The Biocage is efficient and safe for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion.

Effectiveness of the Dorsal Thermoplastic Locking Orthosis to Prevent Floating Toes in Postoperative Follow-up of Weil Osteotomies

2014 ◽  
Vol 7 (5) ◽  
pp. 356-362 ◽  
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Tulio Diniz Fernandes ◽  
Candida Luzo ◽  
Rafael Trevisan Ortiz ◽  
Marcos Sakaki ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Healing Process ◽  
Case Series ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Surgical Incision ◽  
Superficial Wound ◽  
Distal Metatarsal Osteotomy ◽  
American Orthopaedic

Background: The Weil oblique distal metatarsal osteotomy is regularly used in the treatment of primary metatarsalgia. The most frequent complication is the floating toe, which occurs in up to 36% of postoperative follow-up. The theory of reducing the plantar flexor mechanism tension associated with the retraction of the dorsal structures during the healing process of the surgical procedure may explain this negative evolution. Objective: This study aimed at assessing the effectiveness of the Tucade dorsal thermoplastic locking orthosis in the prevention of floating toe after Weil osteotomy. Methods: In all, 30 patients with metatarsalgia diagnosis submitted to Weil osteotomy were treated in the postoperative period with the Tucade dorsal thermoplastic locking orthosis. Results: The floating toe was not observed in this case series. There was 1 case of superficial wound irritation at the dorsal surgical incision and 1 case that evolved with transfer metatarsalgia. Statistical analyses were performed—American Orthopaedic Foot and Ankle Society Scale for lateral toes and extension of the lateral toes—using the t test, and P < .0001 was obtained for comparison of the preoperative and postoperative periods in the population studied. Conclusion: The Tucade dorsal thermoplastic locking orthosis during the postoperative period of Weil osteotomy proved to be effective in the prevention of floating toes. Level of Evidence: Therapeutic Level IV: Case Series

scholarly journals ALIF WITH AUTO-LOCKING CAGE WITHOUT SUPPLEMENTATION - TOMOGRAPHIC ANALYSIS OF INTERBODY BONE FUSION

2018 ◽  
Vol 17 (1) ◽  
pp. 27-30
Author(s):  
LUIS MARCHI ◽  
JOES NOGUEIRA-NETO ◽  
RODRIGO AMARAL ◽  
NICHOLAI FAULHABER ◽  
ETEVALDO COUTINHO ◽  
...  
Keyword(s):  
Bone Growth ◽  
Case Series ◽  
Fusion Rate ◽  
Low Grade ◽  
Disc Space ◽  
Lenke Classification ◽  
Pedicular Screw ◽  
Flexion Extension ◽  
Tomographic Analysis

ABSTRACT Objective: The objective of this work is to study the fusion rate and complications of the mini-ALIF with an auto-locking device at the L5-S1 level. Methods: Retrospective and radiological study. The inclusion criteria were mini-ALIF in L5-S1 with auto-locking cage, DDD and/or low grade spondylolisthesis. The exclusion criteria were posterior/anterior supplementation; lack of 12-month follow-up images, and previous surgery at L5-S1 level. The primary endpoint was fusion assessed in CT images and/or lateral lumbar flexion/extension radiographs. The secondary endpoint was the revision surgery due to device movement/migration or pseudoarthrosis. Lumbar TCs and radiographs were analyzed during 12 months of follow-up. Fusion was defined according to Bridwell/Lenke classification. Results: Sixty-one cases were included in this study. Complete or ongoing fusion was found in 57 cases (93%). Forty-two of the 61 levels (65%) were completely fused after 12 months. Fifteen levels (28%) had evident bone growth, two levels (3%) showed lysis lines around the implant, and two levels (3%) presented lysis lines and depression. Reoperation for pedicular screw supplementation was necessary in two cases (3%), one with vertebral sliding progression (12 months), and one with symptomatic micro-movement (six months). No implant has undergone migration or expulsion of the disc space. Conclusions: Mini-ALIF in L5-S1 level using an auto-blocking interbody implant construction in cases of low segmental instability results in good interbody fusion index and low failure rate, even without the need for further supplementation, but should not be applied indiscriminately. Evidence Level: IV. Type of study: Case series.

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