scholarly journals A comparative study of operative and conservative treatment of intraarticular displaced calcaneal fractures

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
K. Ramachandra Kamath ◽  
Sharan Mallya ◽  
Atmananda Hegde
Keyword(s):  
Operative Treatment ◽  
Calcaneal Fracture ◽  
Calcaneal Fractures ◽  
American Orthopaedic ◽  
One Year ◽  
A Prospective Study ◽  
Operative And Conservative Treatment ◽  
Böhler’S Angle ◽  
Better Than

AbstractThe treatment of intra-articular displaced calcaneal fracture is debatable. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modified Rowe’s Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient’s job was noted after one year and compared with pre-injury status. Fifty five patients with 61 calcaneal fractures were studied. Thirty of them were operated and 31 were treated conservatively. Out of 30 operated cases, Bohler’s angle was restored in 25 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). Thirty one cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p < 0.001, VAS: 4.387 p < 0.001, AOFAS: 2.728 p = 0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler’s angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative treatment.

A COMPARATIVE STUDY OF OPERATIVE AND CONSERVATIVE TREATMENT OF INTRAARTICULAR DISPLACED CALCANEAL FRACTURES.

2021 ◽  
pp. 9-10
Author(s):  
Ranjeet Kumar ◽  
Shree Prakash Singh
Keyword(s):  
Operative Treatment ◽  
Calcaneal Fractures ◽  
American Orthopaedic ◽  
One Year ◽  
A Prospective Study ◽  
Operative And Conservative Treatment ◽  
Methods Of Treatment ◽  
Böhler’S Angle ◽  
Better Than

The methods of treatment of displaced intra-articular calcaneal fractures have always been surrounded by controversies, whether operative treatment is better or conservative. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modied Rowe's Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient's job was noted after one year and compared with pre-injury status. 30 patients with 41 calcaneal fractures were studied. Thirty of them were operated and 21were treated conservatively. Out of 20 operated cases, Bohler's angle was restored in 15 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). 21 cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p<0.001, VAS: 4.387 p<0.001, AOFAS: 2.728 p=0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler's angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative tr

scholarly journals Pediatric calcaneal fractures

2009 ◽  
Vol 1 (1) ◽  
pp. 9 ◽  
Author(s):  
Hobie Summers ◽  
Patricia Ann Kramer ◽  
Stephen K. Benirschke
Keyword(s):  
Operative Treatment ◽  
Treatment Protocol ◽  
Skeletally Immature ◽  
Calcaneal Fractures ◽  
Articular Fractures ◽  
Wound Healing Problems ◽  
Operative Fixation ◽  
Fracture Types ◽  
Böhler’S Angle

Although operative treatment of displaced, intra-articular fractures of the calcaneus in adults is generally accepted as standard practice, operative treatment for the same fractures in the skeletally immature remains controversial, potentially because the outcome for fracture types (intra- vs. extra-articular) and severity (displaced vs. nondisplaced) have been confounded in studies of children. We review herein the results of 21 displaced, intra-articular fractures in 18 skeletally immature patients, who were treated with open reduction and internal fixation using a standard surgical approach and protocol developed for adults. The average pre-operative Böhler's angle on the injured side was -5° (range: -35 - +35) compared to 31° (range: +22 - +47) on the uninjured side, indicating substantial displacement. There were no post-operative infections or wound healing problems, and all but one patient was followed to union (average follow-up: 1.5 years; range: 0.30-4.3 years). Maintenance of reduction was confirmed on follow-up radiographs with an average Böhler's angle of 31° (range: +22 - +49). We demonstrate that results for operative fixation of displaced, intra-articular calcaneal fractures in the skeletally immature are comparable to those in adults when the treatment protocol is the same.

Customised gold weight eyelid implantation in paralytic lagophthalmos

2008 ◽  
Vol 122 (10) ◽  
pp. 1088-1091 ◽  
Author(s):  
N Jayashankar ◽  
K P Morwani ◽  
M J Shaan ◽  
S R Bhatia ◽  
K T Patil
Keyword(s):  
Visual Acuity ◽  
Prospective Study ◽  
Study Design ◽  
Study Group ◽  
Upper Eyelid ◽  
Eyelid Closure ◽  
Gold Weight ◽  
One Year ◽  
A Prospective Study

AbstractGold eyelid implantation is widely considered the procedure of choice to reanimate the upper eyelid in paralytic lagophthalmos. Commercially supplied implants are not readily available in all places and are sometimes cumbersome to import.Objective:We aimed to devise a method whereby every surgeon performing gold eyelid implantation could have easy and quick access to the implant. Furthermore, we aimed to develop a means of creating an implant of the exact weight required for complete eyelid closure.Study design and setting:A prospective study was performed from 1997 to 2005 in a tertiary research hospital, involving 50 subjects requiring gold upper eyelid implantation and using the technique in question.Results:Only patients with a minimum follow up of one year were included in the study group. Symptoms improved in 96 per cent of subjects, who were able to dispense with eyedrops and eye ointments. Visual acuity improved in 92 per cent of patients. There were two extrusions amongst the early cases.Conclusion and significance:Customised gold eyelid implantation offers an alternative in regions where commercial implants are not easily obtained.

MANAGEMENT OF ACUTE APPENDICITIS DURING THE EARLY PHASE OF THE COVID-19 PANDEMIC: A SINGLE NHS CENTRE STUDYONE YEAR FOLLOW UP STUDY.

2021 ◽  
pp. 87-89
Author(s):  
Yamen Jabri ◽  
Md Mahfooz Buksh ◽  
Alicia Skrervin
Keyword(s):  
Operative Treatment ◽  
Open Surgery ◽  
Ct Scanning ◽  
Disease Recurrence ◽  
Diagnostic Value ◽  
Complicated Appendicitis ◽  
Risk Patients ◽  
Risk Of Disease ◽  
One Year

Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year follow up. Methods: Retrospective study covering Pre-pandemic data over March-May,2019 & COVID-19 pandemic data over March-May,2020. We compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups. Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43). In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value for these imaging methods between the 2 groups (87.5% vs 86.6%) During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p<0.04), There were signicantly more complicated appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29). In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period. Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or emergency surgery

scholarly journals An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

2021 ◽  
Vol 9 ◽  
pp. 205031212110409
Author(s):  
Ali Varol ◽  
Yunus Oc ◽  
Bekir Eray Kilinc
Keyword(s):  
Bone Grafting ◽  
Plate Osteosynthesis ◽  
Locking Plates ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Type Iii ◽  
Heel Height ◽  
The Mean ◽  
American Orthopaedic

Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden’s view. Preoperative and postoperative values were evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

scholarly journals Functional outcome of calcaneal locking compression plate

2018 ◽  
Vol 4 (3) ◽  
pp. 493
Author(s):  
George Thomas ◽  
Jinny John
Keyword(s):  
Functional Outcome ◽  
Plantar Flexion ◽  
Lateral Approach ◽  
Lateral View ◽  
Locking Compression Plate ◽  
X Rays ◽  
Calcaneal Fractures ◽  
Compression Plate ◽  
American Orthopaedic ◽  
Böhler’S Angle

<p class="abstract"><strong>Background:</strong> The calcaneus is the frequently injured tarsal bone.75% of calcaneal fractures are intraarticular. Treating calcaneal fractures is a challenge for orthopaedic surgeon due to complex fracture pathology. Our aim is to evaluate the functional outcome of calcaneum Locking compression plate in patients with intraarticular calcaneal fractures with Bohler’s angle &lt;20 degree who are admitted in the department of Orthopaedics, Government Medical College, Kottayam.</p><p><strong>Methods:</strong> In this study, 41 patients with 42 intraarticular calcaneal fractures were operated on with locking compression plate through lateral approach during the period of July 2015 to December 2016. Radiological evaluation done with X-rays. Bohler’s angle was measured from lateral view and those patients with angle &lt;20<sup>0</sup> were selected for study. Patients were followed up clinically and radiologically for 24 weeks. Radiological assessment was done by Bohlers angle. Functional outcome was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) scale.<strong></strong></p><p class="abstract"><strong>Results:</strong> At 24 weeks follow up, 90.5% of the study population had excellent to good functional outcome and 9.5% had fair and none had poor result. All patients had stable hind foot with all having good dorsiflexion and plantar flexion. But some patients had limited inversion and eversion. The mean postoperative Bohler’s angle was 30.02±3.97.</p><p class="abstract"><strong>Conclusions:</strong> Open reduction and internal fixation with locking compression plate gives sound functional outcome, if the surgery is well timed. Anatomical articular reduction especially of the posterior facet to be achieved and restoration of Bohler’s angle to normal range to be attempted.</p>

scholarly journals Results after Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0019
Author(s):  
Wolfram Grün ◽  
Marius Molund ◽  
Fredrik Nilsen ◽  
Are Stødle
Keyword(s):  
Subtalar Joint ◽  
Operation Time ◽  
Clinical Results ◽  
Lateral Approach ◽  
Calcaneal Fractures ◽  
Invasive Approach ◽  
Extensile Lateral Approach ◽  
Arthroscopically Assisted ◽  
American Orthopaedic

Category: Arthroscopy, Trauma Introduction/Purpose: Surgical treatment of calcaneal fractures using the extensile lateral approach is associated with high rates of infection and soft tissue complications. During the last years there was a trend towards less invasive fixation methods. Percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) combines the advantages of good visualization of the posterior facet of the subtalar joint with a minimally invasive approach. We have performed this technique since 2014 in selected Sanders II and III fractures. Methods: We conducted a clinical and radiographic follow-up of 19 patients with 20 calcaneal fractures which had been treated by PACO with a minimum follow-up of 12 months. The follow-up rate was 66% (19 of 29 patients). 18 men and 1 woman with a median age of 44 years (range, 21-65) and a follow-up period of 18 months (12-33) were examined. There were 11 Sanders II and 9 Sanders III fractures. Radiographs of all feet were obtained at final follow-up to evaluate the reduction of the fractures as well as the presence of osteoarthritis of the subtalar joint. Our primary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcomes were the Calcaneus Fracture Scoring System (CFSS), the Manchester- Oxford Foot Questionaire (MOxFQ), the Visual Analog Scale (VAS) for pain and the incidence of complications. Results: The patients were operated on after a median of 4 days after injury (range, 1-12). The operation time was 139.5 minutes (98-234). The patients were discharged 3 days (1-6) postoperatively. Postoperative radiographs showed a Böhler angle of 29.5 degrees (0-40). However, the follow-up radiographs showed subsidence of the fractures and a Böhler angle of 21 degrees (-16-36). 95% of the operated feet showed signs of posttraumatic subtalar osteoarthritis. There were no wound healing complications. Two patients were reoperated with screw removal due to prominent screws. The AOFAS score was 85 (50-100), the CFSS score 85 (26-100), the MOxFQ score 26.6 (0-73.4). The VAS pain score was 0 (0-5.7) at rest and 4 (0-8.2) during activity. Conclusion: Only a few articles have reported the outcome after percutaneous artroscopically assisted calcaneal osteosynthesis. Our results suggest that PACO gives good clinical results and a reduced risk of complications in selected calcaneal fractures. However, since this technique is technically challenging and has a steep learning curve, we expect to be able to further improve our results over time. Prospective longterm studies will be necessary to better document the potential advantages and limitations of this operating technique.

Clinical analysis of first-ever acute ischemic stroke involving the territory of paramedian mesencephalic arteries

Open Medicine ◽  
2007 ◽  
Vol 2 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Peterus Thajeb ◽  
Teguh Thajeb ◽  
Dao-Fu Dai
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Age Of Onset ◽  
Clinical Analysis ◽  
Clinical Triad ◽  
One Year ◽  
Associated Risk Factors ◽  
A Prospective Study ◽  
Bilateral Lesions

AbstractTo determine one-year clinical outcome of patients with first-ever acute ischemic stroke involving the territory of paramedian mesencephalic arteries (PMAS), we conducted a prospective study evaluating the cognitive functions of 28 patients with PMAS. Neuropsychological tests were performed during the first month of stroke onset and at the 12th month of follow-up. There were 12 women and 16 men. Mean age of onset for women and men was 70 years and 65 years, respectively. Progressing strokes occurred in 62% of patients and 96% developed a full-blown picture of the clinical triad of akinetic mutism, hypersomnolence, and bilateral blepharoptosis and ophthalmoparesis. Involuntary movements occurred in 6, and focal myoclonus in 4 patients. The top four associated risk factors were hypertension (68%), hyperlipidemia (57%), diabetes mellitus (46%), and atrial fibrillation (36%). Unilateral midbrain infarctions occurred in 12 patients and bilateral lesions in 16. Thalamic infarctions were unilateral in 10 and bilateral in 13 cases. Three of the 28 (11%) patients died of recurrent cerebral infarctions within 1 year of the onset of PMAS. The recurrent infarctions involved the basilar artery territory in two cases and the carotid system in another. One patient died of acute myocardial infarction. Of the 24 patients who had survived the stroke by 1 year, 20 (71%) developed dementia. We conclude that first-ever ischemic stroke with PMAS is not a benign syndrome. Most patients developed dementia by 1 year after the stroke.

TREATMENT OF TRIGGER FINGERS BY INJECTION OF METHYLPREDNISOLONE ACETATE AND LIDOCAINE (DEPO-MEDROL®)

Hand Surgery ◽  
1996 ◽  
Vol 01 (02) ◽  
pp. 103-105
Author(s):  
J. Joris Hage ◽  
Jaap D.K. Munting
Keyword(s):  
Side Effects ◽  
Prospective Study ◽  
Success Rate ◽  
Adult Patients ◽  
Methylprednisolone Acetate ◽  
Short Term ◽  
Local Injections ◽  
One Year ◽  
A Prospective Study

Thirty-six adult patients with 44 trigger fingers of less than four months' duration entered a prospective study on the efficiency of treatment with local injections of a combination of corticosteroids and lidocaine. From this study it may be concluded that the short-term success rate (93%) of one to three injections of methylprednisolone and lidocaine 2% (Depo-Medrol®) is comparable to that achieved by surgical or percutaneous tenolysis. At one year of follow-up, this success rate still amounted to 86%. In our hands, this therapy is without complications or side effects.

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