scholarly journals Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seungbae Oh ◽  
Yong-Sik Kim ◽  
Soon-Yong Kwon ◽  
Jiyoung Jung ◽  
Chiyoung Yoon ◽  
...  
Keyword(s):  
Case Series ◽  
Limb Length ◽  
Leg Length ◽  
Propensity Score Matching Analysis ◽  
Lag Screw ◽  
Significant Difference ◽  
Trauma Surgeons ◽  
Gamma3 Nail ◽  
Sliding Distance ◽  
Limb Length Inequality

AbstractThe purpose of this study is to compare the cut-out rate and sliding distance associated with limb length inequality between operations using a standard non-sliding lag screw versus those using a non-sliding lag screw with U-blade (RC) in the Gamma3 nail. This is a retrospective review of two case series involving different lag screws for the Gamma3 nail. Propensity score matching analysis was used to adjust the confounding factors. A comparative analysis of 304 patients who treated with Gamma3 nail with either a standard non-sliding lag screw or a U-Blade (RC) lag screw was performed. Between 2014 and 2018, 152 patients were treated with U-blade (RC) lag screws, and these patients were matched with those treated with standard lag screws. There was no significant difference in cut-out rate between groups. However, additional use of anti-rotation U-blade (RC) could significantly decrease lag screw sliding, with the group treated with U-Blade (RC) lag screws exhibiting shorter sliding, especially in AO/OTA31 A2 and A3 fractures. Also, in A2 and A3 fractures, the mean lag screw sliding distance was greater than that seen in A1 fractures in both groups. These findings can help trauma surgeons choose the proper implant to reduce leg length inequality.

scholarly journals Limb Lengthening after Primary Total Knee Arthroplasty: Customized Patient-Specific Instrumentation Does Not Affect Expected Limb Lengthening

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Christopher Fang ◽  
Kenneth McAlpine ◽  
Michael Gustin ◽  
Ruijia Niu ◽  
David Freccero ◽  
...  
Keyword(s):  
Primary Total Knee Arthroplasty ◽  
Limb Lengthening ◽  
Limb Length ◽  
Patient Specific ◽  
Leg Length ◽  
Patient Specific Instrumentation ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Length Changes

Introduction. Expectations for limb length differences after TKA are important for patient perception and outcomes. Limb length discrepancies may occur due to postoperative leg length increases, which can lead to decreased patient functionality and satisfaction and even possible litigation. The purpose of this study is to examine the frequency and extent of limb lengthening among various preoperative deformities and between two different implant systems. Methods. Preoperative and postoperative full-length standing radiographs were obtained between August 2018 and August 2019 to measure mechanical axis and limb length of operative limbs. Demographic information such as age, sex, and BMI was also collected. Patients were grouped into categories for pre- and postoperative subgroup analysis: valgus, varus, customized implant, and conventional implant. Regression analysis was performed to evaluate significant relationships. Results. Of the 121 primary TKAs analyzed, 62% of the knees showed an increase in limb length after TKA, with an average lengthening of 5.32 mm. Preoperative varus alignment was associated with a mean lengthening of 3.14 mm, while preoperative valgus alignment was associated with a mean lengthening of 16.2 mm. Overall, there were no statistically significant differences in limb lengths pre- and postoperatively ( p  = 0.23) and no significant changes in limb length for any subgroup. Further, no variables were associated with limb length changes ( p  = 0.49), including the use of customized implants ( p  = 0.2). Conclusions. Limb lengthening after TKA is common and, on average, occurs more significantly in valgus knees. No significant difference in limb lengthening could be demonstrated using customized over conventional implants. Preoperative counseling is important to manage patient expectations.

Flagpole Femoral Prosthesis Trial: An Aid to Leg Length Equalization in Revision of the Deficient Proximal Femur

2003 ◽  
Vol 13 (2) ◽  
pp. 116-118
Author(s):  
P.J. Roberts ◽  
P.A. Gregson ◽  
C. McGeoch
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Limb Length ◽  
Soft Tissue Balance ◽  
Femoral Prosthesis ◽  
Leg Length ◽  
Total Hip ◽  
Limb Length Inequality

Obtaining soft tissue balance and correct tension across a total hip arthroplasty can be challenging. This is particularly so following revision of a proximally deficient femur. Although stability of the hip arthroplasty is the paramount concern, limb length inequality is a consideration that is of importance to both surgeon and patient. We describe a novel adaptation in instrumentation to help the surgeon faced with these problems when using cemented Exeter components.

scholarly journals Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others?

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jehyun Yoo ◽  
Sangmin Kim ◽  
Junyoung Choi ◽  
Jihyo Hwang
Keyword(s):  
Femoral Fractures ◽  
Walking Ability ◽  
Fixation Failure ◽  
Neck Shaft Angle ◽  
Lag Screw ◽  
Femur Fractures ◽  
Significant Difference ◽  
Shaft Angle ◽  
Sliding Distance ◽  
Screw Group

Abstract Background Intramedullary hip nails may be classified as blades or screws depending on the type of lag screw used. Recently, a combination of lag screw types with a U-clip insertion has also been used. The purpose of this study was to evaluate the clinical and radiological outcomes of these new screw types. Methods A total of 185 patients with trochanteric femoral fractures (age ≥ 65 years) who underwent surgery with intramedullary nails were selected. Surgeries with InterTrochanteric/SubTrochanteric (ITST), Proximal Femoral Nail Antirotation (PFNA), and Gamma 3 U-Blade lag screws were performed between January 2011 and June 2016. The AO/OTA classification, presence of a basicervical fracture type on 3D-CT, BMI, BMD, reduction quality, position of the lag screw, TAD (tip apex distance) of the lag screw, sliding distance of the lag screw, varus change (neck shaft angle), radiological union period, fixation failure and functional outcome as determined by walking ability were analyzed. Results There were 3/60 (5.0%) cases of fixation failure in the ITST group, all caused by cut-out; 4/57 (7.0%) in the PFNA II group: 3 caused by cut-through and 1 by metal fracture; 1/68 (1.5%) in the Gamma 3 U-Blade lag screw group (P = 0.301). In each group, the sliding distance of the lag screw showed a significant difference (P = 0.017), whereas significant sliding over 10 mm showed no statistically significant results. Conclusion There was only one (1.5%) case of fixation failure in the Gamma 3 U-Blade lag screw group. The sliding distance of the U-Blade was found to be in the middle, between the PFNA II (shorter) and ITST (longer) implants. The new rotational control lag screw seems to be comparable to other screw types.

scholarly journals Outcomes of U-Blade Lag Screw for Cephalomedullary Fixation of Unstable Trochanteric Femur Fractures: A Case Control Study

2020 ◽  
Vol 11 ◽  
pp. 215145932097997
Author(s):  
Joon Soon Kang ◽  
Yong Tak Kwon ◽  
Young Ju Suh ◽  
Tong Joo Lee ◽  
Dong Jin Ryu
Keyword(s):  
Clinical Outcomes ◽  
Gamma Nail ◽  
Matched Pair ◽  
Fixation Failure ◽  
Lag Screw ◽  
Femur Fractures ◽  
Hip Screw ◽  
Matching Criteria ◽  
Gamma3 Nail ◽  
Sliding Distance

Background: Unstable trochanteric femur fractures in elderly patients with osteoporosis are still challenging. Gamma3 nail with the U-blade lag screw (U-blade gamma nail) has been developed to improve mechanical stability of proximal femoral fragment. This study aimed to compare the clinical and radiologic outcomes of U-blade gamma nail to proximal femoral nail antirotation (PFNA), and standard Gamma3 nail (gamma nail) for unstable trochanteric femur fractures. Methods: A retrospective matched-pair case study was performed with U-blade gamma nail, PFNA, and gamma nail. During 2012-2018, 970 patients with unstable trochanteric femur fractures were reviewed. Matching criteria were set as follows: 1) sex; 2) age (± 3 years); 3) body mass index (± 2 kg/m2); 4) bone mineral density (± 1 T-score in femur neck). Finally, a total of 159 patients were enrolled. We assessed the tip-apex distance (TAD), neck shaft angle, and hip screw sliding distance using plain radiographs. Also, we evaluated the clinical outcomes with Koval’s grade and fixation failure during 2 years. Results: The mean postoperative TAD was not significantly different among the 3 groups (p = 0.519). However, the change in the TAD at 1 year (p = 0.027) and 2 years (p = 0.008) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. The hip screw sliding distance at 1 year (p = 0.004) and 2 years (p = 0.001) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. However, there was no significant difference of Koval’s grade and fixation failure among the 3 groups (p = 0.535). Conclusion: U-blade gamma nail showed favorable radiologic results in terms of the change in the hip screw position. However, U-blade gamma nail was not superior to PFNA and gamma nail in clinical outcomes.

Criteria positive and criteria negative anaphylaxis, with a focus on undifferentiated somatoform idiopathic anaphylaxis: A review and case series

2020 ◽  
Vol 41 (6) ◽  
pp. 436-441 ◽  
Author(s):  
Daniel A. Rosloff ◽  
Kunal Patel ◽  
Paul J. Feustel ◽  
Jocelyn Celestin
Keyword(s):  
Diagnostic Criteria ◽  
Statistical Significance ◽  
Case Series ◽  
Poor Response ◽  
Response To Treatment ◽  
Fisher Exact Test ◽  
Subjective Symptoms ◽  
Significant Difference ◽  
Physical Findings ◽  
Idiopathic Anaphylaxis

Background: Undifferentiated somatoform (US) idiopathic anaphylaxis (IA) is considered a psychogenic disorder characterized by a lack of observable physical findings and poor response to treatment. Although failure to diagnose true anaphylaxis can have disastrous consequences, identification of US-IA is crucial to limit unnecessary expenses and use of health care resources. Objective: To better define the presentation and understand the potential relationship between US-IA and underlying psychiatric comorbidities. Methods: We retrospectively reviewed 110 visits by 107 patients to our institution for evaluation and management of anaphylaxis over a 1-year period. The patients were classified as having either criteria positive (CP) or criteria negative (CN) anaphylaxis based on whether they met Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium criteria for the clinical diagnosis of anaphylaxis. Patient characteristics, including objective and subjective signs and symptoms, and the presence of psychiatric diagnoses were collected and analyzed. Statistical significance was assessed by using the Fisher exact test. A literature review of US-IA and other psychogenic forms of anaphylaxis was performed. Results: Patients with CP anaphylaxis were more likely to present with hypotension, wheezing, urticaria, and vomiting than were patients with CN anaphylaxis. The patients with CN anaphylaxis were more likely to present with subjective symptoms of sensory throat tightness or swelling compared with patients with CP anaphylaxis. No significant difference was detected in the prevalence of psychiatric conditions between the two groups. Conclusion: Patients who met previously established diagnostic criteria for anaphylaxis were more likely to present with objective physical findings than those who did not meet criteria for true anaphylaxis. CN patients who presented for treatment of anaphylaxis were more likely to present with subjective symptoms. Formal diagnostic criteria should be used by clinicians when evaluating patients with suspected anaphylaxis.

Introduction of intraoperative neuromonitoring does not necessarily improve overall long-term outcome in elective aneurysm clipping

2020 ◽  
Vol 132 (4) ◽  
pp. 1188-1196 ◽  
Author(s):  
Tobias Greve ◽  
Veit M. Stoecklein ◽  
Franziska Dorn ◽  
Sophia Laskowski ◽  
Niklas Thon ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Predictive Value ◽  
Neurological Outcome ◽  
Positive Impact ◽  
Case Series ◽  
Intraoperative Neuromonitoring ◽  
Neurosurgical Procedures ◽  
Long Term Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference

OBJECTIVEIntraoperative neuromonitoring (IOM), particularly of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs), evolved as standard of care in a variety of neurosurgical procedures. Case series report a positive impact of IOM for elective microsurgical clipping of unruptured intracranial aneurysms (ECUIA), whereas systematic evaluation of its predictive value is lacking. Therefore, the authors analyzed the neurological outcome of patients undergoing ECUIA before and after IOM introduction to this procedure.METHODSThe dates of inclusion in the study were 2007–2014. In this period, ECUIA procedures before (n = 136, NIOM-group; 2007–2010) and after introduction of IOM (n = 138, IOM-group; 2011–2014) were included. The cutoff value for SSEP/MEP abnormality was chosen as an amplitude reduction ≥ 50%. SSEP/MEP changes were correlated with neurological outcome. IOM-undetectable deficits (bulbar, vision, ataxia) were not included in risk stratification.RESULTSThere was no significant difference in sex distribution, follow-up period, subarachnoid hemorrhage risk factors, aneurysm diameter, complexity, and location. Age was higher in the IOM-group (57 vs 54 years, p = 0.012). In the IOM group, there were 18 new postoperative deficits (13.0%, 5.8% permanent), 9 hemisyndromes, 2 comas, 4 bulbar symptoms, and 3 visual deficits. In the NIOM group there were 18 new deficits (13.2%; 7.3% permanent, including 7 hemisyndromes). The groups did not significantly differ in the number or nature of postoperative deficits, nor in their recovery rate. In the IOM group, SSEPs and MEPs were available in 99% of cases. Significant changes were noted in 18 cases, 4 of which exhibited postoperative hemisyndrome, and 1 suffered from prolonged comatose state (5 true-positive cases). Twelve patients showed no new detectable deficits (false positives), however 2 of these cases showed asymptomatic infarction. Five patients with new hemisyndrome and 1 comatose patient did not show significant SSEP/MEP alterations (false negatives). Overall sensitivity of SSEP/MEP monitoring was 45.5%, specificity 89.8%, positive predictive value 27.8%, and negative predictive value 95.0%.CONCLUSIONSThe assumed positive impact of introducing SSEP/MEP monitoring on overall neurological outcome in ECUIA did not reach significance. This study suggests that from a medicolegal point of view, IOM is not stringently required in all neurovascular procedures. However, future studies should carefully address high-risk patients with complex procedures who might benefit more clearly from IOM than others.

scholarly journals Prediction accuracy of standard and total keratometry by swept-source optical biometer for multifocal intraocular lens power calculation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hun Lee ◽  
Jae Lim Chung ◽  
Young Jun Kim ◽  
Jae Yong Kim ◽  
Hungwon Tchah
Keyword(s):  
Cataract Surgery ◽  
Case Series ◽  
Intraocular Lenses ◽  
Power Calculation ◽  
Neutral Position ◽  
Swept Source ◽  
Refractive Outcomes ◽  
Case Series Study ◽  
Significant Difference ◽  
Optical Biometer

AbstractWe aimed to compare the refractive outcomes of cataract surgery with diffractive multifocal intraocular lenses (IOLs) using standard keratometry (K) and total keratometry (TK). In this retrospective observational case series study, a total of 302 patients who underwent cataract surgery with multifocal IOL implantation were included. Predicted refractive outcomes were calculated based on the current standard formulas and a new formula developed for TK using K and TK, which were obtained from a swept-source optical biometer. At 2-month postoperatively, median absolute prediction errors (MedAEs) and proportion of eyes within ± 0.50 diopters (D) of predicted postoperative spherical equivalent (SE) refraction were analyzed. There was no significant difference between MedAEs or proportion of eyes within ± 0.50D of predicted refraction from K and TK in each formula. In TFNT00 and 839MP IOL cases, there was no difference between MedAEs from K and TK using any formula. In 829MP IOL cases, MedAE from TK was significantly larger than that from K in Barrett Universal II/Barrett TK Universal II (P = 0.033). In 677MY IOL cases, MedAE from TK was significantly larger than that from K in Haigis (P = 0.020) and Holladay 2 (P = 0.006) formulas. In the subgroup analysis for IOL, there was no difference between the proportion of eyes within ± 0.50 D of predicted refraction from K and TK using any formula. TFNT00 and 839MP IOLs were favorable with TK, with 677MY IOL with K and 829MP IOL being in a neutral position, which necessitates the study that investigates the accuracy of the new TK technology.

Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

2017 ◽  
Vol 38 (5) ◽  
pp. 485-495 ◽  
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Chiara Ursino ◽  
Nicola Serra ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Graft ◽  
Repeated Measures ◽  
Osteochondral Lesion ◽  
Young Patients ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Lesion Size ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

scholarly journals Villoglandular adenocarcinoma of the uterine cervix: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Anna K. Dietl ◽  
Matthias W. Beckmann ◽  
Konrad Aumann
Keyword(s):  
Systematic Review ◽  
Uterine Cervix ◽  
Case Reports ◽  
Case Series ◽  
Disease Free Survival ◽  
Conservative Group ◽  
Pubmed Database ◽  
Significant Difference ◽  
Stage Ia ◽  
Invasive Management

Abstract Purpose Villoglandular adenocarcinoma (VGA) of the uterine cervix has been classified as a rare subtype of cervical adenocarcinoma with good prognosis. A conservative surgical approach is considered feasible. The main risk factor is the presence of other histologic types of cancer. In this largest systematic review to date, we assess oncological outcomes associated with conservative therapy compared to those associated with invasive management in the treatment of stage Ia and Ib1 VGA. Methods Case series and case reports identified by searching the PubMed database were eligible for inclusion in this review (stage Ia–Ib1). Results A total of 271 patients were included in our literature review. 54 (20%) patients were treated by “conservative management” (conization, simple hysterectomy, and trachelectomy) and 217 (80%) by “invasive management” (radical hysterectomy ± radiation, hysterectomy, and radiation). Recurrences of disease (RODs) were found in the conservative group in two (4%) cases and in the invasive group in nine (4%) cases. There was no significant difference in disease-free survival (DFS) according to conservative or invasive treatment (p = 0.75). The histology of VGA may be complex with underlying usual adenocarcinoma (UAC) combined with VGA. Conclusion The excellent prognosis of pure VGA and the young age of the patients may justify the management of this tumor using a less radical procedure. The histological diagnosis of VGA is a challenge, and pretreatment should not be based solely on a simple punch biopsy but rather a conization with wide tumor-free margins.

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