Computer-Assisted Gradual Correction of Charcot Foot Deformities: An In-Depth Evaluation of Stage One of a Planned Two-Stage Approach to Charcot Reconstruction

2020 ◽  
Vol 59 (4) ◽  
pp. 841-848 ◽  
Author(s):  
Philip Wrotslavsky ◽  
Stephen J. Kriger ◽  
Samuel M. Hammer-Nahman ◽  
James G. Kwok
Keyword(s):  
Foot Deformities ◽  
Computer Assisted ◽  
Charcot Foot ◽  
Two Stage ◽  
Gradual Correction

Histopathological assessment of a two-stage reconstructive procedure of the infected Charcot foot

2021 ◽  
Author(s):  
Alexander T. Mehlhorn ◽  
Ulrich Illgner ◽  
Stefan Lemperle ◽  
Hubert Hoerterer ◽  
Veith Krenn ◽  
...  
Keyword(s):  
Reconstructive Procedure ◽  
Charcot Foot ◽  
Two Stage

scholarly journals Changes in loading distribution in patients with Charcot foot during long-term follow-up

2018 ◽  
Vol 21 (2) ◽  
pp. 99-104
Author(s):  
Anastasia G. Demina ◽  
Vadim B. Bregovskiy ◽  
Irina A. Karpova ◽  
Tatiana L. Tcvetkova
Keyword(s):  
Foot Deformities ◽  
Charcot Foot ◽  
Maximal Increase ◽  
Custom Made ◽  
Long Term Follow Up ◽  
Maximal Peak ◽  
Peak Pressures ◽  
Different Parts

Background. The inactive stage of the diabetic Charcot arthropathy foot (CA) is characterised by fixed foot deformities and an absence of inflammation. However, it remains unclear if the shape of the foot and its biomechanics change during long-term follow-up. Aim. To evaluate changes in loading distribution of the affected foot, in patients with inactive CA, during long-term follow-up. Materials and methods. Twenty seven patients with unilateral inactive CA (19 females, 8 males) were studied. Computer pedography (emed AT, novel gmbh) was performed and baseline and the last studies were analysed. Maximal peak pressures (PP) were obtained for the first and the last studies and the percentage of the PP change was calculated for the total follow-up period and for periods: 24 months, 2448 months, 48 months. Results. PP increased: under the hallux 50%; 1st metatarsal30.7%; 2nd toe20%; 2nd toe6%; midfoot9%. PP decreased under 35 toes up to 67%. Significant changes at the first period were found under 35 toes only (62%). The increase in loading under the other parts of the foot appeared at 24 months; however, these changes became significant between 24 and 48 months and peaked after 48 months of follow-up. The maximal increase of PP was noticed under the hallux, the 2nd toe, metatarsals 13 and the midfoot. Conclusions. We revealed the gradual redistribution of PP, under the different parts of the foot, in patients with inactive CA. This redistribution reflects changes in the shape of the affected foot. The loading increased under the hallux, the 2nd toe and the corresponding metatarsals, 3rd metatarsal and midfoot, and decreased under the 35 toes. These changes increased during the follow-up, becoming more pronounced after 4 or more years. Our data may be useful for constructing custom-made footwear for patients with CA.

Anesthetic Management For Two-Stage Computer-Assisted, Stereotactic Thalamotomy in a Child With Hallervorden-Spatz Disease

2000 ◽  
Vol 12 (2) ◽  
pp. 107-111 ◽  
Author(s):  
Mark T. Keegan ◽  
Randall P. Flick ◽  
Joseph Y. Matsumoto ◽  
Dudley H. Davis ◽  
William L. Lanier
Keyword(s):  
Anesthetic Management ◽  
Computer Assisted ◽  
Two Stage ◽  
Stereotactic Thalamotomy

scholarly journals Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

2018 ◽  
Vol 1 (2) ◽  
pp. 112-120
Author(s):  
Daniela–Elena Ion
Keyword(s):  
Soft Tissues ◽  
Life Quality ◽  
Foot Deformities ◽  
Charcot Foot ◽  
Neuropathic Arthropathy ◽  
Multicenter Studies ◽  
Tendon Lengthening ◽  
Key Features ◽  
Metatarsophalangeal Joints ◽  
Reconstructive Techniques

Abstract Introduction and purpose:Charcot neuroarthropathy defines a cluster of progressive lesions affecting the joints and bones, as well as the soft tissues of the foot in the context of diabetes, a pivotal role being attributed to peripheral neuropathy. Loss of sensation and proprioception, subsequent repeated trauma, muscle and autonomic nervous system impairment contribute to the alteration of the foot’s architecture and distribution of pressure, ultimately triggering ulceration and gangrene. The urge to avoid amputation has fueled the development of conservative and reconstructive techniques capable of delaying, if not preventing such negative outcomes. The purpose of this review was to present the most frequently used reconstruction procedures and the challenges arising in adapting them to particular foot morphologies and lesion stages. Methods:Literature search was conducted using PubMed, resulting in around 90 articles, multicenter studies and reviews, 26 of which were considered most relevant in providing the guidelines for orthopedic reconstruction and postoperative care in Charcot foot patients with diabetic neuropathy prevailing over arteriopathy. Results:The tarsometatarsal and metatarsophalangeal joints are most frequently affected. Closed reduction, arthrodesis, and tendon lengthening are key features of an efficient correction, alternatively accompanied by resections and tenotomies. Ulceration and callus debridement may also be necessary, while prolonged casting and immobilization remain obligatory. Conclusions:Most authors agree that stabilizing the deformities, optimizing the pressure on the soft tissues, and promoting the healing of potential lesions are the main purposes of the interventions. Prompt recognition and correction of Charcot foot deformities improve life quality and minimize the prospects of amputation.

Two-stage reconstruction of infected Charcot foot using internal fixation

2021 ◽  
Vol 103-B (10) ◽  
pp. 1611-1618
Author(s):  
Venu Kavarthapu ◽  
Basil Budair
Keyword(s):  
Internal Fixation ◽  
Limb Salvage ◽  
Care Plan ◽  
Surgical Reconstruction ◽  
Charcot Foot ◽  
Foot Deformity ◽  
Two Stage ◽  
Infected Nonunion ◽  
Hardware Failure

Aims In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method. Methods We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months’ follow-up. Results We identified 23 feet in 22 patients with a mean age of 56.7 years (33 to 70). The mean postoperative follow-up period was 44.7 months (14 to 99). Limb salvage was achieved in all patients. At one-year follow-up, all ulcers have healed and independent full weightbearing mobilization was achieved in all but one patient. Seven patients developed new mechanical skin breakdown; all went on to heal following further interventions. Fusion of the hindfoot was achieved in 15 of 18 feet (83.3%). Midfoot fusion was achieved in nine of 15 patients (60%) and six had stable and painless fibrous nonunion. Hardware failure occurred in five feet, all with broken dorsomedial locking plate. Six patients required further surgery, two underwent revision surgery for infected nonunion, two for removal of metalwork and exostectomy, and two for dynamization of the hindfoot nail. Conclusion Two-stage reconstruction of the infected and deformed Charcot foot using internal fixation and following the principle of ‘long-segment, rigid and durable internal fixation, with optimal bone opposition and local antibiotic elusion’ is a good form of treatment provided a multidisciplinary care plan is delivered. Cite this article: Bone Joint J 2021;103-B(10):1611–1618.

scholarly journals Risk factors for development of nephropathy in patients with a diabetic Charcot foot

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Rasmus Bo Jansen ◽  
Per E. Holstein ◽  
Bo Jørgensen ◽  
Klaus Kirketerp Møller ◽  
Ole Lander Svendsen
Keyword(s):  
Risk Factors ◽  
Impaired Renal Function ◽  
Rare Complication ◽  
Total Duration ◽  
Foot Deformities ◽  
Creatinine Ratio ◽  
Charcot Foot ◽  
Albumin Creatinine Ratio ◽  
Urine Albumin ◽  
Urine Albumin Creatinine Ratio

Abstract Objective Charcot foot is a rare complication to neuropathy and can cause severe foot deformities and ulcerations, which often require prolonged antibiotical treatment. The objective of this retrospective study was to investigate whether this treatment is associated to impaired renal function. Results In total, 163 patients were included, of whom 105 (64%) had received β-lactam antibiotics for a mean total duration of 13.0 months. There was a significant increase in the urine albumin/creatinine ratio in the group that received antibiotics (p = 0.017), and the use of antibiotics was associated to a subsequent diagnosis of nephropathy (p = 0.01). Patients treated with antibiotics had a 21.9% risk of developing subsequent nephropathy versus 5.2% for patients not treated with antibiotics. We suggest increased awareness on signs of nephropathy in patients with severe Charcot foot.

scholarly journals Automatic vertebrae localization and segmentation in CT with a two-stage Dense-U-Net

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pengfei Cheng ◽  
Yusheng Yang ◽  
Huiqiang Yu ◽  
Yongyi He
Keyword(s):  
Detection Rate ◽  
Region Of Interest ◽  
Computer Assisted Surgery ◽  
Computer Assisted ◽  
Location Error ◽  
Dice Coefficient ◽  
Two Stage ◽  
Second Stage ◽  
Vertebrae Segmentation ◽  
Whole Spine

AbstractAutomatic vertebrae localization and segmentation in computed tomography (CT) are fundamental for spinal image analysis and spine surgery with computer-assisted surgery systems. But they remain challenging due to high variation in spinal anatomy among patients. In this paper, we proposed a deep-learning approach for automatic CT vertebrae localization and segmentation with a two-stage Dense-U-Net. The first stage used a 2D-Dense-U-Net to localize vertebrae by detecting the vertebrae centroids with dense labels and 2D slices. The second stage segmented the specific vertebra within a region-of-interest identified based on the centroid using 3D-Dense-U-Net. Finally, each segmented vertebra was merged into a complete spine and resampled to original resolution. We evaluated our method on the dataset from the CSI 2014 Workshop with 6 metrics: location error (1.69 ± 0.78 mm), detection rate (100%) for vertebrae localization; the dice coefficient (0.953 ± 0.014), intersection over union (0.911 ± 0.025), Hausdorff distance (4.013 ± 2.128 mm), pixel accuracy (0.998 ± 0.001) for vertebrae segmentation. The experimental results demonstrated the efficiency of the proposed method. Furthermore, evaluation on the dataset from the xVertSeg challenge with location error (4.12 ± 2.31), detection rate (100%), dice coefficient (0.877 ± 0.035) shows the generalizability of our method. In summary, our solution localized the vertebrae successfully by detecting the centroids of vertebrae and implemented instance segmentation of vertebrae in the whole spine.

scholarly journals A Fast SVM-Based Tongue’s Colour Classification Aided by k-Means Clustering Identifiers and Colour Attributes as Computer-Assisted Tool for Tongue Diagnosis

2017 ◽  
Vol 2017 ◽  
pp. 1-13 ◽  
Author(s):  
Nur Diyana Kamarudin ◽  
Chia Yee Ooi ◽  
Tadaaki Kawanabe ◽  
Hiroshi Odaguchi ◽  
Fuminori Kobayashi
Keyword(s):  
Red Light ◽  
Support Vector ◽  
Computer Assisted ◽  
Transitional Region ◽  
Two Stage ◽  
True Rate ◽  
Lighting Condition ◽  
Tongue Diagnosis ◽  
Support Vectors ◽  
Stage Classification

In tongue diagnosis, colour information of tongue body has kept valuable information regarding the state of disease and its correlation with the internal organs. Qualitatively, practitioners may have difficulty in their judgement due to the instable lighting condition and naked eye’s ability to capture the exact colour distribution on the tongue especially the tongue with multicolour substance. To overcome this ambiguity, this paper presents a two-stage tongue’s multicolour classification based on a support vector machine (SVM) whose support vectors are reduced by our proposed k-means clustering identifiers and red colour range for precise tongue colour diagnosis. In the first stage, k-means clustering is used to cluster a tongue image into four clusters of image background (black), deep red region, red/light red region, and transitional region. In the second-stage classification, red/light red tongue images are further classified into red tongue or light red tongue based on the red colour range derived in our work. Overall, true rate classification accuracy of the proposed two-stage classification to diagnose red, light red, and deep red tongue colours is 94%. The number of support vectors in SVM is improved by 41.2%, and the execution time for one image is recorded as 48 seconds.

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