Radiographic Outcomes of Talonavicular Joint Arthrodesis with Varying Fixation Techniques in Stage III Adult Acquired Flatfoot Reconstruction

2021 ◽  
Author(s):  
Vincent G. Vacketta ◽  
Jacob M. Jones ◽  
Frances Hite Philp ◽  
Karl R. Saltrick ◽  
Ryan L. McMillen ◽  
...  
Keyword(s):  
Stage Iii ◽  
Talonavicular Joint ◽  
Radiographic Outcomes ◽  
Fixation Techniques

scholarly journals Patient-Reported and Radiographic Outcomes in Primary and Revision Stage II, III, and IV Adult- Acquired Flatfoot Deformity Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0006
Author(s):  
Rusheel Nayak ◽  
Milap Patel ◽  
Anish R. Kadakia
Keyword(s):  
Patient Reported Outcomes ◽  
Stage Iv ◽  
Stage Ii ◽  
Stage Iii ◽  
Primary Stage ◽  
Radiographic Outcomes ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
Patient Reported ◽  
Adult Acquired Flatfoot Deformity

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Adult-Acquired Flatfoot Deformity (AAFD) is a progressive hindfoot and midfoot deformity that causes pain and disability. It presents as a plano-valgus deformity from the failure of static and dynamic medial osteoligamentous stabilizers. Stage II presents as a passively correctable, flexible deformity of the foot; stage III presents as a fixed or arthritic deformity of the foot; and stage IV presents with marked deformity of the foot caused by failure of the deltoid ligament and subsequent peritalar instability. Although operative treatment of AAFD is dependent on the stage, there is little data on patient- reported and radiographic outcomes stratified by primary versus revision stage II, III, and IV reconstruction surgery. Methods: Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores were prospectively obtained on 46 consecutive patients who underwent AAFD reconstruction between November 2013 and January 2019 with minimum 12-month follow-up (average 23 months). Twenty patients underwent stage II reconstruction, 5 of which were revision surgeries; 19 patients underwent stage III reconstruction, 8 of which were revision surgeries; and 7 patients underwent stage IV reconstruction, all of which were primary surgeries. Radiographic correction was measured pre- and post-operatively and correlated with PROMIS scores. Measurements included the talonavicular uncoverage angle, talonavicular uncoverage percent, AP talo-first metatarsal angle, Meary’s angle, medial cuneiform height, and medial cuneiform-fifth metatarsal height. Results: For the overall cohort, PROMIS PF increased significantly from 37.6+-5.7 to 42.4+-6.8 (p=0.0014). PROMIS PI improved significantly from 64.7+-6.3 to 54.6+-9.5 (p<0.0001). PROMIS scores were not statistically different between AAFD stages. Change in PROMIS PI was significantly greater in primary (-12.3) versus revision (-3.7) surgery (p=0.0157). Change in PROMIS PF was non- significantly greater in primary (+4.0) versus revision surgery (+2.3). All radiographic measurements improved significantly (p<0.05). In primary stage II AAFD, pre-operative PROMIS PI scores correlated with pre-operative medial cuneiform-fifth metatarsal height (r = -0.606, p = 0.0479). In addition, in primary stage II AAFD, post-operative PROMIS scores correlated with post-operative medial cuneiform height (PROMIS PF: r=0.7725, p=0.0020; PROMIS PI: r=-0.5692, p=0.0446). Conclusion: Patient-reported and radiographic outcomes improve significantly after AAFD reconstruction. There was no significant difference in PROMIS scores between AAFD stages. However, stage III patients had non-significantly lower improvements in PROMIS PF, likely due to loss of function after arthrodesis. Primary operations had better patient-reported outcomes compared to revision operations. In primary stage II AAFD, reconstructing the medial arch correlates significantly with improvement in pain and functionality. This survey of outcomes after primary and revision stage II, III, and IV reconstruction should help clinical decision making by providing data on expected surgical improvement.

Evaluation of Clinical and Radiographic Outcomes of Complete Subtalar Release in Clubfoot Treatment

2008 ◽  
Vol 98 (6) ◽  
pp. 451-456 ◽  
Author(s):  
Onder Kalenderer ◽  
Ali Reisoglu ◽  
Ali Turgut ◽  
Haluk Agus
Keyword(s):  
Surgical Techniques ◽  
Clinical Results ◽  
Radiographic Measurement ◽  
Radiographic Examination ◽  
Navicular Bone ◽  
Talonavicular Joint ◽  
Radiographic Outcomes ◽  
Talar Head ◽  
Tarsal Bones

Background: We evaluated patients with unilateral clubfoot deformity who were treated by complete subtalar release according to Simons’ criteria and assessed the correlation between clinical and radiographic results. Methods: Eleven patients underwent a complete subtalar release through a Cincinnati incision. Evaluation included a questionnaire and clinical and radiographic examination. Results: Mean follow-up was 12 years 8 months. The radiographic measurement differences in the diagnostic angles between normal feet and clubfeet were not significant. Shortening of the talus and the navicular bone was significant. The talar dome was flattened in seven patients and was flattened, sclerotic, and irregular in one. Flattening of the talar head was detected in eight patients, irregularity in one, and deformity and sclerosis in one. Six patients had deformity in the talonavicular joint. The navicular bone was wedge shaped in nine patients and subluxated dorsally in seven. The talar head was congruent with the navicular bone semilunar in normal feet; this relation was not detected in patients treated for clubfoot. Conclusion: Radiographic changes, such as flattening of the talar, a wedge-shaped navicular bone, dorsal navicular migration, irregularity, and lack of congruence of the talonavicular joint, can be encountered postoperatively in clinically and cosmetically healthy patients. These changes may be caused by the nature of the disease, correcting manipulations or casting, or surgical techniques. Although complete subtalar release is an effective procedure for satisfactory clinical results, maintenance of anatomical configuration, but not normal anatomical development of tarsal bones, can be achieved with this method. (J Am Podiatr Med Assoc 98(6): 451–456, 2008)

LONG-SEGMENT SPINAL FIXATION USING PELVIC SCREWS

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A183-A190 ◽  
Author(s):  
Luis M. Tumialán ◽  
Praveen V. Mummaneni
Keyword(s):  
Screw Fixation ◽  
X Rays ◽  
Pelvic Fixation ◽  
Computed Tomographic ◽  
Structural Support ◽  
Radiographic Outcomes ◽  
Flexion Extension ◽  
Fixation Techniques ◽  
Sacral Tumors

ABSTRACT OBJECTIVE Long spinal constructs that extend to the sacrum place added stress on sacral screws. To prevent premature loosening of sacral fixation in these cases, the addition of pelvic screw (iliac screw) fixation has gained in popularity. Pelvic screw fixation has also been used in cases where sacral screw fixation is not possible (e.g., in sacral tumors). Pelvic screw fixation is more straightforward than prior pelvic rod fixation techniques (e.g., the Galveston technique). We describe our technique for pelvic screw fixation and review our experience with this technique. METHODS Twenty consecutive patients who underwent spinal-pelvic fixation were followed over a 3-year period (2004–2007). The patient population consisted of 11 men and 9 women with an average age of 58.8 years. Indications for spinal-pelvic fixation in this series included kyphoscoliosis, lumbosacral pseudoarthrosis, sacral fractures, lumbosacral spondylolisthesis, sacral tumors, and lumbar osteomyelitic fractures. Radiographic outcomes were assessed using flexion-extension x-rays and computed tomographic scans. Clinical outcomes were assessed using Odom's criteria and modified Prolo scale. RESULTS One patient was lost to radiographic follow-up. One patient died after surgery. The mean follow-up for the remaining patients was 13 months (range, 1–21 mo). Odom's outcomes were rated as good to excellent in 11 (58%), fair in 7 (37%), and poor in 1 (5%) (one patient died). Preoperative and postoperative modified Prolo scores were 10.4 and 12.9, respectively (mean improvement, 2.5). Radiographic fusion across the lumbosacral junction was obtained in 16 (89%) of the 18 patients with follow-up. One patient required revision of a pelvic screw. There was one infection requiring explantation of hardware. CONCLUSION Pelvic screw fixation is a safe and effective technique that provides added structural support to S1 screws in long-segment spinal fusions. Furthermore, pelvic screw fixation provides a distal point of fixation in cases where sacral screw fixation is not possible. The use of polyaxial screws and connectors makes this technique easier than Galveston rod fixation of the pelvis.

Structural aspects of tracheary element differentiation in suspension cultures of Zinnia elegans

1989 ◽  
Vol 47 ◽  
pp. 768-769
Author(s):  
C. H. Haigler ◽  
A. W. Roberts
Keyword(s):  
Tracheary Element ◽  
Vesicle Fusion ◽  
Zinnia Elegans ◽  
Cellulose Synthesis ◽  
Tracheary Elements ◽  
Animal Cells ◽  
Mesophyll Cells ◽  
Fixation Techniques ◽  
Localized Patterns ◽  
Structural Aspects

Tracheary elements, the water-conducting cells in plants, are characterized by their reinforced walls that became thickened in localized patterns during differentiation (Fig. 1). The synthesis of this localized wall involves abundant secretion of Golgi vesicles that export preformed matrix polysaccharides and putative proteins involved in cellulose synthesis. Since the cells are not growing, some kind of endocytotic process must also occur. Many researchers have commented on where exocytosis occurs in relation to the thickenings (for example, see), but they based their interpretations on chemical fixation techniques that are not likely to provide reliable information about rapid processes such as vesicle fusion. We have used rapid freezing to more accurately assess patterns of vesicle fusion in tracheary elements. We have also determined the localization of calcium, which is known to regulate vesicle fusion in plant and animal cells.Mesophyll cells were obtained from immature first leaves of Zinnia elegans var. Envy (Park Seed Co., Greenwood, S.C.) and cultured as described previously with the following exceptions: (a) concentration of benzylaminopurine in the culture medium was reduced to 0.2 mg/l and myoinositol was eliminated; and (b) 1.75ml cultures were incubated in 22 x 90mm shell vials with 112rpm rotary shaking. Cells that were actively involved in differentiation were harvested and frozen in solidifying Freon as described previously. Fractures occurred preferentially at the cell/planchet interface, which allowed us to find some excellently-preserved cells in the replicas. Other differentiating cells were incubated for 20-30 min in 10(μM CTC (Sigma), an antibiotic that fluoresces in the presence of membrane-sequestered calcium. They were observed in an Olympus BH-2 microscope equipped for epi-fluorescence (violet filter package and additional Zeiss KP560 barrier filter to block chlorophyll autofluorescence).

Dx of Stage III Melanomas Likely To Rise in 2010

2009 ◽  
Vol 40 (11) ◽  
pp. 1-2
Author(s):  
BRUCE JANCIN
Keyword(s):  
Stage Iii

Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽  
2006 ◽  
Vol 35 (3) ◽  
pp. 157-166 ◽  
Author(s):  
Hach-Wunderle ◽  
Hach
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Stage Iii ◽  
High Ligation ◽  
Surgical Trauma ◽  
Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

Lymphatic Mapping and Sentinel Node Identification for Colorectal Cancer

Swiss Surgery ◽  
2001 ◽  
Vol 7 (6) ◽  
pp. 252-255 ◽  
Author(s):  
Ota ◽  
Lin
Keyword(s):  
Sentinel Node ◽  
Lymphatic Mapping ◽  
Primary Treatment ◽  
Stage Iii ◽  
Nodal Disease ◽  
Node Negative ◽  
Intraoperative Procedures ◽  
Sentinel Node Identification ◽  
Node Metastases ◽  
Molecular Assessment

The primary treatment of resectable CRC is surgical resection. Postoperative adjuvant therapies are recommended when lymph node metastases are found (stage III). There is evidence that about 20% of node negative CRC cases (stage II) are understaged, i.e., they are actually node positive (stage III). New intraoperative procedures (lymphatic mapping and sentinel node identification) that are able to detect occult macro- and micrometastases. Molecular assessment of nodal disease should improve the current staging criteria for colon cancer and could influence recommendation for adjuvant treatment.

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