Metacarpal and Phalangeal Lengthening by Callus Distraction

2001 ◽  
Vol 26 (1) ◽  
pp. 13-16 ◽  
Author(s):  
S. HOUSHIAN ◽  
T. IPSEN
Keyword(s):  
External Fixator ◽  
Callus Distraction ◽  
Functional Improvement ◽  
Traumatic Amputation ◽  
Non Union ◽  
Bone Length ◽  
Epiphyseal Closure

Twelve metacarpals and two phalanges in 14 patients (nine males and five females) were lengthened between August 1992 and March 1999 by the callus distraction technique using a small external fixator (Orthofix®). The indications were traumatic amputation (10 cases), aplasia (three cases) and hypoplasia owing to premature epiphyseal closure of the metacarpal (one case). All patients were reviewed with a median follow-up time of 39 (range, 9–88) months. The median age of the patients was 15 (range, 4–39) years. The median lengthening was 21 (range, 13–34) mm which was a median of 82% (range, 38–162) of the original bone length. The median times for callus distraction and consolidation were 4.5 and 7.5 weeks respectively. All except one patient tolerated the procedure well and were satisfied with the results. Functional improvement was seen in 13 out of 14 patients, but non-union was observed in one patient.

The Challenges of Monoaxial Bone Transport in Orthopedics and Traumatology

2017 ◽  
Vol 19 (4) ◽  
pp. 0-0 ◽  
Author(s):  
Michele Bisaccia ◽  
Giuseppe Rinonapoli ◽  
Luigi Meccariello ◽  
Auro Caraffa ◽  
Bartosz Cukierman ◽  
...  
Keyword(s):  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Soft Tissue Reconstruction ◽  
Non Union ◽  
Duration Of Hospitalization ◽  
Monolateral External Fixator

Background. Bone defects represent the main challenging problem for the orthopedic surgeon and, consequently, they increase the duration of hospitalization, risk of complications and health expenditures. The aim of our observational, descriptive and retrospective study is to evaluate the outcomes of patients treated with a mo­nolateral external fixator for bone defects greater than 3 cm. Material and methods. Between January 2003 and January 2013, 21 patients were treated at our center by bone transfer with a monolateral external fixator. The main etiologies were trauma in 17 cases (80.9%) and tumors in 4 cases (19.1%). Mean follow-up was 5 years for non-union and 3 years for tumors. Our clinical evaluation was based on ASAMI (Association for the Study ad Application of the Methods of Ilizarov) scores during this follow-up period. Results. The functional outcomes, based on ASAMI scores, were excellent in 12 cases, good in 7 and poor in 2. Conclusion. 1. A review of the literature related to our experience shows that bone transport is an effective tech­nique to repair loss of bone in the lower limbs. The use of a system of external fixation enables corrective actions throughout the treatment that can be in­dividualized on a case-by-case basis. In our experience, the LRS fixator (Orthofix) is a sta­ble, easy-to-use and very handy device. 2. In situations where soft tissue reconstruction procedures are needed, the size and shape of the splint should be such as not to constitute an obstacle. Fur­thermore, the use of pins rather than transfixation wires eliminates the risk of neuro / vascu­lar injury such as may occur during the application of a circular fixator. 3. The analysis of the cases presented here indicates that where possible the technique of bone transport produces good results and can often salvage the limb. Amputation should be reserved only for cases where the general and / or local preoperative status indicate that the surgeon can expect a poor result or when the compliance of the patient is determined to be inadequate.

Understanding the Obstacles to Uptake of Intervention Programmes and Services for Persons with Dementia

2020 ◽  
Vol 17 (6) ◽  
pp. 526-533
Author(s):  
Ha N.H. Lien ◽  
Emily J. Koh ◽  
Philip L.K. Yap
Keyword(s):  
Medical Records ◽  
Cognitive Engagement ◽  
Functional Improvement ◽  
Related Factors ◽  
Related Services ◽  
Phone Calls ◽  
Information Session ◽  
Adequate Information ◽  
Care At Home

Background: Utilisation of intervention programmes and services for Persons with Dementia (PWD) has been generally modest despite the growing numbers. One reason has been the lack of knowledge about dementia and information on such services. Objective: We sought to close this gap by providing caregivers with an information session about dementia and the importance and availability of related services. We explored the uptake of intervention programmes and services and reasons for non-uptake thereafter. Methods: Two hundred and seventy-five PWD and caregiver dyads attended the Dyad Education and Empowerment Programme (DEEP). At the DEEP, while caregivers underwent an information session, PWD were assessed by a multidisciplinary team on their need and suitability for programmes and services such as daycare, cognitive engagement programmes and physical rehabilitation. The dyads then received individualized recommendations on the appropriate services, if any. Follow-up through medical records review and phone calls was conducted one month after DEEP to ascertain if the dyads had acted upon the recommendations and if not, what difficulties they encountered. Results: One hundred and eleven PWD received recommendations, of which 40 (36.0%) agreed and enrolled in the services while 71 (64%) declined. Thematic analysis of the reasons for non-uptake revealed 3 themes: PWD-related factors (e.g., refusal, functional improvement or decline), caregiverrelated factors (adequacy of care at home, other care arrangements), and service-related factors (e.g., cost, timing). Conclusion: Despite adequate information, there are other reasons for non-uptake of dementia- related services, some of which should be addressed to improve service updates and to provide better care for PWD.

Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

2020 ◽  
Author(s):  
Hongfeng Sheng ◽  
Weixing Xu ◽  
Bin Xu ◽  
Hongpu Song ◽  
Di Lu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Theoretical Basis ◽  
New Technology ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

scholarly journals Failure analysis and recommendations for treatment of posttraumatic non-unions of the distal humerus during childhood

2021 ◽  
Vol 47 (2) ◽  
pp. 313-324 ◽  
Author(s):  
Dirk Walther Sommerfeldt ◽  
Peter Paul Schmittenbecher
Keyword(s):  
Failure Analysis ◽  
Revision Surgery ◽  
Distal Humerus ◽  
Implant Removal ◽  
Supracondylar Fractures ◽  
Stable Fixation ◽  
Non Union ◽  
Pediatric Traumatology ◽  
Clinical Cases

Abstract Purpose Non-unions of the distal humerus are rare complications of common children’s fractures such as radial condyle fractures and supracondylar fractures. The aim of this paper was to update the knowledge about etiology, reasons, management, and results of these troublesome, and sometimes debilitating entities. Methods The sparse literature concerning nonunions following condylar or supracondylar fractures was analyzed together with the presentation of some typical clinical cases. Results In most of the cases, non-unions were induced by neglect, unstable fixation, too early implant removal, too much revision surgery, and an inconsequent transfer of follow-up algorithms, or combinations of the above. Treatment of non-union should start as early as possible because the effort of required surgery increases with time that the nonunion has been neglected. Often a combination of stable fixation of the pseudarthrosis and correction of the elbow axis are necessary to achieve a satisfying outcome. Conclusion In pediatric traumatology, qualified and consequent care for children’s fractures of the distal humerus can prevent rare complications such as non-unions in almost any situation. If such a disturbance of healing is noticed, immediate and adequate, i.e. children specific surgical consequences achieve best results.

scholarly journals Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

2021 ◽  
Author(s):  
Cesare Faldini ◽  
Francesca Barile ◽  
Fabrizio Perna ◽  
Stefano Pasini ◽  
Michele Fiore ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Idiopathic Scoliosis ◽  
Case Series ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Mechanical Complication ◽  
Non Union ◽  
Implant Retention ◽  
Surgical Data

Abstract Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

scholarly journals Risk Factors for Non-union in First MTPJ Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035 ◽  
Author(s):  
Andrew Molloy ◽  
Clifford Butcher ◽  
Lyndon Mason
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Univariate Analysis ◽  
Dorsal Plate ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Severe Hallux Valgus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus occurs in up to 1 in 40 adults with 1st MTPJ arthrodesis being the gold standard operation for advanced disease. Our aim was to retrospectively identify risk factors for delayed / non-union of first metatarsophalangeal joint arthrodesis using a dorsal plate with cross screw. Methods: Case note and radiograph analysis was performed for operations between April 2014 and April 2016 with at least 6 months post-operative follow up. Union was defined as bridging bone across the fusion site on AP and lateral radiographic views with no movement or pain at the MTPJ on examination. All patients operations were performed or directly supervised by one of three fellowship trained consultant foot surgeons. Surgery was performed through a dorsal approach using a dorsal locking plate with compression screw. Blinded preoperative AP radiographs were analysed for the presence of a severe hallux valgus angle equal to or above 40 degrees. Intra-observer reliability was acceptable (95% CI: 1.6-2.3 degrees). Smoking and co-morbidities underwent univariate analysis for significance. Following initial result results, surgery in patients with arthritic hallux valgus were fixed using a separate plantar to dorsal / medial to lateral lag screw and dorsal locking plate Results: 71 patients with a mean age of 61 years (range, 29 to 81) comprised the initial patient group. Mean follow up time was 13 months for both union and nonunion groups (range 6 to 30 months). 7 patients were identified as delayed or nonunion (9.9%). All had hallux valgus angles of >25%. Age, diabetes, COPD and rheumatoid arthritis did not show significant associations with non-union. All smokers progressed to union (n = 17). Moderate to severe hallux valgus (relative risk: 1.29, p < 0.005) and under correction of >25 valgus at the MTPJ (relative risk: 14.44, p < 0.001) were significantly associated with non/delayed union. In the second group, 18 patients of similar demographics, there were no failure of reductions and 100% union rate Conclusion: Preoperative moderate to severe hallux valgus and under-correction of deformity are the most significant risk factors for non-union. The construct used for fixation needs to be chosen on the basis of the deforming forces. If so, excellent union rates can be achieved

Long-Term Results of Radioscapholunate Fusion Following Fractures of the Distal Radius

1997 ◽  
Vol 22 (6) ◽  
pp. 705-710 ◽  
Author(s):  
L. NAGY ◽  
U. BÜCHLER
Keyword(s):  
Long Term Results ◽  
Short Term ◽  
Non Union ◽  
Partial Fusion ◽  
Traumatic Lesions ◽  
Residual Motion ◽  
Radioscapholunate Fusion ◽  
Wrist Fusion

Fifteen patients with radioscapholunate (RSL) fusion for traumatic lesions of the radiocarpal junction, whose short-term results have been previously reported, were reassessed after an average follow-up time of 8 years. Five patients had undergone wrist fusion because of non-union or early progressive arthritis. Of the ten wrists with retained mobility, eight continued to function satisfactorily. Two wrists were painful for reasons other than secondary midcarpal arthritis. Patient satisfaction was comparable in both groups with the wrist score better for wrists with residual motion. The survival of RSL partial wrist fusion corresponded inversely with the number of preceding operations and the range of motion before partial fusion. Secondary midcarpal arthritis, if present, arose early and was well tolerated. Failures were strongly linked to technical mistakes and complications.

scholarly journals Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Using Transfibular Approach

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001 ◽  
Author(s):  
Alexej Barg ◽  
Charles Saltzman
Keyword(s):  
Range Of Motion ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Trabecular Metal ◽  
Non Union ◽  
Early Loosening ◽  
Early Results ◽  
Ankle Replacement ◽  
Patient Reported

Category: Ankle, Ankle Arthritis Introduction/Purpose: In the last two decades, total ankle replacement (TAR) has gained more acceptance as a treatment option in patients with end-stage ankle osteoarthritis. However, there is a lack of literature on TAR using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results of a patient cohort treated with TAR using a lateral transfibular approach by a single surgeon. Methods: Fifty-five primary total ankle arthroplasties using the Zimmer trabecular metal implant were performed in 54 patients (29 men and 25 women; mean age, 67.0 years) from October 2012 to December 2014. Clinical assessment including pain evaluation and measurement of ankle range of motion was done preoperatively and at the latest follow-up. Weight-bearing radiographs were used to determine the angular alignment of the tibial and talar components and to analyze the bone-implant interface. Intraoperative and postoperative complications, revision surgeries, and failures were evaluated. Results: Implant survival was 93% at 36 months follow-up. There were 3 revisions of a tibial component due to aseptic loosening. In 10 of 55 procedures, a secondary procedure was performed during follow-up. Mean follow-up duration was 26.6 ± 4.2 months. No delayed union or non-union was observed for fibula healing. The average VAS pain score decreased significantly from 7.9 ± 1.3 to 0.8 ± 1.2. The average total range of motion increased significantly from 22.9° ± 11.8° to 40.2° ± 11.8°. Conclusion: Early results of Zimmer trabecular metal total ankle replacement demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of one year. In the first 55 consecutive cases, the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening requiring revision due to lack of bony ingrowth was seen in 3 of 55 cases.

scholarly journals Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Jialin Liu ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Segmental Bone Transport ◽  
The Mean ◽  
Forearm Bone ◽  
Segmental Bone ◽  
Transport Technique

Abstract Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

scholarly journals Renal functional improvement after pediatric pyeloplasty in kidneys with split renal function less than 20%: a single institute experience

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Elsayed Salih ◽  
Ibrahim Abdelmaksoud ◽  
Mohamed Elfeky ◽  
Gamal Selmy ◽  
Hussein Galal ◽  
...  
Keyword(s):  
Renal Function ◽  
Statistical Significance ◽  
Functional Improvement ◽  
Renal Unit ◽  
Poor Renal Function ◽  
Split Renal Function ◽  
Renal Function Deterioration ◽  
Number Of Patients ◽  
The Mean

Abstract Background Pediatric pyeloplasty in ureteropelvic junction obstruction (UPJO) is indicated in renal impaired drainage or renal function deterioration. The improvement of renal function after pediatric pyeloplasty is still controversial in poorly functioning kidneys. Past studies on poorly functioning kidneys had a variable SRF specification, and these studies often had a limited number of patients so that they did not achieve statistical significance. The study aims to detect the renal functional improvement after pediatric Anderson-Hynes pyeloplasty (AHP) with split renal function (SRF) less than 20% (poor renal function). Results A retrospective study included 46 pediatric patients with unilateral UPJO who underwent open AHP with SRF < 20% on a renal isotope scan from August 2012 to October 2018. Success was defined based on either improvement in symptoms, improvement in drainage on postoperative renography, and/or improvement or stability in SRF on the renal scan done 6 months postoperatively and yearly thereafter. Deterioration of SRF by more than 5% was deemed to be deterioration. An increase in SRF of more than 5% was deemed to be an improvement. A total of 46 patients with a mean age of 32 months with poor renal function on isotope renogram (SRF < 20%) were included. All patients had an obstructive pattern on the preoperative radionuclide scans. The median preoperative SRF was 9.26%. The mean (range) follow-up was 30 months. The success rate was 91.3%. Three patients underwent redo pyeloplasty, whereas a secondary nephrectomy was necessary for one. The remaining (42) patients showed stability or improvement of SRF with no further symptoms. Renal scintigraphy at 6 and 12 months after surgery revealed significantly increased SRF compared to preoperative one. Conclusion Poorly functioning renal unit with SRF < 20% can show functional improvement and recoverability after pediatric pyeloplasty.

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