scholarly journals Drill and Fill Technique for the Treatment of Scaphoid Delayed Unions and Nonunions

2019 ◽  
Vol 09 (02) ◽  
pp. 116-123
Author(s):  
Dennis S. Lee ◽  
David T. Lee ◽  
Sasidhar Uppuganti ◽  
Daniel S. Perrien ◽  
Nicholas D. Pappas ◽  
...  
Keyword(s):  
Cancellous Bone ◽  
Repeated Measures ◽  
Histomorphometric Analysis ◽  
Proximal Pole ◽  
Compression Screw ◽  
Level Of Evidence ◽  
Cancellous Bone Grafting ◽  
Screw Insertion ◽  
Post Hoc

Abstract Background This article reviews the results of a surgical technique using three iterations of drilling, autologous cancellous bone grafting (filling), and use of an intraosseous compression screw for the treatment of nondisplaced or minimally displaced scaphoid delayed unions or nonunions. Methods Part 1—Cadaveric study: Three cadaveric scaphoids underwent stained cancellous bone graft packing and headless cannulated compression screw placement using a single iteration of drilling and graft packing. Three additional scaphoids were allocated to the triple “drill and fill” group, and underwent three iterations of drilling and graft packing before screw insertion. Graft particle distribution on mid-sagittal sections was assessed under fluorescence microscopy. Comparison of normalized areas between the single and triple “drill and fill” groups was performed using repeated measures ANOVA and Tukey's post hoc test.Part 2—Clinical study: Twelve patients with minimally displaced scaphoid delayed unions and nonunions treated between April 2007 and December 2013 with the triple “drill and fill” technique were included. The average follow-up was 60.4 weeks. Two fellowship-trained musculoskeletal radiologists independently reviewed images for fracture healing. Results By the histomorphometric analysis, there was improved autograft distribution along the screw tract, particularly within the proximal pole, with three iterations of drilling and filling. Clinically, 11 of 12 delayed unions and nonunions had healed. Conclusion Our results support the use of the “drill and fill” technique as an option for the treatment of select nondisplaced or minimally displaced scaphoid nonunions and delayed unions at the waist without avascular necrosis of the proximal pole. Level of Evidence This is a Level IV study.

scholarly journals Intraosseous Ganglion of the Distal Tibia: Clinical, Radiological, and Operative Management

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Sedeek Mohamed Sedeek ◽  
Q. Choudry ◽  
S. Garg
Keyword(s):  
Cancellous Bone ◽  
Bone Grafting ◽  
Distal Tibia ◽  
Operative Management ◽  
Cystic Lesions ◽  
Cancellous Bone Grafting ◽  
Intraosseous Ganglion ◽  
Initial Surgery ◽  
Ganglion Cysts

Intraosseous ganglia are benign cystic lesions located in the subchondral bone. Intraosseous ganglion cysts of the ankle are relatively uncommon. We present a case of recurrent intraosseous ganglion in the ankle of a 41-year-old female who had recurrence after initial surgery. She was treated effectively by curettage and autogenous cancellous bone grafting. At the final follow-up, satisfactory results were obtained with no recurrence or complications.

scholarly journals Time Course of Autonomic Symptoms in Postural Orthostatic Tachycardia Syndrome (POTS) Patients: Two-Year Follow-Up Results

2020 ◽  
Vol 17 (16) ◽  
pp. 5872
Author(s):  
Franca Dipaola ◽  
Caterina Barberi ◽  
Elena Castelnuovo ◽  
Maura Minonzio ◽  
Roberto Fornerone ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Repeated Measures ◽  
Time Course ◽  
Orthostatic Intolerance ◽  
Occupational Status ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Autonomic Symptoms ◽  
Post Hoc

Postural orthostatic tachycardia syndrome (POTS) is a multifactorial condition capable of chronically reducing the quality of life and the work ability of patients. The study aim was to assess the burden of autonomic symptoms in a cohort of POTS patients over 2 years. Patients’ clinical profiles were assessed by the 31-item Composite Autonomic Symptom Score questionnaire (COMPASS 31) and a visual analog scale (VAS). One-way ANOVA for repeated measures followed by Dunnett’s post-hoc test were used to compare symptoms at baseline and at 1 and 2 years. Out of 42 enrolled patients, 25 had a 1-year follow-up and 12 had a 2-year follow-up. At baseline, the reported burden of autonomic symptoms was high (overall COMPASS 31 = 49.9 ± 14.3 /100). Main complaints were related to orthostatic intolerance according to both COMPASS 31 and VAS. Fourteen patients were rendered inactive because of symptoms. At 1-year follow-up, a statistically significant improvement in pupillomotor function and overall score was detected by the COMPASS 31. These findings were confirmed at 2 years, together with a significant reduction in quality of life impairment, assessed by VAS. However, these improvements did not change patients’ occupational status. Awareness of POTS diagnosis, patient monitoring, and tailored therapies can help to improve patients’ condition.

scholarly journals Ipsilateral and Contralateral Torque Responses to Bilateral and Unilateral Maximal, Fatiguing, Isokinetic Leg Extensions

2020 ◽  
Vol 8 (4) ◽  
pp. 25
Author(s):  
Tyler J. Neltner ◽  
John Paul V. Anders ◽  
Joshua L. Keller ◽  
Robert W. Smith ◽  
Terry J. Housh ◽  
...  
Keyword(s):  
Isometric Contraction ◽  
Repeated Measures ◽  
Central Fatigue ◽  
Peak Torque ◽  
Maximal Voluntary Isometric Contraction ◽  
Repeated Measures Anova ◽  
The Right ◽  
Post Hoc ◽  
Isokinetic Peak Torque

Background: Few studies have compared performance fatigability (PF) for bilateral versus unilateral isokinetic tasks. Objectives: The purpose of this study was to examine: Mode-specific testing responses to isokinetic fatigue, differences in PF between bilateral and unilateral leg extensions, and the effects of fatiguing, unilateral, dynamic leg extensions on contralateral isokinetic peak torque (PT) and maximal voluntary isometric contraction (MVIC). Methods: Eight men (mean ± SD: age= 22.5 ± 2.5 yr.) completed pre- and post-testing for PT and MVIC following 50 bilateral, unilateral right or left leg maximal, isokinetic leg extensions at 180°·s-1, on three separate days. Fatigue-induced decreases in PT and MVIC were used to quantify PF. The data were analyzed with a 4-way repeated measures ANOVA, follow up, and post-hoc analyses. Results: The results indicated that there were no differences (p > 0.05) in PF for the bilateral versus unilateral fatiguing tasks, decreases in PT (p < 0.001 - 0.016; d = 0.54 - 2.58) and MVIC (p < 0.001 - 0.006; η2p = 0.682 - 0.962) for the exercised legs during unilateral fatigue, and a contralateral increase (p = 0.007) in PT following the right leg fatiguing task. Conclusion: The results indicated that PT was more sensitive to fatiguing isokinetic tasks than was MVIC. In addition, there was a facilitation of PT in the contralateral leg following unilateral right leg fatigue. The differences in PT and MVIC testing may be attributable to the timing and/or relative contributions of peripheral and central fatigue.

Mid-term outcome of volar plate fixation for scaphoid nonunion

2020 ◽  
Vol 102-B (12) ◽  
pp. 1697-1702
Author(s):  
Philip Marcel Jozef Schormans ◽  
Maria A. Kooijman ◽  
Jan A. Ten Bosch ◽  
Martijn Poeze ◽  
Pascal F. W. Hannemann
Keyword(s):  
Functional Outcome ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Locking Plate ◽  
Plate Fixation ◽  
Ct Scans ◽  
Scaphoid Nonunion ◽  
Cancellous Bone Grafting ◽  
The Mean

Aims Fixation of scaphoid nonunion with a volar locking plate and cancellous bone grafting has been shown to be a successful technique in small series. Few mid- or long-term follow-up studies have been reported. The aim of this study was to report the mid-term radiological and functional outcome of plate fixation for scaphoid nonunion. Methods Patients with a scaphoid nonunion were prospectively enrolled and treated with open reduction using a volar approach, debridement of the nonunion, and fixation using a locking plate and cancellous bone grafting, from the ipsilateral iliac crest. Follow-up included examination, functional assessment using the patient-rated wrist/hand evaluation (PRWHE), and multiplanar reformation CT scans at three-month intervals until union was confirmed. Results A total of 49 patients with a mean age of 31 years (16 to 74) and a mean duration of nonunion of 3.6 years (0.4 to 16) were included. Postoperatively, the nonunion healed in 47 patients (96%) as shown on CT scans. The mean time to union was 4.2 months (3 to 12). Due to impingement of the plate on the volar rim of the radius and functional limitation, the hardware was removed in 18 patients. At a median follow-up of 38 months in 34 patients, the mean active range of motion (ROM) improved significantly from 89° to 124° (SD 44°; p = 0.003). The mean grip strength improved significantly from 52% to 79% (SD 28%; p < 0.001) of the contralateral side. The mean PRWHE score improved significantly from 66 to 17 points (SD 25; p < 0.001). Conclusion Locking plate fixation supplemented with autologous cancellous bone grafting is a successful form of treatment for scaphoid nonunion. Functional outcomes improve with the passage of time, and mid-term results are excellent with a significant improvement in ROM, grip strength, and functional outcome as measured by the PRWHE. Cite this article: Bone Joint J 2020;102-B(12):1697–1702.

scholarly journals Angular Stable Miniplate Fixation of Chronic Unstable Scaphoid Nonunion

2017 ◽  
Vol 07 (01) ◽  
pp. 024-030 ◽  
Author(s):  
Peter Brink ◽  
Martijn Poeze ◽  
Pascal Hannemann ◽  
Philip Schormans
Keyword(s):  
Range Of Motion ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Scaphoid Nonunion ◽  
Previous Surgery ◽  
Level Of Evidence ◽  
Cancellous Bone Grafting ◽  
Scaphoid Fractures ◽  
Radiological Healing

Background Around 5 to 15% of all scaphoid fractures result in nonunion. Treatment of long-lasting scaphoid nonunion remains a challenge for the treating surgeon. Healing of scaphoid nonunion is essential for prevention of scaphoid nonunion advanced collapse and the subsequent predictable pattern of radiocarpal osteoarthritis. Purpose The purpose of this study was to investigate the feasibility of fixation of the scaphoid nonunion with a volar angular stable miniplate and cancellous bone grafting. We hypothesized that this technique could be successful, even in patients with previous surgery for nonunion and in patients with a long duration of nonunion. Patients and Methods A total of 21 patients enrolled in a single-center prospective cohort study. Healing of nonunion was assessed on multiplanar computed tomography scan of the wrist at a 3-month interval. Functional outcome was assessed by measuring grip strength, range of motion, and by means of the patient-rated wrist and hand evaluation (PRWHE) questionnaire. Results During follow-up, 19 out of 21 patients (90%) showed radiological healing of the nonunion. The range of motion did not improve significantly. Postoperative PRWHE scores decreased by 34 points. Healing occurred regardless of the length of time of the nonunion (range: 6–183 months) and regardless of previous surgery (38% of patients). Conclusion Volar angular stable miniplate fixation with autologous cancellous bone grafting is a successful technique for the treatment of chronic unstable scaphoid nonunion, even in patients with long-lasting nonunion and in patients who underwent previous surgery for a scaphoid fracture. Rotational interfragmentary stability might be an important determining factor for the successful treatment of unstable scaphoid nonunion. Level of Evidence Level IV.

Rigid Internal Fixation of Basilar Fractures of the Proximal Phalanges by Cancellous Bone Grafting Only

2001 ◽  
Vol 26 (5) ◽  
pp. 455-458 ◽  
Author(s):  
M. STRICKLER ◽  
L. NAGY ◽  
U. BÜCHLER
Keyword(s):  
Return To Work ◽  
Internal Fixation ◽  
Cancellous Bone ◽  
Bone Healing ◽  
Bone Grafting ◽  
Cancellous Bone Grafting ◽  
Rigid Internal Fixation ◽  
Secondary Displacement

Ten patients with 13 basilar metaphyseal impaction fractures of the proximal phalanges of the fingers were treated with “rigid internal fixation” by bone grafting alone. When retrospectively reviewed at a mean follow-up of 32 months, bone healing had occurred without any relevant secondary displacement of the fracture fragments. The final ranges of motion were good and return to work was quicker than expected.

scholarly journals Η διδασκαλία του θεατρικού παιχνιδιού στο μάθημα της προσαρμοσμένης φυσικής αγωγής ως μέσο ανάπτυξης κοινωνικών δεξιοτήτων παιδιών με διαταραχή αυτιστικού φάσματος

2019 ◽  
Author(s):  
Μαρία Μπέλλα
Keyword(s):  
Autism Spectrum Disorder ◽  
Group Work ◽  
Repeated Measures ◽  
Autism Spectrum ◽  
T Test ◽  
Repeated Measures Anova ◽  
Multisource Assessment ◽  
Students With Autism ◽  
Post Hoc

Η απόκτηση και ικανότητα χρήσης κοινωνικών δεξιοτήτων με βάση την ερμηνεία που αποδίδεται στη θεωρία του Κοινωνικού Κονστροκτουβισμού διαδραματίζει σημαντικό ρόλο στην κοινωνική ανάπτυξη των παιδιών να αλληλοεπιδρούν αποτελεσματικά με το περιβάλλον και να επιτυγχάνουν κοινωνικούς στόχους. Η απουσία ή η έλλειψη κοινωνικών δεξιοτήτων όπως παρατηρείται στα παιδιά με Διαταραχή Αυτιστικού Φάσματος (ΔΑΦ), μπορεί να οδηγήσει στην απομόνωση. Η σχολική ζωή μέσω των διαφόρων δραστηριοτήτων προσφέρει καθημερινά κίνητρα για πολύπλευρες εμπειρίες που αυξάνουν τις κοινωνικές επαφές και την ομαλή προσαρμογή στην ομαδική ζωή της τάξης. Σκοπός της παρούσας μελέτης ήταν ο σχεδιασμός, η εφαρμογή και αξιολόγηση επίδρασης ενός προγράμματος θεατρικού παιχνιδιού στην ανάπτυξη κοινωνικών δεξιοτήτων παιδιών με ΔΑΦ, μέσα από το μάθημα της Φυσικής Αγωγής (ΦΑ). Στην έρευνα συμμετείχαν έξι παιδιά, με Αυτισμό Υψηλής Λειτουργικότητας (ΥΛΑ), ηλικίας 9-11 ετών που φοιτούσαν σε τμήματα ένταξης δημοτικών σχολείων και παιδιά (N=132) της ίδιας ηλικίας που φοιτούσαν σε γενικές τάξεις των ίδιων σχολείων και παρακολουθούσαν από κοινού το μάθημα της ΦΑ. Η έρευνα περιλάμβανε, σχεδιασμό και εφαρμογή ενός προγράμματος θεατρικού παιχνιδιού, χρήση της λίστας «κοινωνικών δεξιοτήτων/δεξιοτήτων παιχνιδιού» του εργαλείου παρατήρησης COMPASS (Collaborative Model for Promoting Competence and Success for Students with Autism Spectrum Disorder) διενέργεια συνεντεύξεων με τους εκπαιδευτικούς, χρήση της κλίμακας «Πολλαπλής πηγής Αξιολόγησης της Κοινωνικής Ικανότητας των Παιδιών» (ΠΠΑΚΙ) (Multisource Assessment of Children’s Social Competence; MASCS) και της κλίμακας «Αισθημάτων για την Ομαδική Εργασία» (ΕΚΑΟΕ) (Feelings Towards Group Work; FTGW). Το πρόγραμμα είχε διάρκεια 8 εβδομάδων με συχνότητα δύο φορές εβδομαδιαίως για 45 λεπτά ανά εκπαιδευτική συνεδρία. Στις συνεντεύξεις με τις εκπαιδευτικούς, και την ανάλυση των ερωτήσεων ανοικτού τύπου, εφαρμόστηκε η μέθοδος της φαινομενολογικής προσέγγισης, ενώ για τις ερωτήσεις κλειστού τύπου έγινε έλεγχος ανεξαρτησίας χ2 στον παράγοντα ειδικότητα. Όσον αφορά την παρατήρηση των παιδιών με ΥΛΑ, στη συχνότητα εμφάνισης δέκα παρατηρούμενων μεταβλητών, έγινε καταγραφή μέσω τετράβαθμης κλίμακας, και ακολούθησε t-test για εξαρτημένα δείγματα. Για την αξιολόγηση των αντιλήψεων των παιδιών τυπικής τάξης, για τα παιδιά με ΥΛΑ, και την εύρεση πιθανών διαφορών στα σκορ, από την επίδραση του προγράμματος, στην κοινωνική ικανότητα και την προτίμηση στον ομαδικό τρόπο εργασίας, εφαρμόστηκε t-test για εξαρτημένα δείγματα. Ένα μήνα μετά τη λήξη της παρέμβασης (follow up) και για τον έλεγχο διαφοροποιήσεων από την εφαρμογή του προγράμματος τόσο στις συχνότητες εμφάνισης των παρατηρούμενων μεταβλητών, όσο και στα σκορ των κλιμάκων πραγματοποιήθηκε ανάλυση διακύμανσης επαναλαμβανόμενων μετρήσεων (repeated-measures-ANOVA) και εκτελέστηκαν δοκιμές πολλαπλών συγκρίσεων (post hoc). Τα έξι παιδιά με ΥΛΑ με βάση τα εμπειρικά δεδομένα της έρευνας, ενίσχυσαν και βελτίωσαν τις δεξιότητες συνεργασίας, μοιράστηκαν το ενδιαφέρον τους με τα παιδιά τάξης, και μείωσαν παράλληλα την οξυθυμία, την πρόκληση αναστάτωσης και τη δυσκολία προσαρμογής στην ομάδα, αναλαμβάνοντας παράλληλα πρωτοβουλίες και επιλύοντας προβλήματα εντός ομάδας. Το κύριο συμπέρασμα αυτής της έρευνας είναι ότι το πρόγραμμα θεατρικού παιχνιδιού ήταν επιτυχές, καθώς τα παιδιά με ΥΛΑ ενίσχυσαν την κοινωνική τους αλληλεπίδραση. Με τις κατάλληλες παρεμβάσεις στα προβλεπόμενα προγράμματα σπουδών, την κατάλληλη γνώση των στρατηγικών των δραστηριοτήτων του θεατρικού παιχνιδιού, αυτή η δραστηριότητα μπορεί να αποτελέσει ένα σημαντικό εργαλείο μάθησης κοινωνικών δεξιοτήτων σε επίπεδο τάξης.

scholarly journals CORRELATION BETWEEN THE SCHANZ SCREW INSERTION ANGLE AND THE LOSS OF KYPHOSIS CORRECTION IN THORACOLUMBAR FRACTURES

2020 ◽  
Vol 19 (3) ◽  
pp. 209-212
Author(s):  
FABIO ANTONIO VIEIRA ◽  
ANDRÉ SOUSA GARCIA ◽  
FERNANDO TADASHI SALVIONI UETA ◽  
DAVID DEL CURTO ◽  
RENATO HIROSHI SALVIONI UETA ◽  
...  
Keyword(s):  
Statistical Difference ◽  
Burst Fracture ◽  
Level Of Evidence ◽  
Thoracolumbar Burst Fractures ◽  
Screw Insertion ◽  
Insertion Angle ◽  
Kyphosis Correction ◽  
Screw Insertion Angle ◽  
Parallel Assembly

ABSTRACT Objective To compare the Schanz screw insertion angle and the loss of the regional kyphosis correction in thoracolumbar burst fractures following posterior short instrumentation surgery. Methods Patients with a thoracolumbar burst fracture between levels T11-L2 were divided into two groups (parallel and divergent) according to the angle formed between the Schanz screw and the vertebral plateau. Regional kyphosis was evaluated in preoperative, immediate postoperative and last follow-up radiographs. Results Of the 58 patients evaluated, 31 had a parallel assembly and 27 had a divergent assembly. When we analyzed the angle of kyphosis, no statistical difference was observed between the pre- and postoperative radiographs. However, a statistical difference in the last follow-up radiographs and in the final loss of the kyphosis correction was confirmed. Conclusion The insertion of Schanz screws with a divergent assembly presents better radiographic results with less loss of kyphosis correction angle when compared with the parallel assembly technique. Level of Evidence III; Retrospective cohort study.

Does imagining interrupting the flow of urine really elicit contractions of the pelvic floor muscles in stress-incontinent postpartum women?

2021 ◽  
pp. 205141582110391
Author(s):  
Chidiebele P Ojukwu ◽  
Precious C Orji ◽  
Anne U Ezeigwe ◽  
Stephen S Ede ◽  
Adaora J Okemuo ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Repeated Measures ◽  
Muscular Activity ◽  
Pelvic Floor Muscles ◽  
Postpartum Women ◽  
Level Of Evidence ◽  
Post Hoc Analysis ◽  
Vaginal Deliveries ◽  
Post Hoc ◽  
Level 2

Objectives: This study evaluated if imagining interrupting the flow of urine really elicits contractions of the pelvic floor muscles (PFM) in stress-incontinent postpartum women. Methods: A total of 21 postpartum women with recent vaginal deliveries performed four trials of Kegel’s exercises, each prompted by a different contraction technique. PFM activities were measured with a surface electromyography via a vaginal electrode. Inferential statistics of repeated-measures one-way analysis of variance with Bonferroni post hoc analysis were performed to compare the effective recruitment of the PFMs across the four trials. Results: PFM activities significantly varied across the four trials ( p<0.001), with ‘imagination of interrupting urine flow’ eliciting the least muscular activity (25.40±10.98) and ‘abdominal bracing with hip adduction’ elicited the highest activity (49.67±11.33). Conclusion: Findings showed that utilizing many contraction techniques during Kegel’s education is more effective compared to educating patients with one contraction technique. Level of Evidence: Level 2.

When can we expect global sagittal alignment to reach a stable value following cervical deformity surgery?

2021 ◽  
pp. 1-8
Author(s):  
Renaud Lafage ◽  
Justin S. Smith ◽  
Basel Sheikh Alshabab ◽  
Christopher Ames ◽  
Peter G. Passias ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Global Alignment ◽  
Cervical Alignment ◽  
Post Hoc Analysis ◽  
Cervical Deformity ◽  
Cervical Surgery ◽  
Global Sagittal Alignment ◽  
Significant Correction ◽  
Post Hoc

OBJECTIVE Cervical deformity (CD) is a complex condition with a clear impact on patient quality of life, which can be improved with surgical treatment. Previous study following thoracolumbar surgery demonstrated a spontaneous and maintained improvement in cervical alignment following lumbar pedicle subtraction osteotomy (PSO). In this study the authors aimed to investigate the complementary questions of whether cervical alignment induces a change in global alignment and whether this change stabilizes over time. METHODS To analyze spontaneous changes, this study included only patients with at least 5 levels remaining unfused following surgery. After data were obtained for the entire cohort, repeated-measures analyses were conducted between preoperative baseline and 3-month and 1-year follow-ups with a post hoc analysis and Bonferroni correction. A subanalysis of patients with 2-year follow-up was performed. RESULTS One-year follow-up data were available for 121 of 168 patients (72%), and 89 patients had at least 5 levels remaining unfused following surgery. Preoperatively there was a moderate anterior cervical alignment (C2–7, −7.7° [kyphosis]; T1 slope minus cervical lordosis, 37.1°; cervical sagittal vertebral axis [cSVA], 37 mm) combined with a posterior global alignment (SVA, −8 mm) with lumbar hyperextension (pelvic incidence [PI] minus lumbar lordosis [LL] mismatch [PI-LL], −0.6°). Patients underwent a significant correction of the cervical alignment (median ΔC2–7, 13.6°). Simultaneously, PI-LL, T1 pelvic angle (TPA), and SVA increased significantly (all p < 0.05) between baseline and 3-month and 1-year follow-ups. Post hoc analysis demonstrated that all of the changes occurred between baseline and 3 months. Subanalysis of patients with complete 2-year follow-up demonstrated similar results, with stable postoperative thoracolumbar alignment achieved at 3 months. CONCLUSIONS Correction of cervical malalignment can have a significant impact on thoracolumbar regional and global alignment. Peak relaxation of compensatory mechanisms is achieved by the 3-month follow-up and tends to remain stable. Subanalysis with 2-year data further supports this finding. These findings can help to identify when the results of cervical surgery on global alignment can be best evaluated.

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