scholarly journals Surgical Management with Self-Locking Pins and Circumferential Wiring for Treating Comminuted Patella Fractures Achieved Seiza-Style Sitting

Joints ◽  
2021 ◽  
Author(s):  
Kazuha Kizaki ◽  
Soshi Uchida ◽  
Noboru Funakoshi ◽  
Daisuke Mori ◽  
Ryosuke Nakai ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Surgical Procedures ◽  
Knee Flexion ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Surgical Techniques ◽  
Skin Incision ◽  
Rigid Fixation ◽  
Patella Fractures ◽  
Surgical Fixation

AbstractSurgical fixation of comminuted patella fractures is technically challenging. Despite the fact that tension band wiring or screw fixation are the most common surgical procedures, these surgical techniques have crucial limitations for laterally scattered fragments. We demonstrate two cases with comminuted patella fractures undergoing surgical fixation with self-locking pin and circumferential wiring, confirming the rigid fixation achieving deep knee flexion. After midline longitudinal skin incision, 2.0 mm stainless pins (AiMedic MMT, Tokyo, Japan) were inserted radially to penetrate each fragment and 1.2 mm stainless wire was circumferentially looped and self-locked in the holes on the pins, which satisfied rigid fixation. Any restrictions in range of motion and weight bearing were required postoperatively and 3- to 6-month postoperative cares achieved seiza-style sitting with deep knee flexion.

scholarly journals Screw osteosynthesis of transverse fracture of the patella in children

2019 ◽  
Vol 2 (2) ◽  
pp. e000014
Author(s):  
Simon Oksbjerre Mortensen ◽  
Anne Mette Stausholm ◽  
Rikke Thorninger
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Full Range ◽  
Surgical Techniques ◽  
Full Weight Bearing ◽  
Transverse Fracture ◽  
Excellent Outcome ◽  
Fractures In Children ◽  
Patella Fractures ◽  
Special Surgery

ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified superior technique for children. The aim of this study is to assess the functional outcome after screw fixation of transverse patella fractures in children.MethodsTwo boys at 11 years of age were presented with a transverse fracture of the patella within the same week. Open reduction and fixation of the fractured patella with periost sutures and a 4.0 mm titanium screw inserted from the distal fragment. Afterward, the quadriceps expansion was meticulously repaired with sutures.ResultsThe patients could fully weight bear immediately on a fully extended knee in an orthosis. After 4 weeks, radiological healing was obtained. At the 8-week and 6-month follow-up, the modified Hospital of Special Surgery knee score was 100 points in both patients.ConclusionSingle screw fixation provides an excellent outcome after 8 weeks with a full range of motion and full weight bearing, providing a faster recovery.

scholarly journals Intraoperative mobilisation of knee and its effect on the final functional outcome in patella fractures: a clinical study

2018 ◽  
Vol 4 (4) ◽  
pp. 642
Author(s):  
Deepak Aher ◽  
Ajay Dandotiya ◽  
Dharmendra Raghuvanshi ◽  
Abhishek Pathak
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Rating Scale ◽  
Road Traffic ◽  
Weight Bearing ◽  
Operation Time ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Early Weight Bearing ◽  
Patella Fractures

<p class="abstract"><strong>Background:</strong> Treatment of patellar fractures depends on its type, integrity of extensor mechanism and fragments size. Operative measures are tension band wiring and partial or total patellectomy. Early weight bearing and then gradual mobilization and finally quadriceps strengthening remains the crux of physiotherapy. Aim of this study was to see for the effect of intraoperative mobilisation of knee on functional outcome of tension band wiring in patella fractures.</p><p class="abstract"><strong>Methods:</strong> 30 patients were included in this study from January 2016 to February 2018. Tension band wiring was performed in all the patients. Intraoperative mobilisation of knee as allowed was done when patient was under effect of anesthesia. Final functional outcome was assessed as per the modified knee-rating scale of the Hospital for Special Surgery and also range of motion noted. Patients were evaluated at 1 month, 2 month, 6 month and 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients aged from 25-65 years with mean age of 40 years. 26 patients were male and 4 female. In 20 cases, Right knee was involved. All had trauma due to road traffic accident. Mean operation time was 1 hour. At the end of 1 year follow up only 2 patients had range of motion &lt;90, 4 patients had range of motion 90-120 degrees and 24 patients had range of motion &gt;120 degrees. After 1 year, functional outcome was, excellent in 24, good in 4, fair in 1 and poor in 1.</p><p class="abstract"><strong>Conclusions:</strong> Intraoperative mobilisation of knee after a stable fixation with tension band wiring of patella can prove to a very effective method for increasing postoperative range of motion and improving functional outcome.</p>

Changes in Tibiofemoral Joint Space Following Total Knee Arthroplasty During Weight-Bearing Knee Motion

2009 ◽  
Author(s):  
Kartik M. Varadarajan ◽  
Angela L. Moynihan ◽  
Jong Keun Seon ◽  
Andrew A. Freiberg ◽  
Harry E. Rubash ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Weight Bearing ◽  
Surgical Techniques ◽  
Joint Space ◽  
Extensor Mechanism ◽  
Implant Design ◽  
Tibiofemoral Joint ◽  
Total Knee

Increasing the range of knee flexion following total knee arthroplasty (TKA) remains an important objective for design of new implants and advancement of surgical techniques. With the excellent long term (10–15 year) outcome of TKA, surgeons are more confident about performing the procedure on younger, more active patients demanding increased range of knee flexion [1–3]. Numerous factors have been linked to limited flexion (<120°) following TKA, including patient factors such as preoperative range of motion, intraoperative factors such as component malposition, and implant design [1–3]. Extensor mechanism overstretching due to overstuffing of the knee joint is hypothesized to be a contributing factor limiting knee flexion [1–4]. However, no study to date has investigated the changes in tibiofemoral joint space following TKA. The aim of this study was to examine pre- and post-operative tibiofemoral joint space in a group of TKA patients during weight-bearing knee flexion and to compare it to that in the normal/healthy knee. This could help determine if changes in the proximal-distal distance between the femur and the tibia (tibiofemoral joint space) could lead to extensor mechanism overstretching and consequently limited range of flexion.

scholarly journals Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Beixi Bao ◽  
Qingjun Su ◽  
Yong Hai ◽  
Peng Yin ◽  
Yaoshen Zhang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Surgical Outcomes ◽  
Screw Fixation ◽  
Congenital Scoliosis ◽  
Pedicle Screw Fixation ◽  
Rigid Fixation ◽  
Short Segment ◽  
Hemivertebra Resection ◽  
Main Curve

Abstract Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

Females Recruit Quadriceps Faster Than Males at Multiple Knee Flexion Angles Following a Weight-Bearing Rotary Perturbation

2005 ◽  
Vol 15 (3) ◽  
pp. 167-171 ◽  
Author(s):  
Christopher R Carcia ◽  
Sandra J Shultz ◽  
Kevin P Granata ◽  
David H Perrin ◽  
RobRoy L Martin
Keyword(s):  
Knee Flexion ◽  
Weight Bearing

scholarly journals The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Evelina Pantzar-Castilla ◽  
Brian Po-Jung Chen ◽  
Freeman Miller ◽  
Jacques Riad
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Short Term ◽  
Knee Flexion Contracture ◽  
Group 2 ◽  
Group 1

Abstract Background Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP). Methods Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively. Results Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D. Conclusions Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

The Effect of 2 Forms of Talocrural Joint Traction on Dorsiflexion Range of Motion and Postural Control in Those With Chronic Ankle Instability

2017 ◽  
Vol 26 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Cameron J. Powden ◽  
Kathleen K. Hogan ◽  
Erik A. Wikstrom ◽  
Matthew C. Hoch
Keyword(s):  
Postural Control ◽  
Range Of Motion ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Weight Bearing ◽  
Chronic Ankle Instability ◽  
Physical Contact ◽  
Future Research ◽  
Talocrural Joint ◽  
Sham Condition

Context:Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI).Objective:Examine the immediate effects of talocrural joint traction in those with CAI.Design:Blinded, crossover.Setting:Laboratory.Participants:Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering “yes” to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool.Intervention:Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected.Main Outcome Measures:The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P < .05.Results:No significant treatment effects were identified for any variables.Conclusion:A single intervention of ST or OT did not produce significant changes in weight-bearing dorsiflexion range of motion or postural control in individuals with CAI. Future research should investigate the effects of repeated talocrural traction treatments and the effects of this technique when combined with other manual therapies.

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