Modified Graner's Technique with\without Vascularized Capitate Lengthening for Kienböck Disease Stage IIIb—A Pilot Study

2021 ◽  
Author(s):  
Ahmed Naeem Atiyya ◽  
Abdelrahman Eldiasty ◽  
Islam Koriem ◽  
Amr Nabil
Keyword(s):  
Outcome Measures ◽  
Stage Iiib ◽  
Disease Stage ◽  
Functional Evaluation ◽  
Mayo Wrist Score ◽  
Number Of Patients ◽  
Case Series Study ◽  
Kienböck Disease ◽  
Mid Term Results

Abstract Background Intercarpal fusions are used to treat stage IIIb Kienböck disease. They increase force transfer across the radioscaphoid articulation with predisposition to arthritis. Description of Technique This technique is excision of lunate followed by proximal transfer of capitate, with scaphocapitate and triquetrocapitate fusion to increase area of load transfer mimicking wrist hemiarthroplasty. Our purpose is to evaluate mid-term results of this technique. Patients and Methods A prospective case series study was conducted on 11 patients with stage IIIb and IIIc. In seven cases, transfer of the capitate was performed by osteotomizing the capitate just distal to its waist, proximal migration to replace the excised lunate then bone grafting. In four cases, proximal transfer of vascularized pedicled capitate was done. Clinical outcome measures included pain (visual analog scale), grip strength, range of motion, and functional evaluation by modified Mayo wrist score and scoring system of Evans. Radiological outcome measures included healing of fusion mass, progression of the disease, and occurrence of avascular necrosis to the capitate. Results Follow-up period averaged 54 months. Scaphocapitate fusion healing averaged 11 weeks. Union of the lengthened capitate occurred in 10 patients only. There was postoperative improvement in pain scores, grip, Evans, and modified Mayo wrist score. There was postoperative decrease in wrist flexion and extension. One patient showed resorption of the capitate head with progressive radioscaphoid arthritis-necessitated wrist fusion. Conclusion The mid-term results of this technique may be satisfactory due to low incidence of degenerative arthritis in the radioscaphoid joint. However, longer follow-up with recruiting larger number of patients is needed.

scholarly journals Results of scaphocapitate arthrodesis with lunate excision in advanced Kienböck disease at 10.7-year mean follow-up

2017 ◽  
Vol 43 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Amaury Charre ◽  
Stephanie Delclaux ◽  
Costel Apredoai ◽  
Jean-Emmanuel Ayel ◽  
Michel Rongieres ◽  
...  
Keyword(s):  
Grip Strength ◽  
Stage Iv ◽  
Functional Mobility ◽  
Stage Iiib ◽  
Advanced Stage ◽  
Stage Iiia ◽  
Level Of Evidence ◽  
Kienböck Disease

Scaphocapitate arthrodesis with lunate excision was performed for treatment of advanced Kienböck disease in 17 patients (18 wrists). Ten were women and seven men. Five were Lichtmann Stage IIIA, 12 Stage IIIB, and one Stage IV. Minimum follow-up period was 24 months; mean follow-up was 10.7 years (range 2.3 to 22 years, SD 7.1). At the latest follow-up, six patients were very satisfied, nine were satisfied and two were disappointed. Pain was significantly decreased in all cases. Wrist mobility was unchanged. Grip strength was significantly increased. Consolidation of the arthrodesis was confirmed in 17 wrists. We encountered a scaphocapitate nonunion at 12 years follow-up and two cases of styloscaphoid arthritis at 17 and 22 years. Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. Level of evidence: IV

scholarly journals Partial Capitate Shortening Osteotomy and Its Impact on Lunate Revascularization: Mid-Term Results

2019 ◽  
Vol 27 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Mesut Tahta ◽  
Eyup C. Zengin ◽  
Tahir Ozturk ◽  
B. Dirim Mete ◽  
İzge Gunal ◽  
...  
Keyword(s):  
Contralateral Side ◽  
Pinch Strength ◽  
Success Rates ◽  
Number Of Patients ◽  
Shortening Osteotomy ◽  
Kienböck Disease ◽  
Vas Scores ◽  
The Mean ◽  
Clinical And Radiological Results ◽  
Mid Term Results

Background: Treatment of Kienböck disease is still a clinical challenge. The treatment used in each instance is decided according to stage of the disease at presentation. Good clinical and radiological results could be obtained with partial capitate shortening osteotomy. However, mid-term results of this technique and its effect on lunate revascularization are not well known. Objectives: The aim of this study was to report our results of partial capitate shortening osteotomy in the treatment of stage II and IIIA Kienböck disease. Methods: Ten patients were enrolled in the study with a mean age of 37.7 years old (standard deviation [SD] = 9.6). Patients were evaluated clinically in terms of range of motion, DASH and VAS scores, satisfaction with the outcome, and grip/tip/palmar/key pinch strength compared to the contralateral side. Radiological evaluation consisted of Lichtman staging on plain radiographs and lunate revascularization on magnetic resonance imaging (MRI) at both preoperative and postoperative evaluations. Results: The mean duration of follow-up was 55.2 (SD = 24) months. The mean DASH and VAS scores were 14.3 (SD = 6.7) and 1.5 (SD = 1.3), respectively. For patient satisfaction, the mean score was 3.6 (SD = 0.6). The Lichtman stage of 7 patients remained unchanged. Lunate revascularization was detected with MRI in 6 patients. Conclusions: Although the number of patients in the study prevents more strict conclusions, our results are promising, and the technique presented offers minimally but observable lunate revascularization and high success rates in preventing the progression of the disease.

Doxil, Vincritine, Reduced Frequency Dexamethasone in Combination with Thalidomide (DVd-T) Is Associated with Higher Overall and Progression Free Survival as Compared to DVd in Patients with Multiple Myeloma (MM).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2557-2557 ◽  
Author(s):  
Khaldoun Almhanna ◽  
Revathi Suppiah ◽  
Rachid Baz ◽  
Mary Ann Karam ◽  
Beth Faiman ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow Involvement ◽  
Pegylated Liposomal Doxorubicin ◽  
Progression Free Survival ◽  
Disease Stage ◽  
P Value ◽  
Free Survival ◽  
Number Of Patients

Abstract Background: Although initially responsive to chemotherapy, multiple myeloma ultimately relapses. Replacing Adriamycin with pegylated liposomal doxorubicin in the VAD regimen results in a regimen with better safety profile (less neutropenia, alopecia, fewer hospital and clinic visit). DVd resulted in normalizing the angiogenic process however this did not improve PFS or OS. Thalidomide because of its antiangiogenic, immunomodulatory effects and chemo-sensitizing activity through modulating integrins was added to the DVd regimen. Adding the thalidomide to the DVd regimen resulted in an overall response rate of 89% with a CR/NCR rate of 49 % as compared to 60% and 18 % respectively for the DVd. At this stage it is not clear if the quality of response affects outcome in multiple myeloma patients receiving conventional dose therapy. To better assess the prognostic implication of improved quality responses and to define the role of up front Thalidomide, we compared the DVd to the DVd-T regimen by retrospectively reviewing the two trial data, the follow up for both trials is mature. It is still not clear whether thalidomide is more appropriately used up front or in the management of relapse. Methods: we recruited a total of 68 patients in our DVd trial versus 105 patient in the DVd-T trial. A total of 155 patients in both groups were evaluable for follow-up and response (58 received DVd and 97 received DVd-T). Patients were matched for age, disease prognosticators, disease stage, and bone marrow involvement. The newly diagnosed patients were comparable in both groups except for the b 2 microglobulin which was higher in the DVd-T group as compared to the DVd (3.2 vs. 5.0; respectively. p0.05). In the relapsed/refractory group of patients, all variables were comparable. Results: The median follow up was 5 years for the DVd group and 2 years for the DVd-T group. Median age for the DVd was 62 years, which was similar to the DVd-T. For the DVd vs. the DVd-T group of patients achieving complete and near complete remission was 17% vs. 49.5% respectively with a p value of 0.001. Progression free survival was significantly longer for the DVd-T regimens vs. the DVd (28 vs. 13 months p= 0.0002) Figure 1., and for over all survival the median is not reached for the DVd-T vs. 28 months for he DVd (p=0.006). Conclusion: we conclude that the addition of thalidomide significantly improved the quality of response and this appears to translate in to a PFS and OS benefit. While, recently published SWOG data suggests that the overall survival is determined by the duration of the PFS and not the quality of the response, this discrepancy could be related to the small number of patients in our study or the lack of use of biologic immune modulators among SWOG patients. Figure Figure

scholarly journals Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

2020 ◽  
Vol 09 (03) ◽  
pp. 225-229
Author(s):  
Kevin Eng ◽  
Stephen Gill ◽  
Simon Hoy ◽  
Vivek Shridar ◽  
Natasha Van Zyl ◽  
...  
Keyword(s):  
Case Series ◽  
Visual Analogue Score ◽  
Rotational Stability ◽  
Volar Aspect ◽  
Number Of Patients ◽  
Case Series Study ◽  
Structural Graft ◽  
The Mean ◽  
Series Study

Abstract Background The volar scaphoid plate from Medartis (Medartis AG, Austrasse, Basel, Switzerland) is a variable angle titanium locking plate, preformed for the volar aspect of the scaphoid. It does not have compressive capability, and may act as a bridging device. It may provide an advantage over a compression screw where the pathoanatomy is less favorable to such a device with increased rotational stability. It may act as a buttress plate for correction of humpback deformity for example. It has been used in nonunions and with vascularized grafts. Questions Our study aims to assess the results of our patients with scaphoid nonunion treated with scaphoid volar plating over a larger number of patients. We aim to identify techniques to increase the success of plating. Methods Patients from our cohort were retrospectively reviewed. Operations were performed by three hand fellowship trained surgeons and in two centers. Inclusion involved a scaphoid plate procedure for a nonunion of the scaphoid with a minimum of 6 months of follow-up. Exclusions were those who had less than 6 months of follow-up. Data included demographics, patient-rated wrist evaluation (PRWE), a quick disabilities of the arm, shoulder, and hand (qDASH), visual analogue score, and range and grip. Radiology was reviewed. Results Thirty-two eligible patients were assessed. The mean age was 25 years (range 13–46), 2 were female and 15 were smokers. Mean follow-up postsurgery was 18 months. Twenty-nine of 32 patients united (90.6%) on computed tomography scan. Clinical assessment was performed in the 25 patients. The mean qDASH score was 12.5 (range 0–42) and mean PRWE was 11 (range 0–54). The mean arc of motion was 115 degrees. The mean grip strength was 39 kg compared with 41 kg on the nonoperated side. Conclusion We postulate that the plate acts like an internal bridging device, acting over a small distance, and inherent stability of the construct with structural graft and accurate reduction prior to plating is advantageous. Potential problems include plate impingement on the volar lip of the radius, particularly when trying to plate more proximal fractures. Ideally, it is utilized for mid to distal waist fractures.

scholarly journals Assault-related severe ocular chemical injury at a London ophthalmic referral hospital: a 3-year retrospective observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038109
Author(s):  
Jeremy John Hoffman ◽  
Edward Joshua Casswell ◽  
Alex John Shortt
Keyword(s):  
Observational Study ◽  
Outcome Measures ◽  
Surgical Intervention ◽  
Retrospective Observational Study ◽  
Secondary Outcome ◽  
Tertiary Referral ◽  
Work Related ◽  
Number Of Patients ◽  
Grade 3

ObjectivesTo understand the incidence, causes, management and outcomes of intentional (assault) and unintentional severe ocular chemical injuries (SOCI) at an urban tertiary referral centre in the UK.DesignRetrospective observational study.SettingA London tertiary referral ophthalmic centre, Moorfields Eye Hospital.ParticipantsAll cases of SOCI presenting between 1 September 2011 and 31 August 2014 were identified. The definition of SOCI was grade 3 or 4 on the Hughes-Roper-Hall classification system. We identified 25 cases (6 in 2011–2012, 8 in 2012–2013, 11 in 2013–2014). Median age was 31.1 years. 23 cases (92%) were male.Primary and secondary outcome measuresThe primary outcome was the proportion of cases of SOCI caused by assault, per year. Secondary outcome measures included the number of cases of SOCI, injury characteristics and mechanism, initial and long-term management, visual outcome and the need for surgical intervention.ResultsBetween 2011 and 2012, 3/6 cases were due to assault (50%); between 2012 and 2013, 7/8 were due to assault (87.5%); and between 2013 and 2014, 6/11 were due to assault (54.4%). Assault was responsible for 16/25 (64%) cases overall, while 8/25 (32%) cases were work related. The causative agent was known to be alkali in 16/25 (64%), while 10/25 (40%) did not complete the follow-up. The mean number of clock hours of limbal ischaemia was 5.24 (SD 2.97). 17/25 (68%) were Hughes-Roper-Hall grade 3. Surgical intervention occurred in 1/25. The final best-corrected visual acuity was 6/12 or worse in 11/25 (44%) and was counting fingers or worse in 4/25 (16%).ConclusionsPrevious studies found that SOCI had a low incidence and that work-related injuries were the most common cause. Our study demonstrates an increasing incidence of SOCI, which may be accounted for by a rise in assault using corrosive substances. A high number of patients did not attend regularly for follow-up and visual outcomes from these injuries are poor.

Mid-term results of lateral unicondylar mobile bearing knee arthroplasty

2018 ◽  
Vol 100-B (1) ◽  
pp. 42-49 ◽  
Author(s):  
T. Walker ◽  
N. Zahn ◽  
T. Bruckner ◽  
M. R. Streit ◽  
G. Mohr ◽  
...  
Keyword(s):  
At Risk ◽  
Los Angeles ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Oxford Knee Score ◽  
Mobile Bearing ◽  
Dislocation Rate ◽  
Number Of Patients ◽  
Mid Term Results

Aims The aim of this independent multicentre study was to assess the mid-term results of mobile bearing unicondylar knee arthroplasty (UKA) for isolated lateral osteoarthritis of the knee joint. Patients and Methods We retrospectively evaluated 363 consecutive, lateral UKAs (346 patients) performed using the Oxford domed lateral prosthesis undertaken in three high-volume knee arthroplasty centres between 2006 and 2014. Mean age of the patients at surgery was 65 years (36 to 88) with a mean final follow-up of 37 months (12 to 93) Results A total of 36 (10.5%) patients underwent revision surgery, giving a survival rate of 90.1% at three years (95% confidence intervals (CI) 86.1 to 93.1; number at risk: 155) and 85.0% at five years (95% CI 77.9 to 89.9; number at risk: 43). Dislocation of the mobile bearing occurred in 18 patients (5.6%) at three years (95% CI 1.0 to 16.4; number at risk: 154) and in 20 patients (8.5%) at five years (95% CI 1.0 to 27.0; number at risk: 42). There were no significant differences in the dislocation rate between the participating centres or the surgeons. We were not able to identify an effect of each surgeon’s learning curve on the dislocation rate of the mobile bearing. The clinical outcome in patients without revision surgery at final follow-up was good to excellent, with a mean Oxford knee score of 40.3 (95% CI 39.4 to 41.2), a mean Tegner activity score of 3.2 (95% CI 3.1 to 3.3) and a mean University of California, Los Angeles score of 5.7 (95% CI 5.5 to 5.9). Conclusion Our data, which consists of a high number of patients treated with mobile bearing UKA in the lateral compartment, indicates a high revision rate of 15% at five years with dislocation of the mobile bearing being the main reason for implant failure. Despite the good functional and clinical results and the high patient satisfaction in our study group, we therefore discontinued using mobile-bearing lateral UKA in favour of a fixed-bearing component. Cite this article: Bone Joint J 2018;100-B:42–9.

scholarly journals Pilot study of ziv-aflibercept in myopic choroidal neovascularisation patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Amin E. Nawar ◽  
Heba M. Shafik
Keyword(s):  
Intravitreal Injection ◽  
Outcome Measures ◽  
Macular Thickness ◽  
Older Age ◽  
Central Macular Thickness ◽  
Age Group ◽  
Younger Age ◽  
Number Of Patients ◽  
Myopic Cnv

Abstract Background Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia. The present study evaluated the efficacy and safety of the intravitreal injection of ziv-aflibercept in patients with myopic CNV. Methods This prospective interventional study was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years or older. This study was performed in the Ophthalmology Department of Tanta University Eye Hospital, Tanta University, Egypt. Optical coherence tomography (OCT) was performed for all patients at baseline and monthly after injection during the 6-month follow up period. The main outcome measures were changes in BCVA and CMT. The exploratory outcome measures were CNV size, IOP and the number of injections needed in each age group during the study period. Results Patients with myopic CNV younger than 40 years needed fewer injections (2.00 ± 0.76) than patients older than 40 years (2.50 ± 1.00), with no statistical significance detected between the two groups (p-value 0.246). CNV was smaller in the younger age group (p-value 0.209), best corrected visual acuity (BCVA) improved significantly in the younger and older age groups (p-values 0.001 and 0.028, respectively), and central macular thickness (CMT) decreased significantly after 6 months, from 242.88 ± 23.83 μm to 191.13 ± 13.83 μm in the younger age group and from 251.33 ± 26.60 μm to 197.08 ± 17.64 μm in the older age group (p = 0.001). No significant correlation was found between the final BCVA and either the spherical equivalent or central macular thickness after 6 months, with p-values of 0.135 and 0.145, respectively. No significant changes in IOP were detected in either group after the intravitreal injection. Conclusion Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV; however, a larger number of patients and a longer follow-up period are needed to confirm our results. This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 26-2-2020.

scholarly journals Clinical features and overall survival among elderly cancer patients in a tertiary cancer center

2015 ◽  
Vol 13 (4) ◽  
pp. 487-491 ◽  
Author(s):  
Yuri Philippe Pimentel Vieira Antunes ◽  
Diogo Diniz Gomes Bugano ◽  
Auro del Giglio ◽  
Rafael Aliosha Kaliks ◽  
Theodora Karnakis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Solid Tumors ◽  
Early Stage ◽  
Large Population ◽  
Disease Stage ◽  
Cancer Center ◽  
Early Stage Disease ◽  
Number Of Patients

ABSTRACT Objective To evaluate the epidemiological profile and overall survival of a large population of elderly individuals diagnosed with solid tumors in a tertiary hospital. Methods This retrospective study included patients aged >65 years, diagnosed with solid tumors between January 2007 and December 2011, at Hospital Israelita Albert Einstein, São Paulo, Brazil. The medical records were reviewed to obtain information about clinical variables and overall survival. Results A total of 806 patients were identified, and 58.4% were male. Mean age was 74 years (65 to 99 years). The most common types were prostate (22%), colorectal (21%), breast (19%), and lung cancer (13%), followed by bladder (8%), pancreas (6%), and other types (11%). The majority of patients were diagnosed at early stage disease. After a median follow-up of 27 months (15 to 45 months), 29% of the patients (234/806) died, predominantly in the group older than 70 years. For the entire cohort, the median 2-year survival rate was 71%. Median overall survival was not reached within the study period. In a multivariate analysis, age (HR: 1.35; 95%CI: 1.25-1.45; p<0.001) and disease stage (HR: 1.93; 95%CI: 1.75-2.14; p<0.001) were independent negative predictors of poor survival. Conclusion The most prevalent tumors were prostate, colorectal, breast, and lung cancer, with the larger proportion diagnosed at initial stages, reflecting the great number of patients alive at last follow-up.

Pronator quadratus pedicled bone graft in the treatment of Kienböck disease: follow-up 2 to 12 years

2019 ◽  
Vol 45 (4) ◽  
pp. 396-402 ◽  
Author(s):  
Young Ho Shin ◽  
Jun O Yoon ◽  
Jae Jung Ryu ◽  
Tae Kyoon Lee ◽  
Shin Woo Choi ◽  
...  
Keyword(s):  
Bone Graft ◽  
Grip Strength ◽  
Wrist Pain ◽  
Stage Iiib ◽  
Daily Activities ◽  
Stage Iiia ◽  
Level Of Evidence ◽  
Pronator Quadratus ◽  
Kienböck Disease

We inserted a pronator quadratus pedicled bone graft into the avascular lunate with preservation of its corticocartilaginous portion for the treatment of Kienböck disease. Twenty-seven patients (14 men, 13 women; mean age, 42 years (range 17–66 years)) were treated between September 2005 and July 2014 and followed up from 2 to 12 years. Three patients had Lichtman stage II disease, 13 had stage IIIA, and 11 had stage IIIB. Among them, 18 patients showed radiological improvement in lunate morphology. The Lichtman stage was unchanged in 23 patients and aggravated in four patients. The Stahl index was significantly decreased, but grip strength was significantly improved and 18 patients did not have any wrist pain during daily activities. Although our technique did not restore the already changed carpal malalignment, it improved lunate morphology. Clinically, it provided satisfactory pain levels in two-thirds of the patients and grip strength was improved. Level of evidence: IV

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