Juvenile idiopathic arthritis: surgical management

2011 ◽  
Author(s):  
Nicholas D. Riley ◽  
A. Hashemi–Nejad
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Soft Tissue ◽  
Surgical Management ◽  
Surgical Procedure ◽  
Articular Surface ◽  
Normal Growth ◽  
Operative Management ◽  
Soft Tissue Release ◽  
Non Operative Management

♦ Approximately 10% of juvenile idiopathic arthritis cases will require a surgical procedure♦ Non-operative management aims to prevent deformity, promote normal growth, and maintain function♦ Perioperative problems must be anticipated and managed appropriately♦ Deformity may be treated by soft tissue release and/or osteotomy♦ Synovectomy may be useful if the articular surface is well-preserved♦ Arthrodesis is rarely indicated except in the wrist/hand♦ Arthroplasty is successful in restoring function.

scholarly journals Solid organ injury in blunt trauma abdomen: an etiological evaluation and success rate of non-operative management

2018 ◽  
Vol 5 (4) ◽  
pp. 1350
Author(s):  
Ramachandra M. L. ◽  
Krishna S. R.
Keyword(s):  
Blunt Trauma ◽  
Surgical Management ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Abdominal Injury ◽  
Organ Injury ◽  
Free Fluid ◽  
Road Traffic Accidents ◽  
Non Operative Management

Background: Trauma remains the most common cause of death for all individuals between the ages of 1 and 44 years. 10% of these fatalities are attributable to abdominal injury. The Indian fatality rates for trauma are 20 times that for developed countries. The management of patients with blunt abdominal injury has evolved greatly over the last few decades from complete surgical management historically to present non operative management in most of the cases. In view of increasing number of road traffic accidents, rampant increase in construction work, accidental fall from height, this study is conducted to look into the causes of such incidents and also to strengthen the already established rules of non operative management in cases of blunt trauma abdomen.Methods: This is a prospective study of 53 patients who presented to K. R. Hospital, Mysuru, Karnataka, for management of blunt trauma abdomen over the period of January 2016 to June 2017. Unstable patients with initial resuscitation underwent Focused Assessment Sonography for Trauma. Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen. Organ injuries were scaled according to the American Association for the Surgery of Trauma and these patients were managed conservatively after ruling out hollow viscus perforation.Results: Majority of the patients belonged to male sex (85%) and of the age group 21-40 years constituting 58.3% of patients. Road traffic accident was the most common mode of injury which included 35 patients (66%). A total of 19 cases had splenic injury out of which 13 (68.5%) underwent non operative management and 6 (31%) underwent emergency Splenectomy. liver injury was present in 15 patients and all were managed conservatively. In total non operative management was done in 73.5% of cases and surgical management was done in 26.5% of cases.Conclusions: The presence of free fluid with organ injury always does not mandate laparotomy. Patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in non operative management of blunt trauma abdomen. RTA being the most common mode of injury, adequate measures should be taken to prevent road traffic accidents by strict action and traffic norms and citizen education.

scholarly journals Protocol for a systematic review of the incidence of infection in operative vs non-operative management of Seymour fractures in children and adolescents

2020 ◽  
Author(s):  
Ailbhe Lynda Kiely ◽  
Grant Switzer Nolan ◽  
Lilli Cooper
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Children And Adolescents ◽  
Grey Literature ◽  
Operative Management ◽  
Fracture Pattern ◽  
Cochrane Library ◽  
Non Union ◽  
Fractures In Children ◽  
Non Operative Management

Abstract Background Seymour fractures are open, displaced juxta-epiphyseal fractures of the distal phalanx, with an overlying nail bed laceration that occur in children and adolescents with an open physis. This fracture occurs rarely, but its potential consequences are clinically significant. Due to anatomical particulars and proximity to the growth plate, this open fracture may result in soft tissue infection and osteomyelitis, leading to growth arrest and persistent mallet deformity. At present, there is no consensus as to the optimal management of Seymour fractures. The objective of this study will be to systematically evaluate the existing evidence to establish whether operative or non-operative management of Seymore fractures is associated with a lower incidence of infection. Methods We designed and registered a study protocol for a systematic review of comparative and observational studies. A comprehensive literature search will be conducted (from 1966 to present) in MEDLINE, EMBASE, CINAHL, Cochrane Library and Google Scholar databases. Grey literature will be identified through searching Open Grey and dissertation databases using an exhaustive search strategy. All clinical studies examining the management of Seymour fractures in children & adolescents will be included, comparing operative and non-operative groups. Operative management will be defined as formal washout and soft tissue debridement prior to reduction, whether in the emergency department or operating theatre. Non-operative management refers to washout without surgical debridement. Primary outcome measures will be the incidence of superficial and deep infection. Secondary outcomes will include adverse events such mal-union, non-union, need for re-operation, physeal disturbance, nail dystrophy/atrophy. Two independent reviewers will screen all citations, full-text articles, and abstract data. Conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. A narrative synthesis will be performed and if two or more studies with comparable design and reporting the same outcome are identified, data will be pooled for comparative analysis. Discussion This review will provide robust evidence for the management of Seymour fractures, based on a cumulation of existing studies. Due to the rarity of this fracture pattern, included studies are expected to be mainly observational and prone to bias; however, there is value in summarising the evidence, assessing its risk of bias and performing meta-analysis where possible to guide clinicians. Registration PROSPERO CRD42020153726

Use of Skin Z-Plasty for Management of Extension Contracture in Recurrent Claw- and Hammertoe Deformity

1994 ◽  
Vol 15 (4) ◽  
pp. 209-212 ◽  
Author(s):  
Mark S. Myerson ◽  
Paul Fortin ◽  
Pierre Girard
Keyword(s):  
Soft Tissue ◽  
Revision Surgery ◽  
Surgical Procedure ◽  
Metatarsophalangeal Joint ◽  
Soft Tissue Release ◽  
Dorsal Skin ◽  
Scar Contracture

Nine patients with recurrent metatarsophalangeal joint extension contracture after clawtoe or hammertoe procedures were treated with Z-plasty skin closures as part of the revision surgical procedure. The indication for performing the Z-plasty was the presence of scar contracture in the skin that prevented satisfactory correction of the toe. Soft tissue release of the metatarsophalangeal joint was followed by a simple dorsal skin Z-plasty transposition. Patients were evaluated 1 1/2 to 6 years after revision surgery. No recurrence of the extension contracture had occurred.

scholarly journals Predictors of Outcomes of Non-Surgical Management for Acetabular Labral Tears

2018 ◽  
Vol 6 (3_suppl) ◽  
pp. 2325967118S0000
Author(s):  
William Conaway ◽  
Scott D. Martin ◽  
Ravi Agrawal
Keyword(s):  
Surgical Management ◽  
Statistical Significance ◽  
Alpha Angle ◽  
Operative Management ◽  
Cartilage Defects ◽  
Labral Tears ◽  
One Year ◽  
Non Operative Management ◽  
Tönnis Grade

Objectives: Acetabular labral tears are increasingly recognized as a source of hip pain in the younger, active population. Due to a significant focus on surgical intervention, there has been limited investigation on the predictive factors and natural history of non-surgical management of these injuries. Many reports recommend a trial of non-operative management with a variety of modalities including physical therapy, education, non-steroidal anti-inflammatories (NSAIDs), intra-articular injections, and activity modification. However, there is limited data supporting these claims as few studies have explored non-surgical management. Additionally, the authors were not able to find any studies on factors that portend outcomes of non-operative management. We hypothesized that patients with more significant bony FAI pathology or more severe osteoarthritis would have poorer outcomes. Methods: Eighty patients with acetabular labral tears, confirmed by MRI, receiving a minimum of one year of non-surgical management were identified. Subjects completed baseline patient reported outcome measures (PROMs: mHHS, HOS-ADL, HOS-SS, iHOT-33). Sixty five (81.25%) patients completed the same one-year follow-up functional outcomes measures in addition to a satisfaction questionnaire (37F, 28 M). Chart review was conducted to obtain demographic information and radiographic information (Tonnis grade, alpha angle, center edge angle, chondral damage, cartilage defects, cysts, and subchondral edema). Statistical significance ( p<0.05) was determined t-test, anova, or Wilcoxon rank-sum. Results: Average follow up time was 24 months (R:18-30). The mean age was 41.7(R:18-57), average BMI was 26.2 (R18-39), and average Tonnis grade was 0.6 (R0-2). At follow-up, overall patients experienced a significant improvement in functional outcomes (mHHS: 66.6 vs 75.18, HOS-ADL: 75.7 vs 85.8, HOS-SS: 54 vs 69.7, iHOT-33: 47.9 vs 65.4). There was a positive correlation between baseline PROMs and follow-up PROMs as well as a negative correlation between baseline PROMs and change in PROMs over time. Tonnis grade, chondral damage, and cartilage defects portended significantly worse outcomes across all PROMs at follow-up. Presence of cysts or subchondral edema was also correlated with worse outcomes but these findings did not reach statistical significance. (Table 2). Alpha angle >55 (cam lesion) resulted in significantly worse outcomes across all PROMs although CEA>40 (pincer lesion) only reached significance for the HOS ADL and SSS. CEA< 25 (dysplasia) trended toward worse outcomes but did not reach significance. (Table1) Conclusion: Due to the limited healing potential of the labrum, the associated anatomical defects of FAI, and the potential for progression to osteoarthritis, there has been a focus on surgical intervention for FAI and labral tears. Despite a lack of evidence for its use, non-surgical management is frequently cited as the first step to treatment. As we found in a previous analysis, patients with symptomatic labral tears can experience functional improvement after minimum one year of non-surgical management. Those with signs of higher grade arthritis performed significantly worse that their less arthritic counterparts. Those with larger cam and pincer lesions also improved less than patients with less significant bony morphology. This study can help inform surgeons and their patients when they present with hip pain and inquire about non-surgical management. [Table: see text][Table: see text]

scholarly journals Impact of COVID-19 on orthopaedic care: a call for nonoperative management

2020 ◽  
Vol 12 ◽  
pp. 1759720X2093427 ◽  
Author(s):  
Mark R. Phillips ◽  
Yaping Chang ◽  
Robert D. Zura ◽  
Samir Mehta ◽  
Peter V. Giannoudis ◽  
...  
Keyword(s):  
Surgical Management ◽  
Operative Treatment ◽  
Surgical Procedures ◽  
Elective Surgery ◽  
Treatment Options ◽  
Operative Management ◽  
Management Options ◽  
Orthopaedic Care ◽  
Elective Surgical Procedures ◽  
Non Operative Management

Background: Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions. Methods: A systematic search was conducted, and included guidance were categorized as either “Selective Postponement” or “Complete Postponement” of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports. Results: A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown. Conclusion: Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns.

scholarly journals Variation in management of humeral and clavicular shaft fractures amongst fellowship trained orthopedic traumatologists

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Behnam Sharareh ◽  
Christopher Perkins
Keyword(s):  
Surgical Management ◽  
Clavicle Fracture ◽  
Operative Management ◽  
Orthopedic Trauma ◽  
Chi Square ◽  
Medical Comorbidities ◽  
Clavicle Fractures ◽  
Clinically Significant ◽  
Non Operative Management ◽  
Trauma Surgeons

Abstract Background There exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons. The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures with respect to various patient populations. Methods A 6-question survey was created using Surveymonkey.com and distributed via the Orthopedic Trauma Association (OTA) website to fellowship trained orthopedic surgery traumatologists to survey the preferred management of a simple oblique middle 1/3rd diaphyseal humerus fracture and a middle 1/3rd displaced diaphyseal clavicle fracture in the following 3 clinical settings: a healthy laborer, an older patient with co-morbidities, and if the surgeon themselves sustained the injury. The ratio of operative to non-operative management was calculated for all 6 questions. A chi-square value was performed to determine if the results are clinically significant based on the clinical scenario. Results There was 56 responses to the survey that were included in the analysis. Overall, there was a statistically significant trend towards surgical management of the surgeon’s own diaphyseal humerus fractures (55%) compared to that of healthy patients (41%) and those with medical comorbidities (21%) (p = 0.02) A similar trend was noted for operative management for diaphyseal clavicle fractures by the surgeon on their own fractures (43%) compared to that of healthy patients (38%) and those with medical comorbidities (18%) (p = 0.02). Conclusion While there are an increasing number of relative indications for treatment of diaphyseal humerus shaft and clavicle fractures, the results of this survey indicate that fellow-ship-trained orthopedic trauma surgeons prefer surgical management of simple humerus and clavicular fractures in young, healthy patients as well as in themselves.

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