scholarly journals Short-term outcome of surgical arthrodiastasis of the ankle with Ilizarov frame in a cohort of children and young people with juvenile idiopathic arthritis

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Gavin Cleary ◽  
Clare Pain ◽  
Liza McCann ◽  
Kamran Mahmood ◽  
Steven Brookes-Fazakerley ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Joint Space ◽  
Rapid Progression ◽  
Short Term ◽  
Biologic Drugs ◽  
Term Outcome ◽  
Pain Scores ◽  
Ilizarov Frame ◽  
And Function ◽  
Medical Advances

Abstract Objectives Despite medical advances, life-changing articular damage may still occur in patients with JIA. We report a cohort with destructive arthropathy of the ankle treated by surgical arthrodiastasis. Methods Eight patients (nine ankles) received arthrodiastasis by means of an Ilizarov frame between 2009 and 2013. Patient- and clinician-reported outcome measures were collated prospectively, with retrospective analysis of demographics, disease and pre-surgical treatment. Results Pre-surgery, all patients received IA CS (mean 0.8 injections/year) and MTX (mean diagnosis to treatment 3.8 years; two of eight started within 3 months). Seven of eight patients received biologic drugs. Pain scores improved by 56 and 29% (P < 0.005) at 6 and 12 months post-frame removal. American Academy Orthopaedic Foot and Ankle Society ankle–hindfoot scale, Oxford Ankle Foot Questionnaire-Child and Oxford Ankle Foot Questionnaire-Parent scores improved by 171, 62 and 80%, respectively (P < 0.005) at 12 months post-frame removal. Patients remained satisfied with surgical treatment for a mean of 13.3 months. There was transient pin site infection in three patients, and all patients had radiological improvement in joint space. Conclusion Arthrodiastasis with an Ilizarov frame is a safe, well-tolerated technique that should be considered as a short-term joint-preserving procedure to improve pain and function when damage has occurred. Delays to systemic medical treatment in this cohort would be considered out-with standard modern practice but, although less prevalent, destructive ankle arthropathy continues to occur in JIA, and we believe this study to be relevant. The ankle is particularly susceptible to damage and, even if localized, should be treated early and aggressively with DMARDs and rapid progression to biologic therapies. Levelof evidence Level IV.

scholarly journals A prospective randomized comparison of short-term outcome of laparoscopic, totally extra-peritoneal and trans-abdominal pre-peritoneal repairs for inguinal hernia

2020 ◽  
Vol 7 (12) ◽  
pp. 3945
Author(s):  
Saurabh Kumar ◽  
Manmeet Kaur
Keyword(s):  
Inguinal Hernia ◽  
Laparoscopic Repair ◽  
Early Postoperative Period ◽  
Preperitoneal Space ◽  
Short Term ◽  
Term Outcome ◽  
Pain Scores ◽  
Choice Of Procedure ◽  
Duration Of Surgery ◽  
General Surgeons

Background: Laparoscopic repair of inguinal hernia is steadily gaining popularity among general surgeons. Laparoscopically the preperitoneal space can be approached in two different ways, as a result of which two techniques of laparoscopic repair have emerged. We performed this study to compare the two techniques in a randomized setting in order to ascertain, if possible, which of these techniques is preferable when there is a choice.  Methods: This randomized, comparative study was conducted at Shri Mahant Indiresh hospital, Dehradun over a period of three years. Patients with unilateral, uncomplicated, inguinal hernia were randomized into two groups for undergoing surgery using either of these techniques. Patients’ demography and both intraoperative and postoperative variables were compared between the two groups.Results: Mean duration of surgery and mean pain scores in early postoperative period were found to be higher for transabdominal preperitoneal (TAPP) group as compared to totally extraperitoneal (TEP) group. Intraoperative and postoperative complications as well as hospital stay were not significantly different between the two groups.Conclusions: In this study TEP has been found to have an edge over TAPP in some respect but as per the available evidence both techniques are safe and choice of procedure may be tailored according to individual cases.  

scholarly journals Associations Of Abnormalities Detected On Mri And Radiography With Hand Pain And Function In A Population-Based Older Adult Cohort.

2020 ◽  
Author(s):  
Siti Maisarah Mattap ◽  
Karen Wills ◽  
Dawn Aitken ◽  
Andrew Halliday ◽  
Shi-Nan Luong ◽  
...  
Keyword(s):  
Grip Strength ◽  
Joint Space ◽  
Population Based ◽  
Hand Osteoarthritis ◽  
Imaging Features ◽  
Cross Sectional ◽  
X Ray ◽  
Hand Pain ◽  
Pain Scores ◽  
And Function

Abstract Objective To describe associations between hand abnormalities on MRI or radiographs (X-ray) and pain and function in a cross-sectional study of community-based older adults. Methods Distal and proximal interphalangeal index finger joints (n=221) were examined using MRI, X-ray, and hand examination. Hand pain, function, and stiffness were assessed using Australian/Canadian hand osteoarthritis index (AUSCAN) questionnaire. Grip strength was assessed using dynamometer. Models were adjusted for age, sex, and other MRI or X-ray abnormalities. Results Absence of collateral ligament (CLs) on MRI (relative risk; RR=3.15 (95% confidence interval 1.33, 7.50), and joint space narrowing (JSN) on X-ray (RR=2.96 (1.33, 6.58)) was associated with having a painful joint after adjustment for confounders. JSN was also associated with tender joints (RR=2.19 (1.01, 4.76)). Effusion-synovitis was associated with better AUSCAN pain scores (OR=0.51 (0.28, 0.94)) and JSN with worse AUSCAN pain scores (odds ratio; OR=1.67 (1.13, 2.48)). Absent CLs were also associated with stiffer joints (OR=3.12 (1.26, 7.70)) and weaker grip strength (β=-1.69 (-2.95, -0.43)) independent of pain and other features; JSN was also associated with weaker grip strength (β=-0.87 (-1.62, -0.14)). No other MRI or X-ray abnormalities were associated with pain or function independent of age, sex or pain. Conclusion Most MRI abnormalities were not associated with pain and function cross-sectionally. Absent CLs and JSN were associated with painful joints and weak grip strength independent of pain and other imaging features. JSN was also associated with tender joints and absent CLs with stiff joints. Unexpectedly, effusions were associated with reduced odds of pain.

Ulnar head replacement and sigmoid notch resurfacing arthroplasty with minimum 12-month follow-up

2019 ◽  
Vol 44 (9) ◽  
pp. 957-962 ◽  
Author(s):  
Nicholas J. Clark ◽  
Nicholas Munaretto ◽  
Bassem T. Elhassan ◽  
Sanjeev Kakar
Keyword(s):  
Short Term ◽  
Level Of Evidence ◽  
Visual Analogue Pain ◽  
Excellent Outcome ◽  
Ulnar Head ◽  
Pain Scores ◽  
Feasible Option ◽  
And Function ◽  
Joint Arthritis

Our study aimed to report the short-term outcomes of patients who underwent partial ulnar head replacement and distal radial ulnar joint interposition arthroplasty. From 2012 to 2016, nine patients underwent this procedure with mean follow-up of 27 months (range 12–55). Seven of the nine patients had previously undergone surgical intervention on the ipsilateral wrist. The procedure resulted in substantial improvements in pain and function. Mayo Wrist Score improved from 37 preoperatively to 73 postoperatively, and six patients achieved a good or excellent outcome. Visual analogue pain scores decreased from 7 preoperatively to 1 postoperatively. Grip improved from 20 kg preoperatively to 30 kg postoperatively. There was no significant change in wrist range of motion. Two patients underwent revision surgery to improve wrist motion. We conclude that over short-term follow-up the procedure provides a feasible option for distal radial ulnar joint arthritis. Level of evidence: IV

scholarly journals Surgical Treatment of Lumbosacral Discospondylitis with Gentamicin-Impregnated Polymethylmethacrylate Cement and Omentalization

VCOT Open ◽  
2019 ◽  
Vol 02 (01) ◽  
pp. e13-e18
Author(s):  
Maria Manou ◽  
Aurélien Jeandel ◽  
Stéphane Blot ◽  
Pierre Moissonnier
Keyword(s):  
Surgical Treatment ◽  
Histopathological Examination ◽  
Activity Level ◽  
Clinical Report ◽  
Fungal Culture ◽  
Short Term ◽  
German Shepherd ◽  
Term Outcome ◽  
German Shepherd Dog

Objective The aim of this study was to describe a novel technique using a gentamicin-impregnated polymethylmethacrylate (PMMA) plug for the surgical treatment of lumbosacral discospondylitis with concomitant instability. Clinical Report A 7-year-old male German Shepherd dog with lumbosacral (LS) discospondylitis and previously diagnosed with degenerative lumbosacral disease underwent ventral slot and distraction of the L7 to S1 intervertebral space with a gentamicin-impregnated PMMA plug. The lumbosacral joint was accessed via the abdomen. Samples were collected for bacterial culture and sensitivity, fungal culture and histopathological examination. The surgical site was omentalized. Long-term oral antimicrobials were administered. Results Clinical improvement was seen immediately after surgery. Complete return to previous activity level was observed 12 months after surgery. Follow-up radiographs 18 months after the procedure revealed no implant migration. Clinical Significance The gentamicin-impregnated PMMA plug in addition to the surgical debridement seemed to be an effective way for short-term distraction, potentially contributing, along with the appropriate antimicrobial therapy and analgesia, to alleviation of pain immediately after surgery and providing for a good short-term outcome, in this clinical case. The use of cement plugs as sole devices in the LS joint warrants further study.

scholarly journals Comparison of medical and surgical treatment for acute cervical compressive hydrated nucleus pulposus extrusion in dogs

2017 ◽  
Vol 181 (23) ◽  
pp. 625-625 ◽  
Author(s):  
Tana Borlace ◽  
Rodrigo Gutierrez-Quintana ◽  
Frances Ellen Taylor-Brown ◽  
Steven De Decker
Keyword(s):  
Surgical Treatment ◽  
Nucleus Pulposus ◽  
Medical Management ◽  
Clinical Presentation ◽  
Imaging Findings ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Successful Outcomes

Although successful outcomes have been reported after medical and surgical treatment for dogs with cervical hydrated nucleus pulposus extrusion (HNPE), it is unknown which treatment option is preferred. Thirty-four dogs treated medically (n=18) or surgically (n=16) for cervical HNPE were retrospectively identified. Signalment, clinical presentation and imaging findings were compared between medically and surgically treated dogs. Medical management consisted of restricted exercise in combination with physiotherapy. Surgical treatment consisted of a ventral slot procedure. Short-term follow-up information was retrieved from re-examination visits. Long-term outcome was obtained via telephone interviews. More dogs in the surgical group demonstrated cervical hyperaesthesia on initial clinical presentation (P=0.045), otherwise there was no significant difference in signalment, clinical presentation or imaging findings between both groups. Two dogs in the medically managed group underwent surgical decompression due to an unsatisfactory response to medical management. All cases for which long-term information was available (n=30) were neurologically normal at the time of data collection. There were no significant differences for any of the short-term or long-term outcome variables between both treatment groups. This study demonstrated successful outcomes after medical or surgical treatment and suggests that both treatment modalities can be considered for dogs with cervical HNPE.

Age is an important predictor of short-term outcome in endoscopic carpal tunnel release

2009 ◽  
Vol 34 (5) ◽  
pp. 660-664 ◽  
Author(s):  
T. B. HANSEN ◽  
K. LARSEN
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Invasive Technique ◽  
Multivariable Logistic Regression Analysis ◽  
Short Term ◽  
Postoperative Rehabilitation ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Endoscopic Carpal Tunnel Release ◽  
And Function

Endoscopic carpal tunnel release is a minimally invasive technique that may reduce sick leave and facilitate postoperative rehabilitation and short-term outcome. The aim of this study was to investigate the influence of age as a predictor of short-term outcome in endoscopic carpal tunnel release. We did a prospective registration of patient satisfaction, symptoms and function before and 2-months after endoscopic carpal tunnel release in 101 consecutive patients aged 23–94 years and then submitted the data to multivariable logistic regression analysis. Patient age >65 years was a good predictor of a less favourable short-term outcome, and endoscopic carpal tunnel release may not be justified as a routine procedure in elderly patients.

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