scholarly journals Non-surgical management of a tibiofemoral knee dislocation in a patient with sarcoidosis

2019 ◽  
Vol 12 (11) ◽  
pp. e229605
Author(s):  
Daniel Flowers ◽  
Margaret Olmedo
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Functional Outcomes ◽  
Treatment Guidelines ◽  
Knee Dislocation ◽  
Soft Tissue Reconstruction ◽  
Positive Functional ◽  
Tissue Reconstruction ◽  
Non Surgical Treatment ◽  
Complex Injuries

This case presents a patient who sustained a knee dislocation, and who due to her diagnosis of sarcoidosis, other comorbidities, and prolonged use of corticosteroids, external fixation and physical therapy were implemented versus soft tissue reconstruction/repair. Research indicates worse functional outcomes with non-surgical treatment, and guidelines on optimising outcomes in this population are lacking. Integrated care of the patient—even when complex injuries and comorbid medical conditions are present—can lead to positive functional recovery, despite previous data. Evidence from related injuries can be successfully adapted in non-surgical management of these injuries, providing general treatment guidelines.

Carpal Instability Non-Dissociative

1994 ◽  
Vol 19 (6) ◽  
pp. 763-773 ◽  
Author(s):  
T. W. WRIGHT ◽  
J. H. DOBYNS ◽  
R. L. LINSCHEID ◽  
W. MACKSOUD ◽  
J. SIEGERT
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Surgical Management ◽  
Clinical Evidence ◽  
Wrist Pain ◽  
Carpal Instability ◽  
Soft Tissue Reconstruction ◽  
Results Of Treatment ◽  
Significant Difference ◽  
Tissue Reconstruction

A retrospective study of 45 patients with symptoms of wrist pain and weakness with clinical evidence of instability is presented. These patients had normal intrinsic interosseous ligaments demonstrated arthrographically or surgically. They were followed for a minimum of 18 months and an average of 5.8 years. All patients demonstrated instability of the proximal carpal row which is referred to as carpal instability non-dissociative (CIND). Seven patients were treated non-operatively and 38 were treated operatively. Surgical management consisted of soft tissue reconstruction directed at the area of instability in 34 cases, joint levelling osteotomy in six, three of whom also had soft tissue reconstructions, and mid-carpal fusion in one. The overall good and excellent results were a disappointing 56% and there was no significant difference between the non-surgical and surgical groups. The best results were found in the ulna-minus CIND patients who underwent a joint levelling osteotomy, with 83% good and excellent results. CIND is associatedwith extrinsic ligamentous laxity; however, significant difficulty exists in locating the precise areas of maximum pathology. This accounts for the unpredictable results of treatment. As our understanding of the pathomechanics of CIND improves, the treatment will become more specific and the results should improve.

Occlusion and Functional Outcomes after Complete Temporomandibular Joint Resection with Soft Tissue Reconstruction

2020 ◽  
Vol 162 (4) ◽  
pp. 589-592
Author(s):  
Jake J. Lee ◽  
Daniel P. Lander ◽  
Ryan S. Jackson ◽  
Joseph Zenga ◽  
Patrik Pipkorn
Keyword(s):  
Soft Tissue ◽  
Temporomandibular Joint ◽  
Functional Outcomes ◽  
Free Tissue Transfer ◽  
Feeding Tube ◽  
Soft Tissue Reconstruction ◽  
Intermaxillary Fixation ◽  
Occlusal Contact ◽  
Tissue Reconstruction ◽  
Interincisor Distance

Reconstructive outcomes after complete temporomandibular joint (TMJ) resection, including the condyle and glenoid fossa bone, are poorly defined in the literature. We described our technique and reviewed occlusion and functional outcomes of 6 consecutive patients undergoing complete TMJ resection and reconstruction with anterolateral thigh free tissue transfer and intermaxillary fixation with elastic bands for 6 to 8 weeks. At median follow-up of 14 months, median Mandibular Function Impairment Questionnaire score was 32 (range, 4-38), indicating mild to moderate impairment. Subjective occlusion was normal in 4 of 6 patients. Premature occlusal contact was seen in 2 of 6 patients. Maximal interincisor distance and horizontal mandibular shift with jaw abduction ranged from 29 to 40 mm and 5 to 8 mm, respectively. Four of 6 tolerated regular diets while 2 adhered to mechanical soft diets; no patients were feeding tube dependent. Soft tissue–only reconstruction after complete TMJ resection resulted in good subjective and objective occlusion in 4 of 6 patients and no cases of severe functional impairment.

scholarly journals Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Koji Nozaka ◽  
Naohisa Miyakoshi ◽  
Hidetomo Saito ◽  
Hiroaki Kijima ◽  
Motoki Mita ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Deformity Correction ◽  
Knee Dislocation ◽  
Varus Deformity ◽  
Soft Tissue Reconstruction ◽  
Leg Length ◽  
Tissue Reconstruction

Abstract Background Severe varus deformity and soft tissue injury caused by a burn around a complex knee dislocation is a rare injury. Soft tissue reconstruction and deformity correction with circular hexapod external fixation of the knee and hinged total knee arthroplasty (TKA) are challenging and can lead to major complications if not performed appropriately. We present a case in which a combination of soft tissue reconstruction, circular hexapod external fixation, and TKA was used treat severe knee dislocation due to burn scarring. Case presentation We report the case of a 58-year-old woman who presented for knee surgery with soft tissue reconstruction, deformity correction with circular hexapod external fixation, and hinged TKA for a severe complex deformity and soft tissue injury caused by a burn injury at 6 months of age. The left leg was shorter by 35 mm in terms of functional leg length discrepancy. She walked with a limp, with a marked varus deformity of the left knee during the stance phase of walking. After a 3-stage repair, the patient was able to walk without assistance, confirming improvement of mobility. Conclusion The treatment method was an effective use of a combination of soft tissue reconstruction, circular hexapod external fixation, and rehearsal surgery using a 3D printed bone model of the modular rotating hinge component of TKA, which was successfully used to treat a severe knee dislocation due to burn scarring. This staged surgery maintained the leg length and ultimately achieved a satisfactory alignment.

scholarly journals Outcomes after Trifocal Femoral Fractures

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Michelle Griffin ◽  
Alastair G. Dick ◽  
Shamim Umarji
Keyword(s):  
Surgical Treatment ◽  
Young People ◽  
Functional Outcomes ◽  
Distal Femur ◽  
Femoral Fractures ◽  
High Energy ◽  
Locking Plates ◽  
Femur Fractures ◽  
Complex Injuries

Trifocal femur fractures are those of the femoral neck, diaphysis, and distal femur. These high-energy injuries predominantly occur in young people with the potential for long-term complications and disability. We present the cases of two men who were treated with proximal dynamic hip screws and distal periarticular locking plates to effectively manage trifocal femur fractures. Our cases have shown union at 2 years with good functional outcomes without the need for reintervention. We provide evidence for a successful surgical treatment option for these rare and complex injuries.

scholarly journals Tricks and pitfalls in the surgical treatment of malignant bone tumours of the forearm in children and adolescents

2021 ◽  
Vol 15 (4) ◽  
pp. 366-371 ◽  
Author(s):  
Bulent Erol ◽  
Omer Sofulu
Keyword(s):  
Surgical Management ◽  
Multidisciplinary Approach ◽  
Functional Results ◽  
Bone Tumours ◽  
Soft Tissue Reconstruction ◽  
Unique Region ◽  
Reconstruction Methods ◽  
Malignant Bone Tumours ◽  
Tissue Reconstruction ◽  
Bone Sarcomas

Malignant bone tumours around the forearm are rare. Nowadays, oncological and surgical management of bone sarcomas of this region has improved significantly. Although the anatomical features are complex, limb-sparing surgery is possible with wide surgical resection. Biological reconstruction methods are promising in this anatomically unique region. In addition, meticulous soft-tissue reconstruction yields good functional results in the hand and wrist. This study reviews malignant bone tumours of the forearm and their oncological and surgical management. Malignant bone tumours should be treated with a multidisciplinary approach based on chemotherapy, radiotherapy and limb salvage procedures.

scholarly journals Wrist deformity, bother and function following wrist fracture in the elderly

2020 ◽  
Author(s):  
Andrew Lawson ◽  
Partiban Santhakumar ◽  
Justine M Naylor ◽  
Tim Churches ◽  
Steve Frost ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Outcomes ◽  
The Elderly ◽  
Wrist Fracture ◽  
Retest Reliability ◽  
Treatment Type ◽  
Patient Reported ◽  
And Function ◽  
Test Retest Reliability ◽  
Non Surgical Treatment

Abstract Objective Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: 1. determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it; 2. test if there were associations between deformity and treatment-type and between deformity and function; 3. test for associations between bother and treatment-type and between bother and function; 4. measure the test-retest reliability of the ‘bother’ question. Results Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR=3.85, p=0.006) but was not significantly associated with functional outcomes (p=0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p=0.006) and this association was clinically significant (MD=35 points). The deformity and bother questions were found to have excellent test-retest reliability; ᴋ=1.00 and ᴋ=0.92, respectively.

scholarly journals Recent Advances in Hand Surgery and Future Prospects

2019 ◽  
Vol 16 (1) ◽  
pp. 211-219 ◽  
Author(s):  
N. Mariappan ◽  
M.Sri Vignesh
Keyword(s):  
Health Care ◽  
Surgical Treatment ◽  
Functional Outcomes ◽  
Hand Surgery ◽  
Future Prospects ◽  
Clinical Specialty ◽  
Recent Advances ◽  
Non Surgical Treatment

The health care in hand surgery deals not only with surgical and non-surgical treatment and management. This field has been recognized much enough and development as independent clinical specialty. This review highlights the importance of hand surgery seems as a separate and independent clinical specialty, progress and challenges faced in past during its development, functional outcomes.

scholarly journals Wrist deformity, bother and function following wrist fracture in the elderly

2020 ◽  
Author(s):  
Andrew Lawson ◽  
Partiban Santhakumar ◽  
Justine M Naylor ◽  
Tim Churches ◽  
Steve Frost ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Outcomes ◽  
The Elderly ◽  
Wrist Fracture ◽  
Retest Reliability ◽  
Treatment Type ◽  
Patient Reported ◽  
And Function ◽  
Test Retest Reliability ◽  
Non Surgical Treatment

Abstract Objective Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: 1. determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it; 2. test if there were associations between deformity and treatment-type and between deformity and function; 3. test for associations between bother and treatment-type and between bother and function; 4. measure the test-retest reliability of the ‘bother’ question. Results Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR=3.85, p=0.006) but was not significantly associated with functional outcomes (p=0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p=0.006) and this association was clinically significant (MD=35 points). The deformity and bother questions were found to have excellent test-retest reliability; ᴋ=1.00 and ᴋ=0.92, respectively.

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