scholarly journals Successful Early Non-Operative Management of Congenital Knee Dislocation: Demonstration via a Case Report

2021 ◽  
pp. 138-144
Author(s):  
Punit Tiwari ◽  
Harmeet Kaur ◽  
Sergey S. Leonchuk
Keyword(s):  
Surgical Intervention ◽  
Knee Dislocation ◽  
Operative Management ◽  
Female Child ◽  
Congenital Deformity ◽  
Full Extension ◽  
Live Births ◽  
Serial Casting ◽  
Congenital Knee Dislocation ◽  
Non Operative Management

Congenital knee dislocation (CKD) is a deformity in which unnatural hyperextension is possible at the knee much beyond the normal 0° full extension while the flexion is severely restricted. Incidence of this rare congenital malformation is 1/100,000 live births. We present a clinical case of unilateral CKD in a 2-week-old female child and our approach of treatment using serial casting. We have been able to demonstrate that if initiated early, within first few weeks of life, the congenital deformity of knee can be managed conservatively without any surgical intervention even in higher grades.

scholarly journals Surgical treatment of tarsal coalitions in children and adolescents

2020 ◽  
Vol 5 (2) ◽  
pp. 80-89
Author(s):  
Alpesh Kothari ◽  
Javier Masquijo
Keyword(s):  
Surgical Intervention ◽  
Operative Management ◽  
Foot And Ankle ◽  
Ankle Pain ◽  
Tarsal Coalition ◽  
Algorithmic Approach ◽  
Tarsal Bones ◽  
Non Operative Management ◽  
Impaired Quality

A tarsal coalition is an abnormal connection between two or more tarsal bones caused by failure of mesenchymal segmentation. The two most common tarsal coalitions are calcaneonavicular coalition (CNC) and talocalcaneal coalition (TCC). Both CNC and TCC can be associated with significant foot and ankle pain and impaired quality of life; there may also be concomitant foot and ankle deformity. Initial, non-operative management for symptomatic tarsal coalition commonly fails, leaving surgical intervention as the only recourse. The focus of this article is to critically describe the variety of methods used to surgically manage CNC and TCC. In review of the pertinent literature we highlight the ongoing treatment controversies in this field and discuss new innovations. The evidence-based algorithmic approach used by the authors in the management of tarsal coalitions is illustrated alongside some clinical pearls that should help surgeons treating this common, and at times complex, condition. Cite this article: EFORT Open Rev 2020;5:80-89. DOI: 10.1302/2058-5241.5.180106

scholarly journals Developing a Clinical Prediction Model for Failed Nonoperative Management of SLAP Tears (220)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0032
Author(s):  
Elyse Berlinberg ◽  
Matthew Kingery ◽  
Amit Manjunath ◽  
Danielle Markus ◽  
Eric Strauss
Keyword(s):  
Prediction Model ◽  
Operative Treatment ◽  
Surgical Intervention ◽  
Predictive Accuracy ◽  
Operative Management ◽  
Treatment Modalities ◽  
Clinical Prediction ◽  
Shoulder Injury ◽  
Clinical Prediction Model ◽  
Non Operative Management

Objectives: Patients with a superior labral anterior to posterior (SLAP) tear of the shoulder are often initially treated non-operatively, but many do not respond and require surgery. Identifying patients who are likely to fail non-operative management and would benefit from early surgical intervention can shorten time of disability and limit resources utilized on unsuccessful treatments. The purpose of this study is to create a clinical prediction model to determine which patients are likely to fail non-operative treatment of SLAP tears and require surgical intervention. Methods: This was a case-control study consisting of patients treated at a single institution for isolated, non-degenerative SLAP tears. Patients with concomitant rotator cuff tears were excluded from this analysis. Patients were retrospectively surveyed using the Research Electronic Data Capture (REDCap) system regarding clinical features of their shoulder injury, non-operative treatments that they received, and key functional outcomes during their post-injury period. Responders underwent additional medical record review to identify other variables related to the clinical presentation and treatment of their shoulder injury. In order to simplify the predictive model and optimize its interpretability, the lasso (least absolute shrinkage and selection operator) method of penalized logistic regression analysis was used to identify the characteristics that were most closely associated with failure of nonoperative treatment. The data was randomly split into a training set and test set. Using the training set, the value of lambda which minimized cross-validation prediction error rate was determined (Figure 1). The final lasso model was then computed. The predictive accuracy of the final model was assessed using the test data set. Results: Overall, 189 patients were contacted and included in the analysis. The mean age of included patients was 29.9 +/- 6.7 years. Thirty-eight patients (20.1%) were female. One hundred and six patients (56.1%) failed non-operative management and required surgical intervention. The final lasso model identified a total of 9 variables that were significantly associated with failure of non-operative management of SLAP tears (Table 1). These predictors included pre-injury overhead sports participation, presence of specific symptoms, severity of pain, and the type of non-operative treatment modalities used. Injury to the dominant extremity, history of prior shoulder injury, patient age, use of NSAIDs, and occupation involving manual labor or overhead work were not associated with failure of nonoperative treatment. The predictive accuracy of the model was 70.3% (95% CI 53.0%, 84.1%). Sensitivity of the model was 81.0% and specificity was 56.3%. Conclusions: A clinical prediction model consisting of variables describing patient characteristics, specific symptoms, and the type of non-operative treatment modalities utilized was found to predict failure of non-operative management of SLAP tears with moderate accuracy. Further refinements of this prediction model, including the inclusion of additional physical examination and imaging variables, will be required before future iterations are tested in clinical practice.

scholarly journals Return to Play Following High-Grade Turf Toe Injuries in National Football League Athletes

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0005
Author(s):  
Benjamin B. Lindsey ◽  
Neil K. Bakshi ◽  
David M. Walton ◽  
James R. Holmes ◽  
Paul G. Talusan
Keyword(s):  
National Football League ◽  
Surgical Intervention ◽  
Operative Management ◽  
Return To Play ◽  
High Grade ◽  
Turf Toe ◽  
The Mean ◽  
And Performance ◽  
Non Operative Management ◽  
Mean Time

Category: Sports; Midfoot/Forefoot; Trauma Introduction/Purpose: Return-to-play (RTP) rates of National Football League (NFL) athletes following surgical intervention for numerous foot and ankle injuries has been reported. To our knowledge, no studies have reported on RTP rates of NFL athletes after non-operative and operative treatment of high-grade turf toe injuries. The purpose of this study was to evaluate the RTP rates in NFL athletes who sustained high-grade turf to injuries. We hypothesized that NFL athletes requiring operative intervention for high-grade turf toe injuries would have lower RTP rates and longer recoveries than athletes treated non- operatively. Additionally, we hypothesized that regardless of treatment, NFL athletes would demonstrate equal productivity following RTP. Methods: Publicly available NFL injury data was reviewed to identify athletes who sustained high-grade turf toe injuries, as indicated by surgical intervention or missed playing time of 2 weeks or more. Athletes were excluded if RTP was prevented for reasons unrelated to the injury. Demographic and performance data was obtained including a player’s injury, date of injury, date of surgery, RTP, time to RTP, number and percentage of games played, and performance. Results: 53 NFL athletes were identified with high-grade turf toe injuries that met inclusion criteria. 28 of these athletes were treated non-operatively and 25 were treated with surgery. The overall RTP rate was 91%. Athletes who were treated non- operatively had a RTP rate of 100% while athletes who underwent surgery had a RTP rate of 80% (P = 0.011). The mean time to RTP for all athletes was 140.9+-111.9 days. The mean time to RTP for non-operatively treated patients was 75.8+-99.0 days, compared with 221.4+-81.6 days for operatively treated athletes (P = 0.002). In skill position athletes who achieved RTP, 78% treated non-operatively were able to return to their prior level of performance compared to only 27% for athletes treated surgically (P = 0.032). Conclusion: There is a significant difference in return to play following surgical versus non-operative management of high-grade turf toe injuries, with only 80% of athletes achieving return to play after surgery. No athletes were able to return the same season as surgery and the mean time to RTP following initiation of treatment was significantly shorter for players who underwent non- operative management. Postoperative performance was also significantly worse in players who underwent surgical intervention compared to non-operative management. This study provides important prognostic information to high level athletes in regards to recovery following high-grade turf toe injuries

scholarly journals Management of pediatric blunt abdominal trauma: تدبير رضوح البطن الكليلة عند الأطفال

2021 ◽  
Vol 5 (4) ◽  
pp. 27-20
Author(s):  
Wassem Ameer Shater, Mohammad Ali Nasser, Ali Mohammad Allou Wassem Ameer Shater, Mohammad Ali Nasser, Ali Mohammad Allou
Keyword(s):  
Operative Treatment ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Surgical Intervention ◽  
Operative Management ◽  
Pancreatic Injury ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Abdominal Injuries ◽  
Non Operative Management

Aim of study: Evaluating a non- operative treatment of pediatric blunt abdominal trauma and avoiding unnecessary surgical intervention in Tishreen University Hospital. Methods: During years (2016- 2020) a retroprospective study was conducted on 62 children who had isolated blunt abdominal trauma or associated with other injuries, most of them were managed by non- operative treatment but some required surgical management. Results: Non- operative management of pediatric blunt abdominal injuries was applied for 59 patients, three patients required a surgical procedure, the spleen was the most organ exposed to injury (40) child, followed by liver (26) child, kidney (4) and (1) pancreatic injury. Non- operative management was successful in most solid organs injuries with grades 1, 2 and 3, but it failed in 5 grade splenic injury. one out of two hollow viscus injuries required surgical intervention. There were no statistical differences between the study groups in age, gender and injury mechanism. Hospital length of stay was significantly longer in patients who underwent a laparotomy (6) days compared to other non- operative patients (3) days, one complication occurred during non- operative management as pseudocyst after pancreatic injury, (4) patient died in the non- operative group due to hemodynamic instability and associated severe cerebral injuries. Conclusion: It is safe to treat most children with blunt abdominal injuries non- operatively if monitoring is adequate with hemodynamic stability.

scholarly journals Predictive Factors for Surgical Intervention in Adhesive Bowel Obstruction: A 5-Year Retrospective Study

2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Afuwape OO ◽  
Ulasi IB ◽  
Ajagbe OA ◽  
Soneye OY ◽  
Ekhaiyeme PA ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Predictive Factors ◽  
Early Phase ◽  
Developing World ◽  
Surgical Intervention ◽  
Operative Management ◽  
Operative Intervention ◽  
Non Operative Management

Background: Adhesive Bowel Obstruction (ABO) is a major cause of intestinal obstruction globally and in the developing world. Although guidelines for its management lean towards initial non-operative management, it is important to identify factors that may predict the need for an operative intervention in the early phase of presentation.

scholarly journals The Elbow UCL Injury Prognosis Score

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0036
Author(s):  
Elizabeth R. Dennis ◽  
John D. Mueller ◽  
Danica D. Vance ◽  
Kayla E. Neville ◽  
Nicole K. Skursky ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Operative Treatment ◽  
Predictive Value ◽  
Surgical Intervention ◽  
Operative Management ◽  
Return To Play ◽  
Non Operative Management ◽  
Prognosis Score

Objectives: No model exists to predict which patients with elbow ulnar collateral ligament (UCL) injuries will successfully return to play (RTP) with non-operative treatment. The reported rates for successful RTP after non-operative management of UCL injuries are limited and vary widely. Furthermore, patient and UCL injury characteristics that influence failure of non-operative treatment have not been established. We sought to identify which factors were most significant in predicting which patients would have successful RTP after non-operative management of UCL injury. In doing so, we created the Elbow UCL Injury Prognosis Score to identify and weigh factors that predict failure of non-operative treatment. The parameters include: age, position, competition level, moving valgus stress test (MVST), 5th finger sensation, UCL tenderness, and MRI findings including tear type, location, and chronicity features. This score will predict which patients will succeed non-operative management, avoiding unnecessary surgery while simultaneously identify patients for whom non-operative management would be delaying the inevitable need for surgical intervention. Methods: 205 patients were evaluated by the senior author for a UCL injury. Physical exam findings, imaging characteristics and patient demographics were retrospectively collected and entered into a HIPAA-compliant REDCap database after IRB approval of the study design. Of these patients, 138 underwent a trial of non-operative treatment and were either cleared for RTP (n= 55) or eventually underwent surgical intervention (n= 83) after a minimum one-month trial of non-operative management. Sixty-seven patients decided to have surgery immediately without trialing non-operative management and were excluded from the scoring system. The Elbow UCL Injury Prognosis Score was developed and validated using stepwise feature selection by Akaike information criterion (AIC). Three-fold cross validation was performed using these ten variables as predictors. The mean and standard deviation of area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value were evaluated. Results: The area under curve for non-operative failure predicting non-operative management failure was 0.79 (0.054), with sensitivity=0.85 (0.088), specificity=0.72 (0.032), positive predictive value=0.83 (0.023), negative predictive value=0.77 (0.091) [mean (standard deviation (SD))]. Patients were predicted to succeed non-operative management if they scored less than 10, while for a score greater than or equal to 10 patients would likely fail non-operative management and require surgical intervention for their UCL injury (Table 1). Conclusion: The Elbow UCL Injury Prognosis Score is a statistically rigorous, powerful tool for predicting which patients will most likely RTP with non-operative treatment. We hope this score can provide surgeons with a useful tool to enhance and enable shared decision making with patients when faced with UCL injuries at all competitive levels. [Table: see text]

Congenital knee dislocation: a rare and unexpected finding

2021 ◽  
Vol 14 (1) ◽  
pp. e234881
Author(s):  
Melanie Yeoh ◽  
Gayatri Athalye-Jape
Keyword(s):  
Treatment Options ◽  
Full Range ◽  
Rare Condition ◽  
Knee Dislocation ◽  
Unexpected Finding ◽  
Independent Mobility ◽  
Serial Casting ◽  
Congenital Knee Dislocation ◽  
Grade Ii

Congenital knee dislocation is a rare condition of unknown aetiology. It could be associated with syndromes or may occur as an isolated entity. The severity of the deformity determines the method of treatment. Treatment options range from conservative casting to surgical correction. The case presented is of a newborn with an isolated grade II dislocation treated with serial casting. On follow-up at 2 years, the patient had a good outcome, with full range of motion and independent mobility.

Sign in / Sign up

Export Citation Format

Share Document