Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery

2018 ◽  
Vol 39 (10) ◽  
pp. 1135-1140 ◽  
Author(s):  
Elizabeth McDonald ◽  
Brian Winters ◽  
Kristen Nicholson ◽  
Rachel Shakked ◽  
Steven Raikin ◽  
...  
Keyword(s):  
Bone Healing ◽  
Case Series ◽  
Ankle Fractures ◽  
High Rate ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Clinical Healing ◽  
Mean Time

Background: In an effort to minimize narcotic analgesia and its potential side effects, anti-inflammatory agents offer great potential provided they do not interfere with bone healing. The safety of ketorolac administration after foot and ankle surgery has not been well defined in the current literature. The purpose of this study was to report clinical healing and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures. Methods: A retrospective review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients received 20 tablets of 10 mg ketorolac Q6 hours. Radiographs were evaluated independently by 2 blinded fellowship-trained orthopedic foot and ankle surgeons to assess for radiographic healing. A total of 281 patients were included, with a median age of 51 years and 138 males (47%). Statistical analysis consisted of a linear mixed-effects regression. Results: In all, 265/281 (94%) were clinically healed within 12 weeks and 261/281 (92%) were radiographically healed within 12 weeks. Within the group of patients that did not heal within 12 weeks, mean time to clinical healing was 16.9 weeks (range = 14-25 weeks), and mean time to radiographic healing was 17.1 weeks (range = 14-25 weeks). In patients taking ketorolac, there were no cases of nonunion in our series (n = 281) and no significant difference found between fracture patterns and healing or complications ( P = .500). Conclusions: Perioperative ketorolac use was associated with a high rate of fracture union by 12 weeks. This is the first study to examine the effect of ketorolac on radiographic time to union of ankle fractures. Additional studies are necessary to determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures. Level of Evidence: Level IV, case series.

scholarly journals NAVIGATED TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS WITH EXTRA-ARTICULAR DEFORMITY

2018 ◽  
Vol 26 (3) ◽  
pp. 170-174 ◽  
Author(s):  
IZUMI TANI ◽  
NAOKI NAKANO ◽  
KOJI TAKAYAMA ◽  
KAZUNARI ISHIDA ◽  
RYOSUKE KURODA ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Radiographic Outcomes ◽  
Navigation Group ◽  
Significant Difference ◽  
Total Knee

ABSTRACT Objective It is difficult to achieve proper alignment after total knee arthroplasty (TKA) in patients with extra-articular deformity (EAD) because of altered anatomical axis and distorted landmarks. As of this writing, only case series have been reported with regard to the usefulness of computer-assisted navigation systems for TKA with EAD. This study therefore compared outcomes in TKA with EAD, with and without navigation. Methods Fourteen osteoarthritis patients with EAD due to previous fracture malunion or operations were assessed. Seven TKAs were performed with navigation (navigation group) and another 7 were performed without navigation (manual group). Clinical and radiographic outcomes were compared before and two years after surgery. Results The mean postoperative Knee Society function score was significantly higher in the navigation group. No significant difference was found in postoperative range of motion and Knee Society knee score. The rate of outliers in radiographic outcomes tended to be lower in the navigation group. Conclusion Better clinical outcomes were achieved in cases in which navigation was used. Computer-assisted navigation is useful in TKA for patients with EAD. Level of Evidence III; Case control study.

scholarly journals Comparative study of the FAOS and FAAM questionnaires as functional assessment instruments for patients with hallux valgus

2020 ◽  
Vol 14 (2) ◽  
pp. 144-147
Author(s):  
Alesson Filipi Bernini ◽  
Silvia Iovine Kobata ◽  
Alexandre Cassini de Oliveira ◽  
Rubens Trabbold Aguiar ◽  
Antônio César Mezêncio da Silveira
Keyword(s):  
Hallux Valgus ◽  
Functional Assessment ◽  
Case Series ◽  
Assessment Instruments ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Functional Scores ◽  
The Right ◽  
Relationship Of

Objective: To compare the Portuguese translations of the Foot and Ankle Activity Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) questionnaires as functional assessment instruments for patients with hallux valgus and assess correlations between scores and severity of deformity. Methods: A total of 28 patients were assessed and the functional scores provided by the FAAM and FAOS questionnaires were compared and their correlations with clinical and radiological severity were analyzed. Results: Mean age was 46.88 years (range: 18 to 64). Laterality was distributed as follows: 57.1% had the deformity on the right foot (16 cases) and 42.9% on the left (12 cases). The deformities identified were graded as follows: 26.1% of patients had mild deformity (6 cases), 45.3% had moderate deformity (14 cases), and 28.6% had severe deformity (8 cases). It was observed that the distribution of scores for the different grades of deformity was the same for both questionnaires. Conclusion: There was no significant difference between the results obtained using the FAAM or the FAOS questionnaire or in the relationship of proportionality between radiological deformity grade and the functional scores obtained using the two tests. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Arthroscopic-assisted arthrodesis in the foot and ankle. Subtalar, tibiotalar, tibiocalcaneal, and metatarsophalangeal: 25 years of experience

2021 ◽  
Vol 0 ◽  
pp. 1-7
Author(s):  
Luis Perez-Carro ◽  
Carlos Rodrigo-Arriaza ◽  
Lorena Trueba-Sanchez ◽  
Gustavo Gutierrez-Castanedo ◽  
Guillermo Menendez-Solana ◽  
...  
Keyword(s):  
Case Series ◽  
Invasive Procedure ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Non Union ◽  
End Stage ◽  
Mean Time ◽  
Radiographic Union

Objectives: Arthritis of the foot and ankle joints provoke pain and restricts function. The arthroscopic assisted arthrodesis (AAA) is a minimally invasive procedure for end stage arthritis to eliminate pain and achieve painless mobilization, with numerous benefits like faster time to union, less blood loss, less morbidity, less infection rate, and less soft tissue complications compared with open surgery. The objective of this paper is to retrospectively evaluate our case series (136 patients) of arthroscopic assisted foot and ankle fusion that includes the subtalar, tibiocalcaneal, tibiotalar and metatarsophalangeal joint in our last 25 years of practice. Level of Evidence: Level IV, retrospective case series. Materials and Methods: Patients who underwent arthroscopic assisted arthrodesis in the foot and ankle were identified by review of a registry. Minimum follow-up was 24 months. Patient demographics characteristics, time to radiographic union, and preoperative and postoperative American Orthopaedic Foot and Ankle Society score (AOFAS) were obtained. Results: Subtalar fusion: 43 patients. Radiographic union was seen in 40 patients at a mean time of 10 weeks (8-14) and non union was seen in three patients, of which 1 required open revision surgery. AOFAS score improved from 43 preoperatively (27-57) to 83 (67-93) postoperatively. Tibiotalar fusion: 55 patients. Radiographic union in a mean time of 12 weeks (7-15) in all 55 cases. AOFAS score improved from 50.5 preoperatively (25-60) to 82 (62-94) postoperatively. Tibiotalocalcaneal fusion: 3 patients. 2 patients with radiographic union at 14 and 16 weeks and 1 showed a fibrotic union of the subtalar joint without pain. AOFAS score improved from 43 preoperatively (34-58) to 78 (67-81) postoperatively. Metatarsophalangeal fusion: 35 patients. Radiographic union in 33 patients at a mean time of 8 weeks (6-11). Two patients presented asymptomatic non union. AOFAS score improved from 38 preoperatively (30-60) to 86 (75-93) postoperatively. Conclusion: Arthroscopic assisted arthrodesis in the foot and ankle is an excellent procedure for end stage degenerated joint.

Safety Profile Associated With Calcaneal Autograft Harvesting Using a Reaming Graft Harvester

2020 ◽  
Vol 41 (12) ◽  
pp. 1487-1492
Author(s):  
Rona W. Law ◽  
Travis M. Langan ◽  
Devon W. Consul ◽  
James Steriovski ◽  
Mark A. Prissel ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Healing ◽  
Complication Rate ◽  
Safety Profile ◽  
Case Series ◽  
Autogenous Bone Graft ◽  
Autogenous Bone ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Surgery

Background: Foot and ankle surgery often requires bone healing, whether in elective arthrodesis or trauma. While primary bone healing is possible, the rate of nonunion in foot and ankle surgery remains variable. The addition of autogenous bone graft can allow for higher union rates by adding to the biology at the site of bone healing. Harvesting autogenous bone graft from the calcaneus for foot and ankle surgery can be done quickly and efficiently and allow for an adequate amount of graft. Methods: A retrospective chart and radiographic review was performed for 1438 patients at a single center between August 1, 2015, and December 15, 2018, who underwent calcaneal autograft harvesting using a power-driven reaming graft harvester. Results: In total, 966 patients were included and evaluated for the safety and complication rate associated with the procedure. Only 1 patient (0.1%) had a major complication, and there were 14 minor complications (1.4%). Conclusion: The safety profile and low complication rate of this case series demonstrate that this simple and efficient calcaneal autograft harvest technique can be considered when a small to moderate amount of autogenous bone graft is required to augment bone healing. Level of Evidence: Therapeutic level IV, case series.

Outcomes of Surgically Treated Fifth Metatarsal Fractures in Major League Soccer Athletes

2021 ◽  
pp. 036354652110302
Author(s):  
Jonathan A. Stone ◽  
Alejandro D. Miranda ◽  
Michael B. Gerhardt ◽  
Bert R. Mandelbaum ◽  
Eric Giza
Keyword(s):  
Case Series ◽  
Return To Sport ◽  
High Rate ◽  
Return To Play ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Major League Soccer ◽  
Major League ◽  
Metatarsal Fractures ◽  
Mean Time

Background: Sports-related fractures of the fifth metatarsal are common in professional athletes. Data regarding outcomes of surgical management including refracture, complications, and return-to-play statistics are available for other professional American sports with a notable exception of soccer. Purpose: To quantify the burden of operative fifth metatarsal fractures in Major League Soccer (MLS) athletes, to compare outcomes as well as refracture and complication rates with other professional sports, to analyze factors that may contribute to treatment failure, and to report on return-to-play characteristics for affected players. Study Design: Case series; Level of evidence, 4. Methods: We searched all injuries in the prospectively collected HealtheAthlete database for MLS for operative fifth metatarsal fractures for seasons 2013 to 2017. Additional information regarding each fracture including demographics, treatment, postoperative course, and return-to-play statistics were compiled from HealtheAthlete and supplemented by teams’ chief medical officers, coaches, trainers, and online sources. Results: There were 21 fractures in 18 players during the study period. Mean time to radiographic healing was 8.5 weeks (n = 17). Mean time to return to play was 11.1 weeks (n = 19). Of 21 fractures, 20 (95%) players returned to sport. Of 18 players, 4 (22.2%) experienced refracture. Of 18 players, 5 (27.8%) and 2 (11.1%) reported previous stress injuries on the contralateral and ipsilateral limb, respectively. Player performance characteristics showed small declines in the first year of return that improved by the second year. Conclusion: MLS athletes who sustain a sports-related fifth metatarsal fracture can expect a high rate of return to sport with time to radiographic healing and return to play as well as risk of refracture similar to other professional cohorts.

Supramalleolar Osteotomy Combined With an Intra-articular Osteotomy for the Reconstruction of Malunited Medial Impacted Ankle Fractures

2018 ◽  
Vol 39 (12) ◽  
pp. 1457-1463 ◽  
Author(s):  
Changjun Guo ◽  
Zongbao Liu ◽  
Yangbo Xu ◽  
Xingchen Li ◽  
Yuan Zhu ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Case Series ◽  
Preoperative Assessment ◽  
Ankle Fractures ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Supramalleolar Osteotomy ◽  
Significant Difference ◽  
The Mean

Background: Malunion of a medial impacted ankle fracture may cause varus ankle deformity. This retrospective study examined the use of supramalleolar osteotomy combined with an intra-articular osteotomy in patients with malunited medial impacted ankle fractures. Methods: Twenty-four patients with malunited medial impacted ankle fracture were treated between January 2011 and December 2014. Using Weber’s classification, 10 had type A fractures and 14 had type B, and with the AO classification, 20 had 44A2 and 4 had 44B3. All of these patients had varus ankle deformity. Supramalleolar osteotomy combined with an intra-articular osteotomy was performed. The visual analog scale (VAS) for pain during daily activities, the Olerud and Molander Scale and the modified Takakura classification stage were used to determine the clinical outcomes and a radiographic analysis was performed. Results: The radiographic parameters, including the tibial ankle surface (TAS) angle and talar tilt angle (TTA), showed significant differences between the preoperative and follow-up assessments. The mean tibial lateral surface (TLS) did not show a significant change. The average Olerud and Molander Scale score improved significantly from 56.4 ± 6.21 preoperatively to 77.0 ± 6.11 at the latest follow-up ( P < .01). The mean VAS decreased significantly from 6.7 ± 0.8 preoperatively to 3.1 ± 0.6 at the latest follow-up ( P < .01). No significant difference in the modified Takakura classification stage was observed between the preoperative assessment and the last follow-up. Conclusions: The use of a supramalleolar osteotomy combined with an intra-articular osteotomy was an effective option for the treatment of malunited medial impacted ankle fractures associated with varus ankle deformity. Level of Evidence: Level IV, retrospective case series.

Fifth Metatarsal Jones Fracture Fixation with a 4.5-mm Cannulated Stainless Steel Screw in the Competitive and Recreational Athlete

2005 ◽  
Vol 33 (5) ◽  
pp. 726-733 ◽  
Author(s):  
David A. Porter ◽  
Melissa Duncan ◽  
Susan J. F. Meyer
Keyword(s):  
Stainless Steel ◽  
Operative Treatment ◽  
Case Series ◽  
Cannulated Screw ◽  
Level Of Evidence ◽  
Jones Fracture ◽  
Stainless Steel Screw ◽  
Metatarsal Fractures ◽  
Clinical Healing ◽  
Mean Time

Background Fifth metatarsal Jones fractures are common in the athletic population. Optimal screw selection for operative treatment has not been determined. Hypothesis A 4.5-mm cannulated screw used for fixation of the fifth metatarsal Jones fractures in athletes is an effective treatment approach. Study Design Case series; Level of evidence, 4. Methods The authors studied 23 consecutive athletes (24 feet) who were treated surgically with a 4.5-mm cannulated screw for fifth metatarsal fractures (Jones fracture) with clinical and radiographic assessments. Results There have been no refractures to date. Clinical healing was 100%. The mean percentage healing as shown on radiographs was 98.9%, with a range of 90% to 100%. All athletes returned to sport at a mean time of 7.5 weeks (range, 10 days to 12 weeks). Two athletes experienced a “reinjury” without need for operative treatment. All athletes were recommended to wear orthoses until their competitive careers were completed. Conclusion Fixation with a stainless steel 4.5-mm cannulated screw gives 100% clinical healing and near-100% healing as shown on radiographs. Clinical Relevance The 4.5-mm cannulated screws can yield reliable and effective healing as evidenced by clinical assessment and radiographs of fifth metatarsal Jones fractures in athletes.

scholarly journals Outcomes of plantar fasciotomy to treat plantar fasciitis

2019 ◽  
Vol 13 (1) ◽  
pp. 42-48
Author(s):  
Rodrigo Guimarães Huyer ◽  
Cíntia Kelly Bittar ◽  
Carlos Daniel Candido de Castro Filho ◽  
Carlos Augusto Mattos ◽  
Mário Sérgio Paulillo De Cillo ◽  
...  
Keyword(s):  
Plantar Fasciitis ◽  
Case Series ◽  
Treatment Level ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Patient Health ◽  
Plantar Fasciotomy

Objective: This study sought to evaluate the effectiveness of a surgery (plantar fasciotomy) to treat plantar fasciitis using the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire. Methods: Patients were retrospectively identified using their postoperative orthopedic (medical) records after receiving medial plantar fasciotomy for plantar fasciitis between 1997 and 2009. Results: A significant difference was observed between the pre- and postoperative AOFAS score; this result indicates that patient health improved after the fasciotomy to treat plantar fasciitis. Conclusions: A strength of this study was its long follow-up time of patients undergoing plantar fasciotomy to treat plantar fasciitis. This surgery is indicated for patients with chronic plantar fasciitis after 6 months without response to conservative treatment. Level of Evidence IV; Therapeutic Studies; Case Series.

Limb Salvage After Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy

2016 ◽  
Vol 38 (3) ◽  
pp. 248-254 ◽  
Author(s):  
Nicholas J. Vaudreuil ◽  
Mitchell S. Fourman ◽  
Dane K. Wukich
Keyword(s):  
Peripheral Neuropathy ◽  
Limb Salvage ◽  
Ankle Joint ◽  
Treatment Algorithm ◽  
Case Series ◽  
Operative Management ◽  
Ankle Fractures ◽  
High Rate ◽  
Retrospective Case ◽  
Level Of Evidence

Background: Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. Methods: This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. Results: The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. Conclusion: This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level of Evidence: Level III, retrospective case series.

Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

2017 ◽  
Vol 38 (5) ◽  
pp. 485-495 ◽  
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Chiara Ursino ◽  
Nicola Serra ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Graft ◽  
Repeated Measures ◽  
Osteochondral Lesion ◽  
Young Patients ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Lesion Size ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

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