The Effect of the Mobile Subtalar Joint on Calcaneal and Supramalleolar Osteotomies

2021 ◽  
pp. 107110072110272
Author(s):  
Fabian Krause ◽  
Ivan Zderic ◽  
Boyko Gueorguiev ◽  
Anandakumar Vellasamy ◽  
Timo Schmid
Keyword(s):  
Subtalar Joint ◽  
Inverse Correlation ◽  
Cadaver Study ◽  
Maximum Pressure ◽  
Moderate Correlation ◽  
Level Of Evidence ◽  
Computed Tomographic ◽  
Before And After ◽  
Prior Trauma ◽  
Compensatory Effect

Background: The mobile subtalar joint (STJ) may compensate for supra- and inframalleolar deformities and counteract the effect of realigning calcaneal or distal tibial osteotomies. The purpose of this study was to evaluate the compensatory effect of the mobile STJ after supramalleolar osteotomy (SMOT) and calcaneus osteotomy (COT) and whether the extent of the compensation correlates with STJ shape and orientation. Methods: In 10 human lower leg cadavers without evidence of deformity or prior trauma 700 Newton load were applied as a simulated standing pose. The center of force (COF) migration, maximum pressure (Pmax), and the area loaded were measured with high-resolution sensors in the ankle before and after 10-mm varus/valgus sliding COT and 10-degree varus / valgus SMOT. A computed tomographic evaluation of subtalar anatomy was conducted to correlate posterior facet curvature, its varus/valgus orientation in the coronal plane, and the effect on COF, Pmax, and area loaded. Results: The COF migration was significant for both varus and valgus SMOTs (varus SMOT: 1.78 mm, P = .0029; valgus SMOT: 1.85 mm, P = .0018) but not for COT (varus COT: 0.45 mm, P = .85; valgus COT: 1.15 mm, P = .11). Pmax and area loaded changed but not significantly. The radius of the posterior STJ surface showed a moderate correlation (varus SMOT: r = 0.61, P = .063; valgus SMOT: r = 0.28, P = .43, varus COT: r = −0.61, P = .063; valgus COT: r = 0.13, P = .38) and the axis a weak inverse correlation (varus SMOT: r = −0.51, P = .013; valgus SMOT: r = 0.58, P = .079; varus COT: r = −0.51, P = .14; valgus COT: r = 0.38, P = .28) with the COF migration after the osteotomies. Conclusion: The compensatory capacity of a mobile STJ is relatively small but appears to limit the effect of COT more than SMOT. The COT is less effective in influencing ankle joint pressure for realignment purposes than SMOT in mobile STJ and clinically more consistent in stiff STJ. Correlations are moderate to weak, whereas the curvature more than orientation of posterior facet inversely correlates with osteotomy’s effects. Level of Evidence: IV (biomechanical cadaver study).

scholarly journals Arthroscopic treatment of subtalar joint injuries

2019 ◽  
Vol 13 (1) ◽  
pp. 22-27
Author(s):  
Felipe Ayusso Correa Sossa ◽  
Inacio Diogo Asaumi ◽  
Alfonso Apostólico Netto ◽  
Rafael Da Rocha Macedo ◽  
Donato Lo Turco ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Level Of Evidence ◽  
Before And After ◽  
Reduction Of Pain ◽  
Vas Scores ◽  
The Mean ◽  
Status Level

Objective: To evaluate the results of arthroscopic treatment of various subtalar joint pathologies. Methods: Retrospective study of patients undergoing arthroscopy of the subtalar joint from 2005 to 2013, totaling 10 cases over a mean follow-up of 27.1 months, in which the American Orthopedic Foot and Ankle Society (AOFAS) scale and pain visual analogue scale (VAS) scores before and after surgery were compared. Results: The preoperative AOFAS scores ranged from 35 to 74, with a mean score of 50.1 points, and the postoperative scores ranged from 82 to 100 points, with a mean score of 90.8 points. When comparing the scores, we observed an average gain of 40.1 points. The mean VAS score for the initial pain assessment was 6.5 points, and the mean postoperative score was 1.4 points. Conclusion: Arthroscopic treatment of the reported subtalar pathologies led to encouraging results, with a significant reduction of pain and improvement of functional status. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals SUBTALAR JOINT IN NEUTRAL AND RELAXED POSITIONS FOR EVALUATION OF MEDIAL LONGITUDINAL ARCH

2021 ◽  
Vol 29 (4) ◽  
pp. 177-180
Author(s):  
ANDRÉ SETTI PERSIANE ◽  
DAIANE MAGALHÃES GOMES NEGRÃO ◽  
RAONE DALTRO PARAGUASSU ALVES ◽  
DIEGO GALACE DE FREITAS ◽  
CLÁUDIO CAZARINI JÚNIOR ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Cross Sectional Study ◽  
Medial Longitudinal Arch ◽  
Strongly Correlated ◽  
Test Results ◽  
Moderate Correlation ◽  
Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Longitudinal Arch

ABSTRACT Objective: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. Methods: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson’s test. Results: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). Conclusion: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

Bone Cysts and Osteolysis in Ankle Replacement

2020 ◽  
pp. 107110072095515
Author(s):  
Ali-Asgar Najefi ◽  
Yaser Ghani ◽  
Andrew J. Goldberg
Keyword(s):  
Prevalence Study ◽  
Resection Margins ◽  
Bone Cysts ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Plain Radiographs ◽  
Computed Tomographic ◽  
Common Location ◽  
Postoperative Setting ◽  
End Stage

Background: Total ankle replacements (TARs) have higher rates of osteolysis than hip or knee replacements. It is unclear whether this is a pathologic immunologic process in response to wear debris, or expansion of pre-existing osteoarthritic bone cysts. We aimed to determine the incidence of bone cysts in patients with end-stage ankle arthritis prior to surgery and review the literature on bone cysts and osteolysis in relation to TAR. Methods: This is a descriptive/prevalence study in which all patients with end-stage ankle arthritis underwent plain radiographic imaging and computed tomographic (CT) scans prior to TAR surgery. Their imaging was assessed for the presence of cysts, measured on sagittal, axial, and coronal slices of the CT scan at the widest diameter. All cysts that would be removed as a result of the bone resection for the implant were excluded using digital analysis software. We assessed 120 consecutive patients with mean age of 63.4 years. Results: Seventeen patients (14%) did not have any bone cysts based on CT images. Ten patients (8%) had cysts that would have been completely removed by surgery, leaving 93 patients for analysis (78%). In 60% of these cases, the cysts were not seen on the plain radiographs. In 39 patients (33%), the cysts were greater than 5 mm in size. The medial (36%) and lateral malleoli (33%) were the most common location for the cysts (mean diameter 4.6±2.0 and 4.2±2.3 mm, respectively). Conclusion: Bone cysts outside of the resection margins for a TAR were present in 78% of patients with ankle arthritis prior to undergoing surgery. In 30% of cases, cysts were greater than 5 mm in size. In 60% of cases, the cysts were not seen on plain radiographs. Preoperative 3-dimensional imaging can provide a foundation to observe and quantify cyst presence, expansion, and time of onset in the postoperative setting. Level of Evidence: Level IIc, diagnostic/prevalence study.

scholarly journals Computed Tomography and Bronchoscopy in Endobronchial Tuberculosis

2003 ◽  
Vol 10 (8) ◽  
pp. 445-448 ◽  
Author(s):  
Halil Yanardag ◽  
Cüneyt Tetikkurt ◽  
Seza Tetikkurt ◽  
Sabriye Demirci ◽  
Tuncer Karayel
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Therapeutic Response ◽  
Histopathological Examination ◽  
Computed Tomographic ◽  
Before And After ◽  
Endobronchial Tuberculosis ◽  
Age Range

BACKGROUND: The therapeutic response to endobronchial tuberculosis is usually evaluated by bronchoscopy. Currently, there are no published studies investigating the use of computed tomography for the evaluation of therapeutic response in endobronchial tuberculosis.OBJECTIVE: A retrospective study was performed to evaluate the bronchoscopic and computed tomographic features of endobronchial tuberculosis before and after treatment. The aim of this study was to investigate the usefulness of computed tomography for the assessment of treatment.METHODS: The clinical, pathological and bronchoscopic features of endobronchial tuberculosis were evaluated in 55 patients. The age range of the patients was 21 to 52 years. Computed tomography and bronchoscopy were performed before and after treatment.RESULTS: Diagnosis of tuberculosis was confirmed by culture and histopathological examination. Bronchoscopic examination revealed 89 endobronchial lesions of various types in 55 patients. The exudative type was the most common. Follow-up bronchoscopy revealed that exudative-, ulcerative- and granular-type lesions healed completely. Computed tomography performed after treatment correlated well with the follow-up bronchoscopic findings.CONCLUSION: The results suggest that follow-up computed tomography is useful for the evaluation of therapeutic response and complications associated with endobronchial tuberculosis, and may replace bronchoscopy.

Lessons learned from volar plate fixation of scaphoid fracture nonunions

2017 ◽  
Vol 43 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Seth D. Dodds ◽  
John B. Williams ◽  
Max Seiter ◽  
Clark Chen
Keyword(s):  
Plate Fixation ◽  
Scaphoid Fracture ◽  
Case Series ◽  
Lessons Learned ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Computed Tomographic ◽  
Volar Aspect ◽  
Fracture Nonunions ◽  
New Type

Treating scaphoid nonunions presents difficulties particularly when there is bone loss, significant humpback deformity or avascular necrosis. We describe a new type of fixation with a volar scaphoid plate that adds to the methods of internal fixation that are available for the treatment of recalcitrant scaphoid nonunions. We will also discuss ‘lessons learned’ from a cases series. The case series includes 20 consecutive patients treated with volar buttress plating and a pedicled vascularized bone graft from the ipsilateral volar distal radius. There was clinical and radiographic evidence of union in 18 of 20 patients, 13 of which were verified by computed tomographic scan. The range of motion was improved in all patients post-operatively. Four patients with radiographic union experienced intermittent clicking with maximal wrist flexion, believed to be due to the impingement of the plate on the volar aspect of the radioscaphoid articulation and underwent removal at approximately 1 year after the index procedure. Volar scaphoid plating is a useful alternative to headless scaphoid screw fixation in the treatment of unstable scaphoid waist fractures and nonunions. Level of evidence: IV

Quantitative Computed Tomographic Scan and Polysomnographic Analysis of Patients with Syndromic Midface Hypoplasia before and after Le Fort III Distraction Advancement

2011 ◽  
Vol 127 (4) ◽  
pp. 1612-1619 ◽  
Author(s):  
Russell E. Ettinger ◽  
Richard A. Hopper ◽  
Gavin Sandercoe ◽  
Yemiserach Kifle ◽  
Babette Saltzman ◽  
...  
Keyword(s):  
Le Fort ◽  
Computed Tomographic ◽  
Midface Hypoplasia ◽  
Le Fort Iii ◽  
Computed Tomographic Scan ◽  
Before And After

scholarly journals Inverse correlation between baseline inhibin B and FSH after stimulation with GnRH: a study of serum levels of inhibin A and B, pro alpha-C and activin A in women with ovulatory disturbances before and after stimulation with GnRH

2000 ◽  
pp. 77-84 ◽  
Author(s):  
FW Casper ◽  
RJ Seufert ◽  
K Pollow
Keyword(s):  
Inverse Correlation ◽  
Strong Relationship ◽  
Serum Levels ◽  
Activin A ◽  
Inhibin B ◽  
Inhibin A ◽  
Before And After ◽  
Pituitary Secretion ◽  
Objective Interest ◽  
A Minor

OBJECTIVE: Interest has focused recently on the influences of the polypeptide factors inhibin and activin on the selective regulation of the pituitary secretion of gonadotropins. DESIGN: Measurement of the concentrations of inhibin-related proteins in relation to the changes in pituitary gonadotropin (FSH, LH) parameters, after GnRH stimulation with a bolus injection of 100 microg gonadorelin, in 19 women with ovulatory disturbances. METHODS: Serum levels of inhibin A and B, activin A, and pro alpha-C were measured using sensitive ELISA kits. RESULTS: Within 60 min after GnRH stimulation, FSH values doubled from 5 to 10 mU/ml (P < 0.001). LH increased 12-fold from 2 to 24 mU/ml (P < 0.001). Activin A showed a significant decrease from 0.47 to 0.36 ng/ml (P < 0.001), whereas pro alpha-C increased from 127 to 156 pg/ml (P = 0.039). The median inhibin A concentration did not show a significant change between baseline and the 60 min value, whereas inhibin B was characterized by a minor, but not significant, increase in the median from 168 to 179 pg/ml (P = 0.408). A significant inverse correlation (P = 0.014) with a mean coefficient of correlation of 0.5516 was found, demonstrating a strong relationship between high inhibin B baseline levels and a small increase of FSH after 60 min. CONCLUSION: Our results show an interesting correlation between the baseline inhibin B and the change in FSH before and after GnRH stimulation. A high baseline inhibin B implies only a minor increase of FSH after 60 min.

Changes to Eye Whiteness and Eyelid/Brow Position With Topical Oxymetazoline in Aesthetic Patients

2021 ◽  
Author(s):  
Shoaib Ugradar ◽  
Jane S Kim ◽  
Noelle Trost ◽  
Emanuil Parunakian ◽  
Erin Zimmerman ◽  
...  
Keyword(s):  
Color Change ◽  
Color Space ◽  
Ophthalmic Solution ◽  
The United States ◽  
Lower Eyelid ◽  
Secondary Outcome ◽  
Level Of Evidence ◽  
Upper Eyelid ◽  
Before And After ◽  
The Mean

Abstract Background Oxymetazoline hydrochloride 0.1% ophthalmic solution has recently been approved in the United States for the treatment of ptosis. Objectives The aim of this study was to assess the upper and lower eyelid position as well as the brow position and the color of the sclera following the ophthalmic administration of oxymetazoline hydrochloride 0.1%. Methods In this prospective cohort study, consecutive patients presenting with ptosis received topical oxymetazoline 0.1%. The primary outcome was measurement of the upper eyelid height (margin-to-reflex distance 1 [MRD1]) and lower eyelid height (MRD2) relative to the center of pupil, along with assessment of brow height, measured on photographs at baseline and 2 hours after instillation of oxymetazoline. The secondary outcome was the assessment of the color of the sclera (eye whiteness) before and after treatment with a novel color space algorithm. Results Twenty-nine patients participated in the study. The mean [SD] MRD1 at baseline was 2.3 [0.6] mm. At 2 hours following oxymetazoline treatment, the mean MRD1 significantly increased to 4.2 [0.9] mm (P &lt; 0.01). The mean MRD2 also significantly increased from 5.3 [0.9] mm to 5.7 [1.0] mm (P &lt; 0.01). Brow position did not change with treatment (P = 0.4). Following treatment, the eye sclera became significantly whiter, with a mean ΔEab (color change) of 9.7 [3.9], with 57 out of 58 eyes experiencing a significant change in color. A change of ΔEab ≥2 is considered visually perceptible to the human eye. Conclusions Within 2 hours of use, oxymetazoline significantly improves the size of the palpebral aperture (MRD1 + MRD2) and also makes the eye appear significantly whiter. Level of Evidence: 4

Stereotactic Intratumoral Photodynamic Therapy for Recurrent Malignant Brain Tumors

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 688-696 ◽  
Author(s):  
Stephen K. Powers ◽  
Sharon S. Cush ◽  
Diana L. Walstad ◽  
Lester Kwock
Keyword(s):  
Photodynamic Therapy ◽  
Magnetic Resonance ◽  
Malignant Gliomas ◽  
Signs And Symptoms ◽  
Resonance Spectroscopy ◽  
Normal Brain ◽  
Hematoporphyrin Derivative ◽  
Neurological Sequelae ◽  
Computed Tomographic ◽  
Before And After

Abstract Photodynamic therapy (PDT) using purified hematoporphyrin derivative and stereotactic intratumorally implanted optical laser fiber(s) was used to treat patients with recurrent malignant gliomas and metastatic melanoma of the brain. Tumor response to PDT was evaluated by recording changes in the volume and pattern of tumor enhancement between computed tomographic and magnetic resonance imaging scans done before and after PDT, metabolic changes in tumor tissue by31 P magnetic resonance spectroscopy, and patient outcome. Toxicity of PDT to brain was evaluated on the basis of changes in the patients' neurological examinations and correlated with changes in brain adjacent to tumor seen on postoperative imaging studies. Dramatic tumor responses to PDT were seen in all gliomas, but no response of tumor to treatment was seen with melanoma. Transient signs and symptoms of increased peritumoral cerebral edema caused by PDT were seen in all patients. Two patients suffered permanent neurological sequelae, monocular blindness and a partial visual field defect, as a result of treatment. Two patients with recurrent anaplastic astrocytomas remain in remission at 45 and 35 weeks after PDT. We conclude that intratumoral photoradiation therapy of hematoporphyrin derivative-photosensitized malignant gliomas effectively produces necrosis of the solid component of malignant gliomas: however, intratumoral photoradiation may not reach the portion of tumor that invades normal brain.

scholarly journals LOW-LOAD RESISTANCE EXERCISE IMPROVES COGNITIVE FUNCTION IN OLDER ADULTS

2018 ◽  
Vol 24 (2) ◽  
pp. 125-129 ◽  
Author(s):  
Amanda Veiga Sardeli ◽  
Marina Lívia Venturini Ferreira ◽  
Lucas do Carmo Santos ◽  
Marília de Souza Rodrigues ◽  
Alfredo Damasceno ◽  
...  
Keyword(s):  
Older Adults ◽  
Response Time ◽  
Resistance Exercise ◽  
Load Resistance ◽  
Level Of Evidence ◽  
Healthy Older Adults ◽  
Results Of Treatment ◽  
Low Load ◽  
Before And After ◽  
Exercise Induced

ABSTRACT Introduction: Resistance exercise (RE) training is widely recommended for increasing muscle strength and mass in older adults. RE is also a potential stimulus to improve cognitive functions (CF), but the best protocol for this purpose is unknown. Objective: To compare the effects of different RE protocols on CF in the same group of individuals. Methods: Twenty-four older adults were randomized (cross over) to control (CON) and lower limb RE protocols with high load (HL - 80% of 1RM), low load (LL - 30% of 1RM) and LL with blood flow restriction (LL-BFR - 30% of 1RM and 50% BFR). For CF assessment, participants underwent the Stroop test before and after each RE protocol. Results: Reduction in response time for Stroop neutral stimuli was greater after LL (effect size (ES) = -0.92) compared to CON (ES = -0.18) and HL (ES = -0.03), but was not different from LL-BFR (ES = -0.24). The reduced response time was associated with reduced parasympathetic modulation and increased cardiac output across protocols. Conclusion: LL was the most effective RE protocol to improve CF of older adults and a potential beneficial effect of LL-BFR on CF (non-significant) was identified. Therefore, LL resistance exercise appears to stimulate acute cognitive improvements in healthy older adults, probably through exercise-induced optimal autonomic modulation changes. Level of Evidence I; Therapeutic studies-Investigating the results of treatment.

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