Operative Management of Foot and Ankle Equinovarus Associated with Focal Dystonia

1998 ◽  
Vol 19 (4) ◽  
pp. 229-231 ◽  
Author(s):  
Thomas J. Moore ◽  
William Evans ◽  
Douglas Murray
Keyword(s):  
Tendon Transfer ◽  
Operative Management ◽  
Clinical Results ◽  
Focal Dystonia ◽  
Functional Improvement ◽  
Foot And Ankle ◽  
Tendon Transfers ◽  
Anterior Tibial ◽  
Clinically Significant

Six surgical procedures, consisting of tendon transfers and releases, were performed in five patients with idiopathic focal dystonia involving the lower extremity. All patients were female. Surgical management was performed to correct clinically significant foot abnormalities. The goal of each procedure was functional improvement and obtaining a plantigrade foot. The SPLATT (split anterior tibial tendon transfer) procedure was performed in each foot with a flexible equinovarus foot abnormality. Follow up at a mean of 27.2 months (range, 8–40 months) yielded satisfactory clinical results without significant complications. Clinical equinovarus has not recurred after this procedure. All patients remain brace-free ambulators.

Can Revision TKA Patients Achieve Similar Clinical Functional Improvement Compared to Primaries?

2019 ◽  
Vol 33 (12) ◽  
pp. 1219-1224 ◽  
Author(s):  
Shikha Sachdeva ◽  
James F. Baker ◽  
Jesse E. Bauwens ◽  
Langan S. Smith ◽  
Nipun Sodhi ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Primary Total Knee Arthroplasty ◽  
Clinical Results ◽  
Implant Design ◽  
Functional Improvement ◽  
P Value ◽  
Average Improvement ◽  
Aseptic Revision ◽  
Revision Tka

AbstractThe etiology of failure following primary total knee arthroplasty (TKA) leading to revision surgery are multifactorial, including infection, instability, loosening, contracture, and wear. Although the majority of patients have successful outcomes following revision TKA, postoperative complications are still increased in these patients when compared to primary patients. For this reason, there has been a continued search to identify options, including prosthesis types, to potentially improve outcomes. Therefore, the purpose of this study was to determine if the clinical results achieved following revision TKA are comparatively similar to primaries using the same implant design. Specifically, we compared (1) Knee Society Functional and Range-of-Motion Knee Scores and (2) component survivorship. This was a retrospective analysis of 100 patients undergoing revision TKA due to an aseptic etiology, who were matched to a cohort of 100 patients who underwent primaries with the same prosthesis. There were no differences in the groups with respect to age at surgery, sex, and body mass index. The mean follow-up was 57 months in the revision group (range 24–105 months) and 67 months in the primary TKA group (range 55–123 months). American Knee Society Scores (KSS) and range of motion measurements recorded preoperatively and at the most recent postoperative visit were compared between both cohorts in order to compare postoperative outcomes. A p value of 0.05 was used for significance. The average improvement between the pre- and postoperative KSS function scores in both groups was similar, with both cohorts demonstrating a 28-point improvement. At 2-year follow-up, all-cause survivorship of the aseptic revision surgeries was 87%. Patients undergoing revision TKA for aseptic loosening can potentially expect similar improvements in clinical function scores and survivorship compared to primary TKA when controlling for implant type.

scholarly journals Outcomes of Tibiotalocalcaneal Arthrodesis using a Custom Three-Dimensional Printed Titanium Truss Implant

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0017
Author(s):  
Daniel Corr ◽  
Jared Raikin ◽  
Joseph T. O’Neil ◽  
Steven M. Raikin
Keyword(s):  
Postoperative Complications ◽  
Short Form ◽  
Three Dimensional ◽  
Functional Improvement ◽  
Salvage Procedure ◽  
Foot And Ankle ◽  
Hindfoot Alignment ◽  
Average Patient ◽  
Osseous Defects

Category: Ankle; Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis (fusion) is considered a salvage procedure for patients with severe hindfoot and ankle pathology. Several techniques have been described for TTC fusion, including the use of an intramedullary rod, plate and screw constructs, screws only, and external fixation/frames. Recently, 3D printing technology has allowed for a new technique to treat large hindfoot and ankle osseous defects with a custom three-dimensional (3D) titanium truss implant. These implants are specifically designed based on preoperative patient computed tomography (CT) scans. Early studies have shown promising radiographic and functional results, though these have been limited largely to expert opinions and case reports. The purpose of this study is to evaluate the clinical, radiographic, and functional outcomes of TTC arthrodesis using a custom 3D titanium truss implant. Methods: A retrospective review of patients who have undergone TTC arthrodesis utilizing a custom 3D-printed titanium truss implant (4WEB Medical, Inc., Frisco, TX) with a fellowship-trained orthopaedic foot and ankle surgeon at a single institution was performed. Patients <18 years old, and those undergoing TTC arthrodesis using any other primary method of filling osseous defects (i.e. femoral head allografts, autografts) were excluded. Patient demographics including age, sex, body mass index (BMI), smoking status, laterality of surgery, co-morbidities (diabetes mellitus, rheumatoid arthritis), preoperative diagnosis, previous hindfoot or ankle surgeries, and any postoperative complications were collected. Patients at least one year removed from the procedure were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) subscale, along with the Visual Analog Scale for pain (VAS) and the Short Form-12 questionnaire (SF-12). Postoperative radiographs were reviewed to assess ankle and hindfoot alignment, implant integrity and any osseous abnormalities. Results: Eighteen patients underwent TTC fusion using custom titanium truss implants and were eligible for follow-up and analysis. Average patient age at the time of surgery was 58.7 years, and average BMI was 30.25 kg/m2. Seven patients (38.9%) were either current or former smokers, and 3 patients (16.7%) were diabetic. On average, patient FAAM ADL scores improved from 33.23 preoperatively to 59.56 (p=0.023), while VAS pain scores decreased from 59.07 to 34.22 (p<0.001). SF-12 Mental Health scores increased from 45.45 to 56.42 (p=0.031), while Physical Health scores improved mildly from 28.78 to 31.75 (p=0.110). Two patients (11.1%) had significant postoperative complications; one patient went on to require below knee amputation, and one patient demonstrated incomplete healing with implant loosening at their most recent follow-up. Conclusion: We have shown that custom titanium truss implants are viable and effective for use in TTC fusion. Use of such implants resulted in significant functional improvement among the cohort with low rates of complications and subsequent surgical interventions.

Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation

1997 ◽  
Vol 86 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Jean Raymond ◽  
Daniel Roy ◽  
Michel Bojanowski ◽  
Robert Moumdjian ◽  
Georges L'Espérance
Keyword(s):  
Endovascular Treatment ◽  
Clinical Results ◽  
Aneurysm Rupture ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Clinically Significant ◽  
Technical Complication ◽  
Fine Print

✓ The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS). There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms. Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients. Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.

Clinical outcomes and dislocation rates after hip reconstruction using the Bioball system

2019 ◽  
Vol 30 (5) ◽  
pp. 609-616 ◽  
Author(s):  
John Dabis ◽  
Jonathan R Hutt ◽  
David Ward ◽  
Richard Field ◽  
Philip A Mitchell ◽  
...  
Keyword(s):  
Femoral Stem ◽  
Clinical Results ◽  
Femoral Anteversion ◽  
Functional Improvement ◽  
Leg Length ◽  
Neck Extension ◽  
Post Surgery ◽  
Iatrogenic Damage ◽  
The Uk

Introduction: Instability accounts for 1/3 of revision total hip arthroplasty (rTHA) performed in the UK. Removal of well-fixed femoral stems in rTHA is challenging with a risk of blood loss and iatrogenic damage to the femur. The Bioball universal adaptor (BUA), a modular head neck extension adaptor, provides a mechanism for optimisation of femoral offset, leg length and femoral anteversion. This can avoid the need for femoral stem revision in selected cases. The aim of this study is to present the clinical results and rate of instability following revision with this BUA at a minimum of 2 years follow-up. Patients and methods: A review of our prospectively collected database was performed. All patients treated with the Bioball device were included. Clinical and radiologic review were performed pre- and post-surgery. Specific enquiry for instability was made. The Oxford Hip Score (OHS), EuroQol (EQ-5D) score and WOMAC scores were calculated pre-and post-operatively. Complications were recorded. Results: 32 rTHA procedures were performed using the Bioball device between 2013 and 2016. 4 patients did not wish to complete post-operative questionnaires. 2 patients (2/28, 7%) complained of recurrent dislocations following their rTHA procedure. 1 patient complained of instability but no dislocation. The median pre-operative EQ-5D was 0.195 (range −0.07–0.85), OHS was 20 (range 5–43) and WOMAC was 29.8 (range 15.5–52.3). The median EQ-5D was 0.85 (range 0.59–1), OHS was 39 (range 21–48) and WOMAC was 91.1 (range 44.5–99.2) at final follow-up. There were significant improvements in the EQ-5D ( p = 0.0009), OHS ( p = 0.0004) and WOMAC ( p = 0.0001). Conclusion: The BUA is associated with significant functional improvement and relatively low dislocation rates in revision THA. It is a viable option for use in the revision setting.

scholarly journals Extensor Digitorum Longus Tenosynovitis Caused by Talar Head Impingement in an Ultramarathon Runner: A Case Report

2007 ◽  
Vol 15 (2) ◽  
pp. 245-247 ◽  
Author(s):  
H Kobayashi ◽  
M Sakurai ◽  
T Kobayashi
Keyword(s):  
Extensor Digitorum Longus ◽  
Operative Management ◽  
Extensor Digitorum ◽  
Foot And Ankle ◽  
Functional Disturbance ◽  
Longus Tendon ◽  
Talar Head ◽  
Stenosing Tenosynovitis ◽  
Non Operative Management

Stenosing tenosynovitis of the extensor digitorum longus tendon is an injury related to ultramarathon running. A 32-year-old male ultramarathon runner developed chronic tenosynovitis of the ankle dorsiflexors. He was diagnosed with extensor digitorum longus tenosynovitis caused by talar head impingement associated with exostosis. He failed to respond to non-operative management and decided to undergo tenosynovectomy of the extensor digitorum longus tendon. The pain was relieved without functional disturbance of the foot and ankle, and the patient returned to running 3 weeks postoperatively. At the 2-year follow-up, he was participating fully in ultramarathons.

Skeletal and dentoalveolar effects using tooth-borne and tooth-bone-borne RME appliances: a randomized controlled trial with 1-year follow-up

2020 ◽  
Author(s):  
Farhan Bazargani ◽  
Henrik Lund ◽  
Anders Magnuson ◽  
Björn Ludwig
Keyword(s):  
Nasal Cavity ◽  
Controlled Trial ◽  
Upper Airway ◽  
Clinical Results ◽  
Maxillary Expansion ◽  
Eligibility Criteria ◽  
Midpalatal Suture ◽  
Clinically Significant ◽  
Plaster Models

Summary Objectives To evaluate and compare the skeletal and dentoalveolar effects of tooth-borne (TB) and tooth-bone-borne (TBB) rapid maxillary expansion (RME). Materials and methods Fifty-two consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years [standard deviation (SD) 1.3], or the TBB group, mean age 9.5 years (SD 1.2). Cone-beam computed tomography (CBCT) records and plaster models were taken before (T0), directly after (T1), and 1 year after expansion (T2). Dentoalveolar and skeletal measurements were made on the CBCT images. The dental expansion was also measured on the plaster models. Randomization Participants were randomly allocated in blocks of different sizes using the concealed allocation principle in a 1:1 ratio. The randomization list was also stratified by sex to ensure homogeneity between groups. Blinding Due to clinical limitations, only the outcomes assessors were blinded to the groups to which the patients were allocated. Results Skeletal expansion in the midpalatal suture and at the level of the nasal cavity was significantly higher in the TBB group. However, the magnitude of the expansion in the midpalatal suture was around 1 mm [95 per cent confidence interval (CI) 0.5–1.7, P = 0.001] more and perhaps not clinically significant. The magnitude of the expansion at the level of the nasal cavity was almost two times higher in the TBB group (95 per cent CI 0.7–2.6, P = 0.001). The dental expansion, alveolar bending, tipping of the molars, and stability 1 year post-expansion did not show any statistically significant differences between the groups. The actual direct cost of the treatment for the TBB group was approximately €300 higher than TB group. Limitations Double blinding was not possible due to the clinical limitations. Conclusions In young preadolescents with constricted maxilla and no signs of upper airway obstruction, it seems that conventional TB RME achieves the same clinical results with good stability 1 year post-expansion at lower cost. Trial registration The trial was not registered.

Patellar Tendinopathy in Athletes

2000 ◽  
Vol 28 (3) ◽  
pp. 392-397 ◽  
Author(s):  
Alfredo Schiavone Panni ◽  
Mario Tartarone ◽  
Nicola Maffulli
Keyword(s):  
Operative Management ◽  
Clinical Results ◽  
Symptomatic Improvement ◽  
Rehabilitation Program ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Patellar Tendinopathy ◽  
Mucoid Degeneration ◽  
Tendon Tissue ◽  
Antiinflammatory Drugs

We report the results of nonoperative and operative management of patellar tendinopathy in 42 athletes with Blazina stage 2 (26 patients) or stage 3 (16 patients) patellar tendinopathy. All patients were initially managed nonoperatively with nonsteroidal antiinflammatory drugs, physical therapy, and a progressive rehabilitation program based on isometric exercises, stretching, and eccentric exercises. After 6 months, 33 patients showed symptomatic improvement and were able to resume their sports. In nine patients with Blazina stage 3 tendinopathy, nonoperative measures failed, and surgery was performed. Operative treatment consisted of removal of the degenerated areas of the tendon, multiple longitudinal tenotomies, and drilling of the lower pole of the patella at the site of tendon attachment. Histologic examination of the excised tendon tissue showed areas of necrosis and mucoid degeneration, and alterations of the bone-tendon junction. After a mean follow-up of 4.8 years, clinical results were excellent or good in all patients. In the group treated nonoperatively, results were better in the patients who had stage 2 tendinopathy than in those with stage 3.

Flexor to Extensor Tendon Transfers in the Hand

1995 ◽  
Vol 20 (1) ◽  
pp. 26-28 ◽  
Author(s):  
W. J. DUNNET ◽  
P. L. HOUSDEN ◽  
R. BIRCH
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Tendon Transfer ◽  
Extensor Tendon ◽  
Contralateral Side ◽  
Vascular Injuries ◽  
Wrist Extension ◽  
Power Grip ◽  
Tendon Transfers

We reviewed 49 cases of flexor to extensor tendon transfer following injury to the radial nerve (22) or brachial plexus (27). Post-operative follow-up averaged 5.6 years (0.5–12.5). Function was improved in 84% (41) of patients. 16% (8) reported no improvement; of these, four (50%) had associated vascular injuries. In those with improvement, impaired coordination and dexterity were reported by 79% (15 of 19) of the plexus injuries and in 64% (14 of 22) of the radial nerve palsies. Premature fatigue was noted by 89% (17 of 19) of plexus injuries and in 82% (18 of 22) of radial nerve palsies. The power of wrist extension averaged 22% of the contralateral side (8% to 80%), power of digital extension was 31% (5% to 130%), and power grip was reduced to 40% (5% to 86%).

Arthroscopic Versus Open Broström-Gould Repair for Chronic Ankle Instability

2020 ◽  
Vol 41 (6) ◽  
pp. 647-653 ◽  
Author(s):  
Bo Jun Woo ◽  
Mun Chun Lai ◽  
Kevin Koo
Keyword(s):  
Clinical Outcomes ◽  
Ankle Instability ◽  
Short Form ◽  
Perioperative Period ◽  
Operative Management ◽  
Chronic Ankle Instability ◽  
Foot And Ankle ◽  
Open Technique ◽  
Level Of Evidence

Background: The open Broström-Gould procedure for the repair of lateral ankle ligament remains the gold standard in operative management of chronic ankle instability. Nevertheless, the arthroscopic technique has been gaining attention among foot and ankle surgeons in the past decade. Our study aimed to compare the clinical outcomes of patients who underwent the arthroscopic and open Brostom-Gould technique over a 12-month follow-up period. Methods: We retrospectively reviewed the database in a tertiary hospital foot and ankle registry from 2015 to 2019. We then performed a 1:1 matching of 26 ankles that underwent the arthroscopic Broström-Gould technique to 26 ankles with the open technique, all performed by a fellowship-trained foot and ankle surgeon, for age, sex, and body mass index. To assess clinical outcomes, visual analog scale scores, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form 36 Health Survey scores were collected at the preoperative and 6- and 12-month follow-up visits, respectively. Results: The arthroscopic group demonstrated significantly less pain in the perioperative period (arthroscopic, 1.0 ± 1.2; open, 2.4 ± 2.2; P = .015) and had higher AOFAS scores at 6 months (arthroscopic, 87.2 ± 11.1; open, 73.5 ± 21.9; P = .028) and 12 months (arthroscopic, 94.2 ± 10.0; open, 70.9 ± 33.1; P = .020). No complications were reported in either group. Twenty patients (76.9%) in the arthroscopic group had preoperative intra-articular abnormalities compared with 24 patients (92.3%) in the open group. Conclusion: The arthroscopic Broström-Gould technique produced better clinical outcomes than the open technique at 12 months of follow-up. Level of Evidence: Level III, retrospective comparative series.

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