The management of Vancouver B1 and C periprosthetic fractures: radiographic and clinic outcomes of a monocentric consecutive series

Introduction: Periprosthetic fractures (PFs) are a main complication after total hip arthroplasty (THA), with rising incidence. The optimal treatment of PFs is still being debated in the literature. Historically, high failure and reoperation rates are reported, although the introduction of locking plates has led to improved results. In this study we report clinical and radiographic outcomes of a consecutive series of Vancouver B1 and C fractures, treated with a novel type of locking plate. We also aim to identify the variables associated with healing time. Methods: Between June 2013 and May 2019, 47 patients were consecutively admitted to the Emergency Department of our Hospital with a diagnosis of PF around a well-fixed THA stem. 31 patients fulfilled the inclusion criteria and were included in the study. All patients underwent osteosynthesis with a novel type of plate (“Ironlady” Intrauma, Rivoli, Italy) through a distally extended posterolateral approach. All surgical procedures were performed with the aim of reducing the rigidity of the fixation construct and preserving periosteal vitality. Demographic data, type of fracture, type of stem and its fixation, surgical details, and clinical and radiographical outcomes were recorded. Each variable was investigated to assess its relationship with fracture healing and healing time. Results: 31 patients were included in the study. 4 patients died before the minimum follow-up of 6 months and were excluded from the series. The final sample consisted of 27 patients. Their median age at operation was 84.8 years (range 65.3–95.4 years); 21 were female. The median follow-up after surgery was 2.36 years (range 6 months–4.7 years). In the cohort there were 22 type Vancouver B1 fractures (81.5%) and 5 type C (18.5%). All fractures occurred postoperatively (no acute intraoperative fractures). Fracture union was achieved in 26 patients (96.3%). The following variables were found to be associated with increased healing time: Vancouver type of fracture, pattern of Vancouver B1 fracture type, age and male gender. Conclusions: On the base of our results, the management of Vancouver B1 and C type of PFs by locking plate osteosynthesis appears to be a safe and effective procedure. To enhance healing and reduce complication rate, accurate surgical technique is required, aiming to implement the proximal fixation, avoid stress rising, reduce rigidity of the osteosynthesis construct and preserve the plate-to-bone gap.

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Autologous Skin Fibroblast and Keratinocyte Grafts in the Treatment of Chronic Foot Ulcers in Aging Type 2 Diabetic Patients

Journal of the American Podiatric Medical Association ◽

10.7547/1010055 ◽

2011 ◽

Vol 101 (1) ◽

pp. 55-58 ◽

Cited By ~ 10

Author(s):

Matteo Monami ◽

Maria Vivarelli ◽

Carla Maria Desideri ◽

Giulio Ippolito ◽

Niccolò Marchionni ◽

...

Keyword(s):

Healing Time ◽

Lower Limbs ◽

Foot Ulcers ◽

Diabetic Patients ◽

Consecutive Series ◽

Type 2 Diabetic Patients ◽

Skin Cell ◽

Type 2 Diabetic

Background: We assessed the tolerability and efficacy of autologous skin cell grafts in older type 2 diabetic patients with chronic foot ulcers. Methods: Treatment with Hyalograft 3D and Laserskin Autograft was proposed to a consecutive series of type 2 diabetic patients older than 65 years affected by long-standing (>6 months) foot ulcers with an area greater than 15 cm2. Ulcer healing rates and measurements of ulcer area were determined monthly for 12 months. Results: Seven patients with 12 ulcers, nine of which received the described treatment, were enrolled. During 12-month follow-up, all of the ulcers healed except one. In the remaining eight ulcers, the median healing time was 21 weeks (interquartile range, 4–29 weeks). Conclusions: Autologous skin cell grafts are feasible, well tolerated, and apparently effective in the treatment of diabetic ulcers of the lower limbs in advanced age. Age did not seem to moderate healing times. (J Am Podiatr Med Assoc 101(1): 55–58, 2011)

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Age-Independent Clinical Outcome in Proximal Humeral Fractures: 2-Year Results Using the Example of a Precontoured Locking Plate

Journal of Clinical Medicine ◽

10.3390/jcm11020408 ◽

2022 ◽

Vol 11 (2) ◽

pp. 408

Author(s):

Rony-Orijit Dey Hazra ◽

Johanna Illner ◽

Karol Szewczyk ◽

Mara Warnhoff ◽

Alexander Ellwein ◽

...

Keyword(s):

Treatment Strategy ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Fracture Reduction ◽

Complication Rates ◽

Locking Plate Osteosynthesis ◽

Group 2 ◽

Group 1

Introduction: The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this fracture entity. Methods: A consecutive series of patients with surgically treated displaced PHF between 01/2017 and 01/2018 was retrospectively analyzed. Patients were treated by locking plate osteosynthesis. The cohort was divided into two groups: Group 1 (≥65 years) and Group 2 (<65 years). At the follow-up examination, the SSV, CMS, ASES, and Oxford Shoulder Score (OS), as well as a radiological follow-up, was obtained. The quality of fracture reduction is evaluated according to Schnetzke et al. Results: Of the 95 patients, 79 were followed up (83.1%). Group 1 consists of 42 patients (age range: 65–89 years, FU: 25 months) and Group 2 of 37 patients (28–64 years, FU: 24 months). The clinical results showed no significant differences between both groups: SSV 73.4 ± 23.4% (Group 1) vs. 80.5 ± 189% (Group 2). CMS: 79.4 ± 21 vs. 81.9 ± 16, ASES: 77.2 ± 20.4 vs. 77.5 ± 23.1, OS: 39.5 ± 9.1 vs. 40.8 ± 8.2; OS: 39.5 ± 9.1 vs. 40.8 ± 8.2. In the radiological follow-up, fractures healed in all cases. Furthermore, the quality of fracture reduction in both groups is comparable without significant differences. The revision rate was 9.5% in Group 1 vs. 16.2% in Group 2. Discussion: Both age groups show comparable functional outcomes and complication rates. Thus, the locking plate osteosynthesis can be used irrespective of patient age; the treatment decision should instead be based on fracture morphology and individual patient factors.

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Associations Between the Fracture Type and Functional Outcomes After Distal Radial Fractures Treated With a Volar Locking Plate

Medicina ◽

10.3390/medicina49090062 ◽

2013 ◽

Vol 49 (9) ◽

pp. 62

Author(s):

Kęstutis Braziulis ◽

Rytis Rimdeika ◽

Rima Kregždytė ◽

Šarūnas Tarasevičius

Keyword(s):

Locking Plate ◽

Hand Function ◽

Linear Regression Analysis ◽

Type A ◽

Dash Score ◽

Volar Locking Plate ◽

Fracture Type ◽

Type C ◽

And Gender

Objective. The aim of this study to investigate the associations of fracture type, age, and gender with hand function after distal radius fractures treated with a volar locking plate at a 6-month follow-up. Material and Methods. A total of 120 patients with displaced distal radius fractures were included into the study. They were operated on using a volar locking plate system. All the fractures were classified according to the AO classification, and the patients were divided into 3 groups by the fracture type. The range of motion and grip strength were evaluated at the 6-month follow-up. Multivariate linear regression analysis was used to evaluate the associations of age, gender, and fracture type with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH questionnaire was completed as an outcome measure. Results. A total of 28 patients experienced type A fractures; 70 patients, type B fractures; and 22 patients, type C fractures. No statistically significant difference regarding age and sex among the groups was observed. At 6 months after the surgery, the mean DASH score for type A, B, and C fractures was 16, 13, and 32, respectively (P=0.01). After the surgery, the radiographic parameters such as the volar tilt and the ulnar variance were significantly worse in the patients with type C fractures. Grip strength and the range of motion of the contralateral healthy hand at the 6-month follow-up were significantly better than those of the operated hand. The linear regression analysis showed that the type C fracture was the only factor significantly associated with lower DASH score. Conclusions. The patients with type C fractures treated with a volar locking plate had a worse wrist function as compared with the patients type A and B fractures at the 6-month follow-up. The postoperative hand function was significantly associated only with the type C fracture, while age and gender had no significant impact.

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Cervical Laminoplasty as a Management Option for Patients With Cervical Spondylotic Myelopathy

Neurosurgery ◽

10.1227/01.neu.0000371981.83022.b1 ◽

2010 ◽

Vol 67 (2) ◽

pp. 272-277 ◽

Cited By ~ 16

Author(s):

Anthony L. Petraglia ◽

Vasisht Srinivasan ◽

Michelle Coriddi ◽

M. Gordon Whitbeck ◽

James T. Maxwell ◽

...

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Medical Center ◽

Demographic Data ◽

Adult Population ◽

Postoperative Outcome ◽

Outcome Data ◽

Consecutive Series ◽

Cervical Laminoplasty ◽

Presenting Symptoms

Abstract BACKGROUND Cervical spondylotic myelopathy (CSM) is one of the leading causes of spinal cord dysfunction in the adult population. Laminoplasty is an effective decompressive procedure for the treatment of CSM. OBJECTIVE We present our experience with 40 patients who underwent cervical laminoplasty using titanium miniplates for CSM. METHODS We performed a retrospective review of the medical records of a consecutive series of patients with CSM treated with laminoplasty at the University of Rochester Medical Center or Rochester General Hospital. We documented patient demographic data, presenting symptoms, and postoperative outcome. Data are also presented regarding the general cost of constructs for a hypothetical 3-level fusion. RESULTS Forty patients underwent cervical laminoplasty; all were available for follow-up. The mean number of levels was 4. All patients were myelopathic, and 17 (42.5%) had signs of radiculopathy preoperatively. Preoperatively, 62.5% of patients had a Nurick grade of 2 or worse. The average follow-up was 31.3 months. The median length of stay was 48 hours. On clinical evaluation, 36 of 40 patients demonstrated an improvement in their myelopathic symptoms; 4 were unchanged. Postoperative kyphosis did not develop in any patients. CONCLUSION The management of CSM for each of its etiologies remains controversial. As demonstrated in our series, laminoplasty is a cost-effective, decompressive procedure for the treatment of CSM, providing a less destabilizing alternative to laminectomy while preserving mobility. Cervical laminoplasty should be considered in the management of multilevel spondylosis because of its ease of exposure, ability to decompress, effective preservation of motion, maintenance of spinal stability, and overall cost.

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Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

BioMed Research International ◽

10.1155/2018/1947024 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12

Author(s):

Carlo Biz ◽

Marco Corradin ◽

Wilfried Trepin Kuete Kanah ◽

Miki Dalmau-Pastor ◽

Alessandro Zornetta ◽

...

Keyword(s):

Minimally Invasive ◽

Predictive Value ◽

Preoperative Planning ◽

Callus Formation ◽

Demographic Data ◽

Percutaneous Technique ◽

Consecutive Series ◽

Metatarsal Bones

Background. The purpose of this prospective study was first to evaluate the safety and effectiveness of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) in treating central metatarsalgia, identifying possible contraindications. The second objective was to verify the potential of DMMO to restore a harmonious forefoot morphotype according to Maestro criteria. Methods. A consecutive series of patients with metatarsalgia was consecutively enrolled and treated by DMMO. According to Maestro criteria, preoperative planning was carried out by both clinical and radiological assessment. Patient demographic data, AOFAS scores, 17-FFI, MOXFQ, SF-36, VAS, and complications were recorded. Maestro parameters, relative morphotypes, and bone callus formation were assessed. Statistical analysis was carried out (p < 0.05). Results. Ninety-three patients (93 feet) with a mean age of 62.4 (31-87) years were evaluated. At mean follow-up of 58.7 (36-96) months, all of the clinical scores improved significantly (p < 0.0001). Most of the osteotomies (76.3%) had healed by 3-month follow-up, while ideal harmonious morphotype was restored only in a few feet (3.2%). Clinical and radiological outcomes were not different based on principal demographic parameters. Long-term complications were recorded in 12 cases (12.9%). Conclusion. DMMO is a safe and effective method for the treatment of metatarsalgia. Although Maestro criteria were useful to calculate the metatarsal bones to be shortened and a significant clinical improvement of all scores was achieved, the ideal harmonious morphotype was restored only in a few feet. Hence, our data show that Maestro criteria did not have a predictive value in clinical outcomes of DMMO.

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The influence of sagittal pelvic malrotation on transverse acetabular ligament guided cup orientation: a retrospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04391-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Tingxian Ling ◽

Zichuan Ding ◽

Mingcheng Yuan ◽

Kai Zhou ◽

Zongke Zhou

Keyword(s):

Demographic Data ◽

Hip Dislocation ◽

Clinical Results ◽

Safe Zone ◽

Consecutive Series ◽

Anterior Hip Dislocation ◽

Safe Zones ◽

Cup Positioning ◽

Transverse Acetabular Ligament

Abstract Background Total hip arthroplasty (THA) candidates frequently present pelvic malrotation. The aim of this study is to analyze how pelvic malrotation influence transverse acetabular ligament (TAL) guided cup orientation and investigate whether pelvic malrotation produce different clinical outcomes after THA. Methods We retrospectively reviewed a consecutive series of THA patients (144 hips) who use TAL as a guidance for cup positioning from March 2017 to January 2020. The patients were divided into normal pelvis (NP) group and backward pelvis (BP) group by sagittal pelvic malrotation assessed by APPA, the angle between the vertical and the APP on standing lateral pelvic radiographs preoperatively. Cup anteversion and inclination and that out of the safe zones were measured and compared in two groups. The demographic data, clinical results, and complications of patients were also compared. Results Backward pelvic malrotation were found in 60.6 % of this cohort of THA candidates. The mean angle of both inclination and anteversion in BP group were significantly larger than that in NP group. The rate of cup for anteversion and inclination above the safe zone in BP group was significantly larger than that in NP group. There were 4 patients in BP group recording anterior hip dislocation after surgery. Other complications were not observed at last follow-up. Conclusions Backward pelvis malrotation may increase TAL guided cup inclination and anteversion, which were inclined to became outlier above the safe zone. This likely increase the rates of dislocation after THA. For the patients with pelvis malrotation, cup positioning should be performed individually instead of guided by TAL.

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Functional and radiological outcome of surgical treatment of distal tibial fracture by minimally invasive percutaneous plate osteosynthesis technique

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200736 ◽

2020 ◽

Vol 6 (2) ◽

pp. 340

Author(s):

Shobha H.P. ◽

Karthik S. ◽

Akshay Dhanda ◽

Lingaraju K. ◽

Giridhar Kumar

Keyword(s):

Minimally Invasive ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Limb Length Discrepancy ◽

Healing Time ◽

Minimally Invasive Plate Osteosynthesis ◽

Superficial Infection ◽

Non Union ◽

Osteosynthesis Technique

Background: Minimally invasive percutaneous plate osteosynthesis (MIPPO) is an established technique for fixation of fractures of the distal third tibia. Aim of our study was to manage extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed.Methods: From June 2018 to June 2019,25 patients of closed distal tibial fractures were operated by MIPPO technique with a distal tibial anatomical locking plate having 4.5 out of 5 proximal and 3.5 out of 4 distal screw holes. The follow up duration was for 1 year.Results: The mean fracture healing time was 17 weeks (range 16 to 32 weeks) and average The American orthopedic foot and ankle score was 88.2 out of a total possible 100 points. At last follow up, superficial infection occurred in 3 patients, deep infection in 1 patient, ankle stiffness in 1 patient, limb length discrepancy <1 cm in 1 patient and malunion in 2 patients.Conclusions: MIPPO technique provides good bone healing and decreases incidence of non-union and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminute fractures.

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New Cementless Total Hip Arthroplasty. A Multicentre Prospective Minimum 2 Year Follow-up Clinical Outcomes Study.

Reconstructive Review ◽

10.15438/rr.11.1.251 ◽

2021 ◽

Vol 11 ◽

Author(s):

Rohit Pandey ◽

Simon Coffey ◽

Rami Sorial

Keyword(s):

Clinical Outcomes ◽

Primary Objective ◽

Posterolateral Approach ◽

Consecutive Series ◽

X Rays ◽

Early Results ◽

Duration Of Surgery ◽

Oxford Hip Score ◽

Outcomes Study

Background: Cementless implants were introduced approximately three decades ago in order to address aseptic loosening of cemented hip prostheses with the aim of early mobilisation, better functional result and bone stock preservation. The primary objective of this study is to introduce a new cementless HA coated implant and report its minimum 2 year follow up results. Material & method: This is a prospective, multi-centre, consecutive series, clinical outcomes study with 75 patients. Inclusion criteria for the study were age 21- 85 years, BMI <40, osteoarthritis of the hip. Patients were operated using a standard posterolateral approach. The Paragon stem and the Global cup were implanted in a cementless method. Patients were reviewed at 6 weeks, 6 months and two years postoperative. At each visit AQoL 6D, VAS Pain, Oxford Hip Score were recorded. Post-operative X-Rays were reviewed at immediate post-operative, 6 months and two years. Results: Mean duration of surgery was 63.1 min with range of 40-120 min. AQoL over time changed from pre-op mean 50.51, at 6 weeks and at 2 years mean 35.06. Oxford hip score had upward trend from pre-op to post-op 6wks assessments and a plateau in following assessments. VAS pain trajectories, showing a clear downward trend from pre-op to post-op 6wks and a plateau in the following postoperative assessments. Discussion & conclusion: The combination of Paragon stem and Global cup incorporates proven features of successful implants. The unique feature of lateral tension grooves and progressive neck dimension with dual offset options. This combination has shown promising early results with early follow up of a minimum of 2 years, with a 100% survivorship of the stem and 98.7% survivorship overall for any reason and is a good cementless option in THA.

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Outcomes in Combined Anterior and Posterior Fusion for 3- and 4-Level Degenerative Lumbar Disc Disease

Kansas Journal of Medicine ◽

10.17161/kjm.v9i3.8610 ◽

2016 ◽

Vol 9 (3) ◽

pp. 50-53

Author(s):

Scott M. Haskins ◽

Alan Moskowitz ◽

John J. Lammli ◽

Eren O. Kuris ◽

Alexander C.M. Chong

Keyword(s):

Lumbar Disc ◽

Demographic Data ◽

Retrospective Chart Review ◽

Published Data ◽

Consecutive Series ◽

Disc Disease ◽

Lumbar Disc Disease ◽

One Year ◽

And Function

Introduction. This study reported the clinical and functionaloutcomes in a consecutive series of patients with3- or 4-level degenerative disc disease (DDD) betweenvertebral levels L2 to S1, who were treated with combinedanterior lumbar interbody fusion (ALIF) and posteriorspinal fusion at one-year and two-year follow-ups. Methods. A retrospective chart review was performed on allpatients who underwent long segment fusion for DDD by asingle surgeon between August 2002 and January 2012. Fiftyfivepatients were identified and 32 had complete charts for review(14 had one-year follow-up and 18 two-year follow-up).In addition to demographic data, disability (Oswestry DisabilityIndex, ODI), pain level (Visual Analog Scale, VAS), andflexion-extension range-of-motion were measured pre- andpost-operatively. Operative data also were collected, includingoperative time, blood loss, surgical implants used, surgicalapproach, operative levels treated, and complications.Results. Both VAS and ODI improved significantly postoperatively.The average VAS score improved from 6.5 ± 1.5(range: 4 - 9) to 4.4 ± 1.7 (range: 2 - 7) for one-year follow-up,and 7.0 ± 1.8 (range: 4 - 10) to 4.4 ± 2.6 (range: 1 - 9) for twoyearfollow-up. For one-year follow-up, the average ODI scoreimproved from 53 ± 19% (range: 18 - 70%) to 37 ± 17% (range:12 - 64%), and for two-year follow-up, the average improvedfrom 53 ± 18% (range: 18 - 80%) to 31 ± 24% (range: 2 - 92%).The level of improvement in pain and function was similar topreviously published data for 1- and 2-level fusions, but overallpain and function scores were worse in this study group. Conclusions. Arthrodesis for 3- and 4-level DDD is, on average,a successful surgery that shows clinically significantimprovements in function and pain similar to fusionfor 1- and 2-levels with low rates of re-operation. Patientswith involvement of 3- or 4-levels have higher disabilityand pain both pre- and post-operatively compared to shorterfusion level involvement. KS J Med 2016;9(3):50-53.

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