scholarly journals Radiographic and Clinical Assessment of Intramedullary Nail Fixation for the Treatment of Unstable Metacarpal Fractures

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Ather Mirza ◽  
Justin Mirza ◽  
Chris Healy ◽  
Vishaaq Mathew ◽  
Brian Lee
Keyword(s):  
Intramedullary Nail ◽  
Case Series ◽  
Extensor Tendon ◽  
Dash Score ◽  
Metacarpal Fractures ◽  
Radiographic Outcomes ◽  
Active Range Of Motion ◽  
The Mean ◽  
Flexible Intramedullary Nail

Background: The purpose of the article was to evaluate clinical and radiographic outcomes in a case series of unstable metacarpal fractures treated with flexible intramedullary nail (IMN) fixation. Methods: A total of 55 patients with unstable metacarpal fractures between 2003 and 2010 were treated with IMN fixation and followed for a minimum of 1 year. The outcomes were assessed via a radiological study of longitudinal and angular collapse, Disabilities of the Arm, Shoulder, and Hand (DASH) score, total active range of motion (ROM) of the wrist, and grip strength testing. Results: In the 55 patients, metacarpal fractures were healed by clinical and radiographic assessment at an average of 12.7 weeks. IMNs were removed in all cases at an average of 13.9 weeks. Patients regained full finger ROM at the final follow-up and were capable of 72.4% of motion at 2 weeks postoperatively. The mean DASH score at the final follow-up was 6.5. Complications included 3 cases of extensor tendon irritation that resolved without functional impairment and 2 cases of “backing out” that required reoperation to replace the pin. In one case, a bony exostosis formed on the affected metacarpal that led to tendon irritation and required operative excision. Conclusions: We found that this technique allowed for the stabilization of fractures, early ROM, resumption of usual activities, reduced immobilization, and minimal complications. A removable orthosis, instead of a cast, allowed for earlier mobilization of the wrist, metacarpophalangeal, and proximal interphalangeal joints.

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

2020 ◽  
pp. 107110072096967
Author(s):  
Carlo Biz ◽  
Alberto Crimì ◽  
Ilaria Fantoni ◽  
Jacopo Tagliapietra ◽  
Pietro Ruggieri
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Radiographic Outcomes ◽  
Case Series Study ◽  
Significant Correction ◽  
The Mean ◽  
Series Study ◽  
Severe Hallux Valgus

Background: This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. Methods: This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. Results: The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients’ satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex ( P = .047), severity ( P = .050), associated procedures ( P = .000), and preoperative angle ( P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. Conclusions: The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. Level of Evidence: Level IV, case series study.

Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

2017 ◽  
Vol 39 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Hani El-Mowafi ◽  
Mazen Abulsaad ◽  
Yasser Kandil ◽  
Ahmed El-Hawary ◽  
Samer Ali
Keyword(s):  
External Fixator ◽  
Intramedullary Nail ◽  
Case Series ◽  
Poor Quality ◽  
Charcot Arthropathy ◽  
Hybrid Fixation ◽  
Level Of Evidence ◽  
Ankle Fusion ◽  
The Mean

Background: Ankle fusion is difficult to achieve in the diabetic Charcot ankle Brodsky type 3a because of the poor quality of the bone and the inability to achieve a stable biomechanical construct. The aim of this study was to report the outcome of ankle fusion using a combination of an intramedullary nail and a circular external fixator in patients with diabetic Charcot arthropathy. Methods: We prospectively studied 24 patients with diabetic Charcot arthropathy of the ankle who were treated by fusion of the tibiotalar joint using a combined retrograde intramedullary nail and Ilizarov external fixator. Their mean age was 50.7 ± 6.9 (range, 43-62) years. The mean follow-up after surgery was 36.4 ± 5.8 (range, 24-98) months. Results: Twenty-two patients (92%) achieved clinical and radiographic solid bony fusion. No patients in this series needed amputation. All the patients were pain free, and the mean American Orthopaedic Foot & Ankle Society Score (AOFAS) improved significantly from 34.6 ± 6.8 to 66.4 ± 4.5 at the last follow-up. Two patients developed an ulcer over the heel due to a prominent nail. The ulcer healed after nail removal. Eight patients developed pin tract infection. Conclusion: We report a successful outcomes of ankle fusions using combined intramedullary nail locked only proximally and ring external fixator (hybrid fixation) in patients with diabetic Charcot arthropathy. Level of Evidence: Level IV, case series.

scholarly journals Fixation of posterior malleolus fractures through posterior access in the ankle

2018 ◽  
Vol 12 (3) ◽  
pp. 193-198
Author(s):  
Vitor Yoshiura Masuda ◽  
Vinicius Felipe Pereira ◽  
Daniel Soares Baumfeld ◽  
Caroline Marques Dos Santos Cavaleiro Cruel Neves ◽  
Caio Nery ◽  
...  
Keyword(s):  
Case Series ◽  
Score Function ◽  
Wound Complications ◽  
Joint Degeneration ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Posterior Malleolus ◽  
The Mean

Objective: The aim of this study is to present the preliminary results of posterior malleolus fixation in a case series by evaluating clinical and radiographic outcomes as well as possible complications related to this approach. Methods: This study involved a case series of 7 patients with posterior malleolus fractures, either isolated or associated with other tibiotarsal injuries, who were surgically treated and evaluated from January 2014 to December 2016 in one of the hospitals of our service. The patients were evaluated for consolidation, pain (Visual Analog Scale (VAS) score), function (American Foot and Ankle Society (AOFAS) score), surgical wound complications and joint degeneration in the postoperative period. Results: The mean follow-up was 66 weeks. All patients presented clinical and radiographic consolidation of the fractures by the sixth weekof the follow-up. The mean pain score according to the VAS was 1.5 and the mean AOFAS score was 92.5. At the end of follow-up, no clinical or radiographic evidence of joint degeneration was observed. Conclusion: Posterior access is a viable alternative that provides good results with few complications for the treatment of posterior malleolus fractures. Level of Evidence IV; Therapeutic Studies; Case Series.

Ligamentous Reconstruction of Scapholunate Dislocation through a Double Dorsal and Palmar Approach

2006 ◽  
Vol 31 (4) ◽  
pp. 445-449 ◽  
Author(s):  
A. MARCUZZI ◽  
A. LETI ACCIARO ◽  
G. CASERTA ◽  
A. LANDI
Keyword(s):  
Dash Score ◽  
Dorsal Approach ◽  
Interosseous Ligament ◽  
Hand Grip ◽  
Active Range Of Motion ◽  
Palmar Approach ◽  
Contralateral Hand ◽  
Ligamentous Reconstruction ◽  
The Mean

Six patients, were treated for scapholunate dissociation by reconstruction of both the palmar and dorsal parts of the scapholunate interosseous ligament through a combined palmar and dorsal approach. The mean active range of motion of the wrist at final follow-up was 44° of flexion and 58° of extension and the mean hand grip strengths was 88% of that of the contralateral hand. The average time to return to work was 105 days and the mean DASH score at a mean follow-up of 32 months was 18. At follow-up, radiographs showed maintenance of the anatomical reduction of the scapholunate articulation in all cases and the scapholunate angle was normal in five patients.

Midcarpal Arthrodesis with Complete Scaphoid Excision and Interposition Bone Graft in the Treatment of Advanced Carpal Collapse (SNAC/SLAC Wrist): Operative Technique and Outcome Assessment

2000 ◽  
Vol 25 (4) ◽  
pp. 341-345 ◽  
Author(s):  
M. SAUERBIER ◽  
M. TRÄNKLE ◽  
G. LINSNER ◽  
B. BICKERT ◽  
G. GERMANN
Keyword(s):  
Operative Technique ◽  
Dash Score ◽  
Carpal Collapse ◽  
Complete Excision ◽  
Active Range Of Motion ◽  
Reliable Procedure ◽  
The Mean ◽  
Midcarpal Arthrodesis ◽  
Slac Wrist

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.

Midterm results of radiocapitellar arthroplasty of the elbow

2019 ◽  
Vol 101-B (11) ◽  
pp. 1362-1369 ◽  
Author(s):  
Giuseppe Giannicola ◽  
Piergiorgio Calella ◽  
Prospero Bigazzi ◽  
Alberto Mantovani ◽  
Paolo Spinello ◽  
...  
Keyword(s):  
Radial Head ◽  
Case Series ◽  
Dash Score ◽  
Mayo Elbow Performance Score ◽  
Elbow Function ◽  
Large Case Series ◽  
Post Traumatic ◽  
The Mean ◽  
Large Case

Aims The aim of this study was to analyze the results of two radiocapitellar prostheses in a large case series followed prospectively, with medium-term follow-up. Patients and Methods A total of 31 patients with a mean age of 54 years (27 to 73) were analyzed; nine had primary osteoarthritis (OA) and 17 had post-traumatic OA, three had capitellar osteonecrosis, and two had a fracture. Overall, 17 Lateral Resurfacing Elbow (LRE) and 14 Uni-Elbow Radio-Capitellum Implant (UNI-E) arthroplasties were performed. Pre- and postoperative assessment involved the Mayo Elbow Performance Score (MEPS), the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and the modified American Shoulder Elbow Surgeons (m-ASES) score. Results The mean follow-up was 6.8 years (3.8 to 11.5). The mean MEPS, m-ASES, and Q-DASH scores improved significantly by 50 (p < 0.001), 55 (p < 0.001), and 54 points (p < 0.001), respectively, with no differences being detected between the implants. Preoperative pronation and supination were worse in patients in whom the UNI-E was used. Two patients with the UNI-E implant had asymptomatic evidence of gross loosening. Conclusion Radiocapitellar arthroplasty yielded a significant improvement in elbow function at a mean follow-up of 6.8 years, with a high implant survival rate when the LRE was used in patients with primary or post-traumatic OA, without radial head deformity, and when the UNI-E was used in patients in whom radial head excision was indicated. Cite this article: Bone Joint J 2019;101-B:1362–1369

Clinical Outcomes of Ready-Made J-Shaped Nail Fixation for Unstable Metacarpal Fractures

2020 ◽  
Vol 25 (03) ◽  
pp. 276-280
Author(s):  
Eichi Itadera ◽  
Seiji Okamoto
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Insertion Site ◽  
Metacarpophalangeal Joint ◽  
Angular Deformity ◽  
Correction Loss ◽  
Metacarpal Fractures ◽  
Radiographic Outcomes ◽  
The Mean

Background: The purpose of this study was to report the clinical outcomes of ready-made J-shaped intramedullary nail fixation for unstable metacarpal fractures. Methods: A total of 25 unstable fractures from 24 patients were evaluated in this retrospective study, comprising 20 metacarpal neck and 5 metacarpal shaft fractures. The mean follow-up was 22 weeks. Functional outcomes were assessed based on the range of motion of the metacarpophalangeal joint. Radiographic outcomes were evaluated by four projections of the postoperative plain radiographs at the final follow-up, and then were rated as excellent if projections at the fracture site showed no correction loss or angular deformity greater than 10°. Surgery time and complications during the treatments were recorded for each case. Results: All 25 fractures obtained bony union. The mean range of motion of the metacarpophalangeal joint was 78° (range, 45°–90°). Radiographic outcomes were excellent in 24 (96%) of 25 fractures. Only one fracture had correction loss. The mean surgery time was 29 minutes (range, 14–61 minutes). Two cases had extensor tendon adhesion at the insertion site, which was easily released when the implant was removed. Conclusions: This study demonstrates that intramedullary fixation with a ready-made J-shaped nail is a reliable treatment option for unstable metacarpal fractures.

Effect of Modified Broström Procedure With Periosteal Flap Augmentation After Subfibular Ossicle Excision on Ankle Stability

2019 ◽  
Vol 40 (6) ◽  
pp. 656-660 ◽  
Author(s):  
Chul Hyun Park ◽  
JeongJin Park
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Case Series ◽  
Level Of Evidence ◽  
Periosteal Flap ◽  
Radiographic Outcomes ◽  
The Mean ◽  
Talar Tilt ◽  
Modified Broström Procedure

Background: The study evaluated the clinical and radiographic outcomes of the modified Broström procedure (MBP) with periosteal flap augmentation after large subfibular ossicle excision for chronic lateral ankle instability (CLAI). Methods: Twenty-two CLAI cases with a large ossicle (≥10 mm) were treated consecutively using the MBP with periosteal flap augmentation after ossicle excision. The mean follow-up duration was 20 months (12-33). For clinical assessment, the visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Karlsson-Peterson score were evaluated preoperatively and at the last follow-up. For radiographic assessment, the size of the ossicle was measured by magnetic resonance imaging, and the talar tilt angle and anterior talar displacement were measured preoperatively and at the last follow-up. Results: The VAS, AOFAS, and Karlsson-Peterson scores improved from 6.3, 68.7, and 56.9 preoperatively to 1.6, 94.5, and 92.4 at the last follow-up, respectively. The mean size of the ossicles was 14.8 mm (11-21 mm). The talar tilt angle and anterior talar displacement improved from 11.2 degrees and 8.3 mm preoperatively to 4.4 degrees and 3.9 mm at the last follow-up, respectively. Conclusion: MBP combined with periosteal flap augmentation after ossicle excision provided good clinical and radiographic outcomes in CLAI with a large ossicle. Level of Evidence: Level IV, case series.

Vascularized posterior interosseous pedicled bone grafting for infected forearm nonunion

2015 ◽  
Vol 41 (4) ◽  
pp. 441-447 ◽  
Author(s):  
R. S. Kamrani ◽  
A. Farhoud ◽  
M. H. Nabian ◽  
L. O. Zanjani ◽  
M. Farzan
Keyword(s):  
Bone Graft ◽  
Dash Score ◽  
Distal Ulna ◽  
Level Of Evidence ◽  
Posterior Interosseous Artery ◽  
Active Range Of Motion ◽  
Interosseous Artery ◽  
The Mean ◽  
Quick Dash

Infected forearm nonunion is challenging to treat. We have used a vascularized pedicled bone graft from the distal ulna based on the posterior interosseous artery to treat forearm nonunion with current or previous signs of infection in six patients. Bone union was achieved after a mean of 3.8 months. After a mean follow-up of 25.7 months, no signs of persistent or reactivation of infection were seen in any patient. The mean Quick DASH score significantly improved from 77.4 to 17.6. In addition, the active range of motion of the wrist improved significantly after surgery. In our patients, a vascularized posterior interosseous pedicled bone from the distal ulna is a reliable vascularized bone graft for managing infected forearm nonunion. The Level of evidence of this study is 4.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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