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.

scholarly journals Intercalary Tricortical Iliac Bone Graft in the Surgical Treatment of Nonunion of Midshaft Clavicular Fractures

2012 ◽  
Vol 15 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Chul Hyun Cho ◽  
Hyung Gyu Jang
Keyword(s):  
Bone Graft ◽  
Clinical Outcomes ◽  
Plate Fixation ◽  
Arthroscopic Surgery ◽  
Iliac Bone ◽  
Dash Score ◽  
Structural Support ◽  
Iliac Bone Graft ◽  
Quick Dash

PURPOSE: The purpose of this study was to evaluate the radiologic and clinical outcomes after intercalary tricortical iliac bone graft with plate fixation for the nonunion of midshaft clavicular fractures.MATERIALS AND METHODS: Between September 2007 and May 2011, 10 patients who were treated by the intercalary tricortical iliac bone graft, with plate fixation for clavicle nonunion, were studied. The mean follow-up period was 30.7 (12~57) months. After the sclerotic bone was excised to the bleeding cortical bone, we interposed the tricortical iliac bone to provide structural support and restore clavicle length, and then fixed the plate and screws. The radiologic outcomes on the serial plain radiographs and clinical outcomes, according to UCLA, ASES and Quick DASH scores, were analyzed.RESULTS: Bony union was obtained in all cases (100%) and the average union time was 18.4 (14~24) weeks. The average respective UCLA and ASES scores improved from 16.7 and 52.1 preoperatively to 27.4 and 83.6 postoperatively (p<0.05). The average Quick DASH score was 40.5, at the final follow-up. Complications were 2 shoulder stiffness, and one case had removal of device and arthroscopic surgery at 11 months, postoperatively. There were no implant failure or infection.CONCLUSION: Intercalary tricortical iliac bone graft, with plate fixation for the nonunion of midshaft clavicular fractures, is a good option that can provide structural support and restore clavicle length, as well as high union rate.

scholarly journals Short- to mid-term outcomes of radial head replacement for complex radial head fractures

2020 ◽  
Vol 23 (4) ◽  
pp. 183-189
Author(s):  
Chung-Sin Baek ◽  
Beom-Soo Kim ◽  
Du-Han Kim ◽  
Chul-Hyun Cho
Keyword(s):  
Heterotopic Ossification ◽  
Radial Head ◽  
Elbow Joint ◽  
Ulnar Neuropathy ◽  
Dash Score ◽  
Radial Head Fractures ◽  
Radial Head Replacement ◽  
The Mean ◽  
Quick Dash

Background: The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes.Methods: Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19–73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27–163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7o of flexion, 4.7o of extension, 76.2o of pronation, and 77.5o of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy).Conclusions: RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.

scholarly journals Midterm Results of Four-Corner Fusion Using Dorsal Circular Plate Fixation

2017 ◽  
Vol 07 (03) ◽  
pp. 262-266 ◽  
Author(s):  
Claus Deglmann ◽  
Vanja Celigoj ◽  
Bernhard Lukas ◽  
Ahmed Elgammal
Keyword(s):  
Circular Plate ◽  
Plate Fixation ◽  
Fixation Method ◽  
Dash Score ◽  
Level Of Evidence ◽  
Plate Removal ◽  
Level Ii ◽  
The Mean ◽  
K Wires

Purpose The purpose of this prospective study was to evaluate the results of four-corner fusion using dorsal circular plate. Methods We operated on 20 patients between 2009 and 2011. Results At a mean follow-up period of 30 months (range: 14–62, SD: 16), the mean VAS improved from 8 (range: 4–10, SD: 2) preoperatively to 4 (range: 0–8, SD: 2). Function measured with the DASH score improved from 37 (range: 10–75, SD: 18) to 26 (range: 2.5–64, SD: 19). Eighteen patients in our series showed full consolidation and two patients showed persistent nonunion. Three cases required plate removal due to dorsal impingement. Conclusion  Four-corner fusion using dorsal circular plate showed satisfactory results in this study, but it did not show superior results compared with simpler fixation methods mentioned in the literature, such as K-wires or screw fixation. Currently, we are principally using K-wires as a fixation method of choice in our four-corner fusion procedures. Level of Evidence  Level II.

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.

Scaphometacarpal arthroplasty: a report of ten cases of trapeziometacarpal prosthesis and trapeziectomy revision

2020 ◽  
Vol 45 (5) ◽  
pp. 483-487 ◽  
Author(s):  
Leo Chiche ◽  
Herve Lamarre ◽  
Stephane Barbary ◽  
Jacques Teissier
Keyword(s):  
Multicentre Study ◽  
Medium Term ◽  
Level Of Evidence ◽  
Power Grip ◽  
Early Loosening ◽  
Cause Of Failure ◽  
The Mean ◽  
Quick Dash ◽  
Lost To Follow Up

Loosening of the trapezial component is a main cause of failure of trapeziometacarpal prostheses. This report presents the preliminary results of scaphometacarpal prostheses used for revision of trapeziometacarpal prostheses and failed trapeziectomies. A retrospective multicentre study was conducted on ten patients. Four had revision surgery after failure of trapeziometacarpal prostheses, five after trapeziectomy and one after a trapezial silicone implant. Pain, mobility, strength, QuickDASH, satisfaction score and radiographs were assessed. Nine patients were assessed (one was lost to follow-up), with a mean follow-up of 34 months. The mean pain score was 1.2/10, Quick-DASH was 39 and opposition according to the Kapandji score was 8.6. Strength was 3 kg for key pinch and 13.6 kg for power grip. One failure was observed, with early loosening of the scaphoid cup. Scaphometacarpal arthroplasty is a reliable medium-term solution for revision of the loosening of a trapeziometacarpal prosthesis with trapezial damage and for failed trapeziectomy. Level of evidence: IV

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.

Outcome of arthroscopic reduction association of the scapholunate joint

2015 ◽  
Vol 41 (1) ◽  
pp. 48-55 ◽  
Author(s):  
S. M. Koehler ◽  
S. M. Guerra ◽  
J. M. Kim ◽  
S. Sakamoto ◽  
A. J. Lovy ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Visual Analogue Score ◽  
Dash Score ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Scapholunate Instability ◽  
Arthroscopic Reduction ◽  
Loss Of Reduction ◽  
The Mean

This study evaluates the arthroscopic reduction association scapholunate technique and outcomes. A total of 18 patients with chronic scapholunate instability with mean follow-up of 36 months were reviewed. Postoperatively, the mean visual analogue score was 2.5 and the mean DASH score was 8. The grip strength was 27 kg on the operative side compared with 32 kg on the uninjured side. The mean wrist flexion was 46° and extension was 56°. Seven patients had complications. Six patients had scapholunate joint widening, one had windshield-wipering of the screws with loss of reduction, and two demonstrated progression of scapholunate advanced collapse deformity. Four patients underwent revision surgeries: two revision arthroscopic reduction association scapholunates and two proximal row carpectomies. A preoperative scapholunate gap of greater than 5 mm and the presence of scapholunate advanced collapse Grade I were both predictive of a complication or revision surgery. Patients with a scapholunate gap of greater than 5 mm or scapholunate advanced collapse had statistically higher complications rates. Level of Evidence IV.

scholarly journals Temporary spanning plate across the elbow for complex fractures of the distal humerus

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ashraf N. Moharram ◽  
Mostafa Mahmoud ◽  
Ahmed Lymona ◽  
Ahmed Afifi ◽  
Mostafa Ezzat ◽  
...  
Keyword(s):  
Bone Loss ◽  
Internal Fixation ◽  
Early Mobilization ◽  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Dash Score ◽  
Level Of Evidence ◽  
The Mean ◽  
Therapeutic Study

Abstract Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study

Ulnar head replacement and sigmoid notch resurfacing arthroplasty with a lateral meniscal allograft: ‘calamari procedure’

2017 ◽  
Vol 42 (6) ◽  
pp. 567-572 ◽  
Author(s):  
S. Kakar ◽  
M. Noureldin ◽  
B. Elhassan
Keyword(s):  
Grip Strength ◽  
Short Term ◽  
Distal Ulna ◽  
Level Of Evidence ◽  
Resurfacing Arthroplasty ◽  
Ulnar Head ◽  
Sigmoid Notch ◽  
Meniscal Allograft ◽  
The Mean

We report the outcomes of ulnar head replacement with concomitant resurfacing of the sigmoid notch with a lateral meniscal allograft that attempted to recreate the palmar and dorsal radioulnar ligaments in four patients. Patients’ ranges of motion, grip strength, postoperative complications and radiographs were assessed. The mean follow-up was 20 (range 12–28) months. There was an increase in postoperative range of motion with an average increase in grip strength of 43% to the unaffected extremity. All patients experienced marked reduction in their postoperative pain. No patients reported symptoms of implant instability. Distal ulna implant arthroplasty with a lateral meniscal allograft gives favourable short-term outcomes. Level of evidence: IV

scholarly journals Ligament Reconstruction of Traumatic Pure Dislocation of Carpometacarpal Joint of the Thumb: A Series of Acute and Chronic Cases

2020 ◽  
Vol 12 (S 01) ◽  
pp. S16-S20
Author(s):  
Farid Najd Mazhar ◽  
Davod Jafari ◽  
Seyed Sajjad Jafari ◽  
Alireza Mirzaei
Keyword(s):  
Grip Strength ◽  
Outcome Measures ◽  
Ligament Reconstruction ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Dash Score ◽  
The Mean ◽  
Quick Dash ◽  
Cmc Joint

Abstract Background Traumatic instability of carpometacarpal (CMC) joint of the thumb without a fracture (pure dislocation of CMC joint) is an uncommon injury, and a universally accepted protocol has not yet been developed for its management. Here, we aim to evaluate the outcome of this injury managed with ligament reconstruction technique, in a series of acute and chronic injuries. Patients and Methods Total nine patients (six acute and three chronic) with pure dislocation of CMC joint who underwent ligament reconstruction surgery were included in this retrospective study. Outcome measures included disabilities of the arm, shoulder, and hand (quick-DASH) questionnaire; visual analog scale (VAS) scoring system; patient-rated wrist/hand evaluation (PRWHE) system; pinch and grip strength; and Kapandji thumb opposition scores. Results The patients’ mean age was 32.55 ± 11.4 years. Their mean follow-up period was 27 ± 12.8 months. The mean postoperative pinch and grip strength was equivalent to 91.5% and 108% of the contralateral hand, respectively. The mean Quick-DASH score was 14.7 ± 19.4. The mean PRWHE score was 18.7 ± 22.4. The mean VAS was 1.1 ± 1.5. The mean Kapandji score was 8.3 ± 1.4. The pinch and grip strength were considerably superior in acute injuries. Degenerative changes were seen in all joints at the latest follow-up. None of our patients needed a revision surgery. Conclusion Ligament reconstruction method could result in favorable outcome in the management of pure dislocation of CMC joint. However, delayed surgery of this injury might adversely affect the outcome measures.

Sign in / Sign up

Export Citation Format

Share Document