Release of partial syndactyly using a trident flap without skin grafting

2019 ◽  
Vol 45 (2) ◽  
pp. 181-186
Author(s):  
Stéphane Guero
Keyword(s):  
Analogue Scale ◽  
Skin Grafting ◽  
Safe Procedure ◽  
Flap Necrosis ◽  
Level Of Evidence ◽  
Single Operator ◽  
Cosmetic Outcomes ◽  
The Mean ◽  
Quantitative Scoring

We reviewed outcomes of a modified trident flap technique in 83 patients for a series of partial syndactyly releases performed by a single operator over 30 years. Only patients with at least 3 years of follow-up (range 3 to 27 years) were included. One-hundred and twenty-seven procedures were performed for 83 patients, and no cases of flap necrosis occurred. Three hands had Grade 1 web creep on Withey’s semi-quantitative scoring system, and two had Grade 2 web creep. Revision surgery was required for one minor contracture and one intermediate contracture. Abduction angles of up to 30° were measured for operated adjacent fingers. The mean satisfaction score of the child or parents on the visual analogue scale was 1.1. The trident flap is a safe procedure, with excellent functional and cosmetic outcomes. The residual scarring is limited to the web, and there is no scarring on the dorsum of the hand. Level of evidence: IV

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient

2019 ◽  
Vol 44 (8) ◽  
pp. 845-849 ◽  
Author(s):  
Angela A. Wang ◽  
Douglas T. Hutchinson
Keyword(s):  
Visual Analogue Scale ◽  
Skin Graft ◽  
Analogue Scale ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
The Mean ◽  
Scar Score

Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7–166). The mean follow-up was 52 months (range 6–111). The mean tourniquet time was 97 minutes (range 66–135) for graft and 84 minutes (55–120) for graftless. The mean finger abduction was 57° (32°–80°) for graft and 54° (38°–80°) for graftless. The mean web creep score was 1.2 (0–3) for graft and 2.1 (0–3) for graftless. The mean scar score was 1.9 (1–3) bilaterally. The mean parents’ visual analogue scale for graft cosmesis was 7.1 (5–9) and 6.2 (4.3–8) for graftless. The surgeon’s visual analogue scale for graft was 7.9 (6.4–9.5) and 6.2 (4–8.7) for graftless. The therapist’s visual analogue scale was 7.9 (6.5–10) and 6.4 (4.7–8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II

scholarly journals Metatarsophalangeal arthrodesis of the hallux using a minimally invasive technique

2021 ◽  
Vol 15 (3) ◽  
pp. 208-212
Author(s):  
Luiz Carlos Ribeiro Lara ◽  
Lúcio Carlos de Azevedo Torres Filho ◽  
Gabriel Lopes de Faria Cervone ◽  
Juan Antonio Grajales ◽  
Glaucia Bordignon ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Analogue Scale ◽  
Hallux Rigidus ◽  
Invasive Technique ◽  
Percutaneous Technique ◽  
Union Rate ◽  
Level Of Evidence ◽  
The Mean ◽  
American Orthopaedic

Objective: To evaluate the outcomes of the metatarsophalangeal arthrodesis (MTPA) of the hallux using a percutaneous technique. Methods: The MTPA of the hallux was performed in a total of 27 feet: 20 patients diagnosed with hallux rigidus and 7 with rheumatoid arthritis. The mean postoperative follow-up time was 30.7 months. The results were evaluated using the visual analogue scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, and regards to union rate. Results: All 27 patients were operated percutaneously and noticed relief of the pain, with a mean increase of 50.9 points in AOFAS scores and a mean decrease of 7.4 points in the VAS. The mean union time was 10 weeks. There were no cases of nonunion. Conclusion: Percutaneous first MTP arthrodesis proved effective for treating hallux rigidus and degenerative rheumatic pathologies. Level of Evidence IV; Therapeutic Studies; Cases Series.

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

scholarly journals A Novel Retensioning Technique for Arthroscopic Repair of PASTA Lesions: A Clinical and Radiologic Outcome Study of 24 Shoulders

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098688
Author(s):  
Su Cheol Kim ◽  
Jong Ho Jung ◽  
Sang Min Lee ◽  
Jae Chul Yoo
Keyword(s):  
Constant Score ◽  
Case Series ◽  
Tendon Healing ◽  
Shoulder Abduction ◽  
Level Of Evidence ◽  
Simple Shoulder Test ◽  
Shoulder Range Of Motion ◽  
Functional Scores ◽  
The Mean

Background: There is no consensus on the ideal treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions without tendon damage. Purpose: To introduce a novel “retensioning technique” for arthroscopic PASTA repair and to assess the clinical and radiologic outcomes of this technique. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed on 24 patients whose PASTA lesion was treated using the retensioning technique between January 2011 and December 2015. The mean ± SD patient age was 57.6 ± 7.0 years (range, 43-71 years), and the mean follow-up period was 57.6 ± 23.4 months (range, 24.0-93.7 months). Sutures were placed at the edge of the PASTA lesion, tensioned, and fixed to lateral-row anchors. After surgery, shoulder range of motion (ROM) and functional scores (visual analog scale [VAS] for pain, VAS for function, American Shoulder and Elbow Surgeons [ASES] score, Constant score, Simple Shoulder Test, and Korean Shoulder Score) were evaluated at regular outpatient visits; at 6 months postoperatively, repair integrity was evaluated using magnetic resonance imaging (MRI). Results: At 12 months postoperatively, all ROM variables were improved compared with preoperative values, and shoulder abduction was improved significantly (136.00° vs 107.08°; P = .009). At final follow-up (>24 months), the VAS pain, VAS function, and ASES scores improved, from 6.39, 4.26, and 40.09 to 1.00, 8.26, and 85.96, respectively (all P < .001). At 6 months postoperatively, 21 of the 24 patients (87.5%) underwent follow-up MRI; the postoperative repair integrity was Sugaya type 1 or 2 for all of these patients, and 13 patients showed complete improvement of the lesion compared with preoperatively. Conclusion: The retensioning technique showed improved ROM and pain and functional scores as well as good tendon healing on MRI scans at 6-month follow-up in the majority of patients. Thus, the retensioning technique appears to be reliable procedure for the PASTA lesion.

scholarly journals Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis

2021 ◽  
Author(s):  
Filippo Migliorini ◽  
Andromahi Trivellas ◽  
Jörg Eschweiler ◽  
Matthias Knobe ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Meta Analysis ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Feasible Alternative ◽  
The Mean ◽  
Persistent Instability

Abstract Purpose This study updates the current evidence on the role of allografts versus autografts for medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral instability. Methods The study was performed according to the PRISMA guidelines. In March 2021, a literature search in the main online databases was performed. Studies reporting quantitative data concerning primary MPFL reconstruction using an allograft were considered for inclusion. The Coleman Methodology Score was used to assess the methodological quality of the selected articles. Results Data from 12 studies (474 procedures) were retrieved. The mean follow-up was 42.2 (15–78.5) months. The mean age was 21.1 ± 6.2 years. 64.9% (285 of 439) of patients were female. At the last follow-up, the Tegner (p < 0.0001), Kujala (p = 0.002) and the Lysholm (p < 0.0001) scores were minimally greater in the autografts. The similarity was found in the rate of persistent instability sensation and revision. The allograft group evidenced a lower rate of re-dislocations (p = 0.003). Conclusion Allografts may represent a feasible alternative to traditional autograft for MPFL reconstruction in selected patients with patellofemoral instability. Allograft tendons yielded similar PROMs, rates of persistent instability, and revision. Allograft reconstructions tended to have modestly lower re-dislocation rates. Level of evidence IV.

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Borrego Rodriguez ◽  
C Palacios Echevarren ◽  
S Prieto Gonzalez ◽  
JC Echarte Morales ◽  
R Bergel Garcia ◽  
...  
Keyword(s):  
Phase Ii ◽  
Hospital Readmissions ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
The Mean ◽  
Acute Cardiovascular Event ◽  
Mean Time

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

2016 ◽  
Vol 37 (12) ◽  
pp. 1333-1342 ◽  
Author(s):  
Prashant N. Gedam ◽  
Faizaan M. Rushnaiwala
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Wound Complication ◽  
Reconstruction Technique ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Perioperative Morbidity ◽  
The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review

2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Operative Management ◽  
Return To Play ◽  
Return To Sports ◽  
Level Of Evidence ◽  
The Mean

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

Extensive curettage using a high-speed burr versus dehydrated alcohol instillation for the treatment of enchondroma of the hand

2013 ◽  
Vol 40 (4) ◽  
pp. 384-391 ◽  
Author(s):  
S. M. Cha ◽  
H. D. Shin ◽  
K. C. Kim ◽  
I. Y. Park
Keyword(s):  
Analogue Scale ◽  
High Speed ◽  
Proximal Phalanx ◽  
Healing Time ◽  
Complete Healing ◽  
Pathological Fractures ◽  
Active Motion ◽  
The Mean ◽  
High Speed Burr

The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients treated with different adjuvant methods after curettage for enchondromas of the hand. Sixty-two patients with enchondroma were treated with high-speed burring (29 patients) or alcohol instillation (33 patients) after curettage. The mean follow-up was 40.8 months. No significant differences in the visual analogue scale, Disabilities of the Arm, Shoulder, and Hand scores, total range of active motion, grip strength, and complete healing time were observed between the groups. The distribution of the results of the formula by Wilhelm and Feldmeier were not significantly different between the groups. No surgery-related complications, postoperative pathological fractures, or recurrence was found in either group. For the treatment of enchondroma in the metacarpal and proximal phalanx, alcohol instillation immediately after curettage was as effective as extensive curettage using a high-speed burr.

Sign in / Sign up

Export Citation Format

Share Document