Arthroscopic reduction and internal fixation of capitellar and trochlear fractures: A case series

2021 ◽  
pp. 175857322110376
Author(s):  
Yiyang Zhang ◽  
Nicholas Chang ◽  
George S Athwal ◽  
Graham JW King
Keyword(s):  
Internal Fixation ◽  
Chart Review ◽  
Case Series ◽  
Open Reduction Internal Fixation ◽  
Referral Centre ◽  
Retrospective Case ◽  
Arthroscopic Reduction ◽  
Patient Demographics ◽  
Soft Tissue Dissection ◽  
Posterior Comminution

Background In a simple isolated capitellar/trochlear fracture without extensive posterior comminution, arthroscopic reduction and internal fixation (ARIF) can provide an alternative option to open reduction internal fixation. The purpose of this retrospective case series was to report on the technique and outcomes of arthroscopic reduction and internal fixation of capitellar/trochlear fractures. Methods All patients that underwent ARIF at a single upper extremity referral centre in the last twenty years were reviewed. Patient demographics, preoperative, intraoperative, and postoperative records were obtained through chart review and telephone followup. Results Ten cases of ARIF were identified over a twenty year period performed by two surgeons. The average age of patients was 37 years (17–63 years), with nine females and one male. With an average followup of eight years, nine of ten patients had a mean range of motion from 0 to 142 degrees. Their average MEPI and PREE score were 93 ± 7 and 8 ± 14, respectively. Four patients had focal cartilage collapse with three that required a reoperation. There were no infections, nonunions, or arthroscopy related complications. Conclusion ARIF offers an alternative to ORIF for capitellar/trochlear fractures producing good results while providing better visualization of the fracture reduction and minimizing soft tissue dissection.

scholarly journals Cerliponase Alfa for the Treatment of Atypical Phenotypes of CLN2 Disease: A Retrospective Case Series

2020 ◽  
pp. 088307382097799
Author(s):  
Eva Wibbeler ◽  
Raymond Wang ◽  
Emily de los Reyes ◽  
Nicola Specchio ◽  
Paul Gissen ◽  
...  
Keyword(s):  
Treatment Duration ◽  
Chart Review ◽  
Rating Scale ◽  
Neuronal Ceroid Lipofuscinosis ◽  
Case Series ◽  
Language Function ◽  
Retrospective Case ◽  
Function Loss ◽  
Clinical Rating Scale

Background: The classic phenotype of CLN2 disease (neuronal ceroid lipofuscinosis type 2) typically manifests between ages 2 and 4 years with a predictable clinical course marked by epilepsy, language developmental delay, and rapid psychomotor decline. Atypical phenotypes exhibit variable time of onset, symptomatology, and/or progression. Intracerebroventricular-administered cerliponase alfa (rhTPP1 enzyme) has been shown to stabilize motor and language function loss in patients with classic CLN2 disease, but its impact on individuals with atypical phenotypes has not been described. Methods: A chart review was conducted of 14 patients (8 male, 6 female) with atypical CLN2 phenotypes who received cerliponase alfa. Pre- and posttreatment CLN2 Clinical Rating Scale Motor and Language (ML) domain scores were compared. Results: Median age at first presenting symptom was 5.9 years. First reported symptoms were language abnormalities (6 [43%] patients), seizures (4 [29%]), ataxia/language abnormalities (3 [21%]), and ataxia alone (1 [7%]). Median age at diagnosis was 10.8 years. ML score declined before treatment in 13 (93%) patients. Median age at treatment initiation was 11.7 years; treatment duration ranged from 11 to 58 months. From treatment start, ML score remained stable in 11 patients (treatment duration 11-43 months), improved 1 point in 1 patient after 13 months, and declined 1 point in 2 patients after 15 and 58 months, respectively. There were 13 device-related infections in 8 patients (57%) and 10 hypersensitivity reactions in 6 (43%). Conclusions: Cerliponase alfa is well tolerated and has the potential to stabilize motor and language function in patients with atypical phenotypes of CLN2 disease.

scholarly journals Limited Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Anne K. Bremer ◽  
Lukas Kraler ◽  
Lars Frauchiger ◽  
Fabian G. Krause ◽  
Martin Weber
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Functional Results ◽  
High Rate ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

2020 ◽  
pp. 107110072095514
Author(s):  
Kevin D. Martin ◽  
Courtney T. Tripp ◽  
Jeannie Huh
Keyword(s):  
Internal Fixation ◽  
Soft Tissues ◽  
Case Series ◽  
Ankle Fractures ◽  
Ct Scans ◽  
Loose Bodies ◽  
Level Of Evidence ◽  
Arthroscopic Reduction ◽  
Malleolar Fractures ◽  
Patient Reported

Background: Posterior malleolar fractures within a trimalleolar ankle fracture pattern are challenging to manage. Posterior ankle arthroscopy provides a means to assess the intra-articular and syndesmotic reductions, while removing loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) in trimalleolar ankle fractures. Methods: From November 2015 to March 2019, we prospectively enrolled consecutive trimalleolar ankle fractures that underwent PARIF by a single surgeon. Preoperative and postoperative computed tomography (CT) scans were interpreted by 2 blinded musculoskeletal radiologists for articular reduction, syndesmosis congruity, and presence of ossific loose bodies. Patient outcomes were assessed using the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, Olerud-Molander Ankle Score (OMAS), and visual analog scale (VAS). A total of 28 trimalleolar ankle fractures were treated with PARIF. Mean patient age was 36 years (range, 19-69). Results: Preoperative CT identified 18 intra-articular loose bodies (range, 0-4) in 36% of ankles and 75% (n = 21) syndesmosis incongruity. Postoperative CT scans demonstrated anatomic intra-articular reduction in all fractures, 41.7% (5/12) syndesmosis incongruity without fixation, and 0% (0/9) with suture-button fixation. At mean 2-year follow-up, the results were good to excellent with mean VAS score 1 (range, 0-4), AOFAS score 84 (range, 63-100), FADI 85 (range, 59-100), and OMAS 76 (range, 40-100). Conclusion: The PARIF technique for displaced posterior malleolar fractures was effective in achieving anatomic intra-articular reduction, syndesmosis congruity, and intra-articular loose body removal, while safely preserving the soft tissues. Level of Evidence: Level IV, prospective case series.

Spina bifida and lower limb amputation in Northern Ireland: A retrospective study of demographics and outcome

2017 ◽  
Vol 41 (5) ◽  
pp. 503-506 ◽  
Author(s):  
Lorraine Graham
Keyword(s):  
Spina Bifida ◽  
Lower Limb ◽  
Chart Review ◽  
Case Series ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Retrospective Case ◽  
Younger Age ◽  
Chronic Skin ◽  
Almost All

Background: Spina bifida is an uncommon cause for lower limb amputation. The causes and level of amputation and mobility outcome for these patients have not been reported previously. Case description: To identify the causes and level of amputation and the mobility outcome for amputee patients with spina bifida. Study design: Retrospective case series. Methods: Chart review of patients identified by computer as having an amputation secondary to neurological or congenital cause. Additional patients identified from the Regional Spina Bifida Medical Clinic. Demographics, cause and level of mobility pre- and post-amputation recorded from the prosthetic notes. Findings: In total, 16 patients were identified who had a diagnosis of spina bifida and a lower limb amputation. Mean age at the time of amputation was 28.5 years. In total, 15 patients had a transtibial amputation. In total, 14 patients post-amputation were able to maintain their mobility, wheelchair or walking, without any change in type of aid needed. Conclusion: Patients with spina bifida appear to require lower limb amputation at a younger age than patients with peripheral vascular disease. Almost all patients had prior chronic skin infection/osteomyelitis as precursors for amputation. The most common level for amputation was transtibial. Mobility was maintained for all patients, albeit for two in a more supported way. Clinical relevance Spina bifida is an uncommon reason for amputation. Patients, are often younger and medically complicated. Chronic skin ulceration, was the most common indication for amputation. Wheelchair or walking ambulance was maintained at the same level for most patients.

scholarly journals Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769628 ◽  
Author(s):  
Patrick N. Siparsky ◽  
James R. Bailey ◽  
Kevin M. Dale ◽  
Mitchell R. Klement ◽  
Dean C. Taylor
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Traumatic Event ◽  
Cruciate Ligament ◽  
Case Series ◽  
Open Reduction Internal Fixation ◽  
Complete Healing ◽  
Senior Author ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Background: Isolated chondral fractures of the knee are a rare and challenging problem, typically occurring with an acute traumatic event such as dislocation of the patella or ligamentous injury. Historically, repair of unstable chondral fragments without osseous attachment has not been recommended due to concerns about the limited healing potential of cartilage. Purpose: To describe a technique for fixation of large isolated chondral fractures of the knee and present 3 cases where large chondral fragments without osseous attachment were fixed successfully with chondral darts and biologic adhesive. Study Design: Case series; Level of evidence, 4. Methods: The senior author reviewed his case logs for all patients on whom he performed open reduction and internal fixation on large isolated cartilage fragments without osseous attachment. Three were extracted from his review. The clinical and radiographic outcomes were retrospectively reviewed. Results: Successful results and complete healing was obtained in all 3 patients. This procedure can be done in the setting of concurrent injury, such as anterior cruciate ligament tear, using single- or multistaged chondral repair and ligament reconstruction techniques. Conclusion: Isolated chondral fragment repair techniques provide the orthopaedic surgeon an additional option for treating these challenging injuries. Primary fixation can be accomplished for what have been historically considered “unsalvageable” fragments.

scholarly journals Lymphoproliferative Lesions in the Setting of HIV Infection: A Five-Year Retrospective Case Series and Review

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Etienne Mahe ◽  
Catherine Ross ◽  
Monalisa Sur
Keyword(s):  
Hiv Infection ◽  
Tertiary Care ◽  
Case Series ◽  
Referral Centre ◽  
Retrospective Case ◽  
Southern Ontario ◽  
Lymphoid Malignancies ◽  
Regional Laboratory ◽  
Associated Lesions ◽  
Work Up

A wide variety of noninfectious lesions have been identified in association with HIV infection. Many hematolymphoid lesions are possible in this patient group, both reactive and neoplastic. Epidemiologic data suggests that lymphoid malignancies are among the most common neoplasms in patients with HIV. We present a selective case series assembled over a 5-year period from the relatively low HIV-prevalence Hamilton Regional Laboratory Medicine Program (HRLMP), a tertiary care referral centre in Southern Ontario. This series serves to demonstrate the wide variety of lymphoid lesions that may be encountered in patients with HIV. In addition to outlining the pathologic work-up necessary in these cases, we discuss characteristics that distinguish the HIV-associated lesions from the pathobiologically similar non-HIV-associated lymphoid lesions.

Evaluating the Applicability of a Biodegradable Osteosynthesis Plating System in the Management of Zygomatico-Maxillary Complex Fractures

2011 ◽  
Vol 145 (6) ◽  
pp. 924-929 ◽  
Author(s):  
Virendra Singh ◽  
Bindu Sharma ◽  
Amrish Bhagol
Keyword(s):  
Internal Fixation ◽  
Analogue Scale ◽  
Case Series ◽  
Open Reduction Internal Fixation ◽  
Early Postoperative Period ◽  
Infraorbital Nerve ◽  
Screw Head ◽  
The Mean ◽  
Design Case

Objective. The present study was undertaken to evaluate and analyze the efficacy of bioresorbable plates and screws in internal fixation of zygomatico-maxillary complex (ZMC) fractures and to evaluate the incidence of complications associated with the procedure. Study Design. Case series with planned data collection. Setting. Pt BD Sharma University of Health Sciences. Subject and Methods. A total of 14 patients with isolated ZMC fractures were included, and exclusion of grossly comminuted, pathological, and infected fractures was done. Open reduction internal fixation was done with biodegradable plates and screws. All patients were reviewed clinically and radiographically at regular follow-up. Occlusion, stability of fracture segments, anesthesia or paresthesia of the infraorbital nerve region, and various complications were assessed periodically. Results. Fourteen patients with 34 fracture sites were included in the study. Intraoperatively, there were 2 incidences of screw head fracture. As observed clinically, there was complete stability of fracture segments, and no maxillomandibular fixation was required postoperatively. Paresthesia of the infraorbital nerve was present in 5 patients, but the sensation recovered completely in the first 3 months after surgery. The mean pain score was 3 on a visual analogue scale. In 1 case, ectropion developed, and dehiscence occurred in another patient in the early postoperative period. Postoperative radiographs were evaluated for the accuracy of fracture reduction and stability of fixation. Conclusion. The biodegradable osteosynthesis system exhibits adequate strength and has negligible complications. This system is technique sensitive with satisfactory results in the management of mild to moderately displaced ZMC fractures.

Hearing Outcomes after Ossicular Reconstruction with Removal of the Malleus

2017 ◽  
Vol 158 (1) ◽  
pp. 144-150 ◽  
Author(s):  
Rex S. Haberman ◽  
Anna M. Salapatas
Keyword(s):  
Chart Review ◽  
Health Care Organization ◽  
Case Series ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Care Organization ◽  
Retrospective Case ◽  
Disease Extent ◽  
Ossicular Chain Reconstruction ◽  
Hearing Outcomes

Objectives (1) Evaluate hearing outcomes of patients after planned malleus removal during ossicular chain reconstruction. (2) Analyze hearing results for titanium (Ti) and hydroxyapatite (HA) total ossicular prostheses (TOPs) and partial ossicular prostheses (POPs). (3) Compare Ti and HA partial prostheses. Study Design Retrospective case series with chart review. Setting Tertiary health care organization. Subjects and Methods A chart review was conducted of 139 consecutive patients who presented with chronic otitis media with perforation (with or without cholesteatoma) and were treated with initial-stage tympanoplasty (with or without mastoidectomy) and managed with TOP (n = 22) or POP (n = 117) between July 2010 and July 2015. The malleus was completely removed in all cases. Hearing was assessed via bone and air conduction pretone averages (0.5, 1, 2 kHz) pre- and postoperatively. Air-bone gap (ABG) and change in ABG (ΔABG) were analyzed. Pre- and postoperative values were compared. Results The overall mean ABG decreased from 29.4 ± 12.3 dB to 18.2 ± 11.4 dB postoperatively ( P < .001) with a mean ΔABG of 14.5 dB (95% CI, 12.793-16.203). Overall success was achieved by 69.1%. The POP group achieved higher success (70.9%) than the TOP group (59.1%; P = .0001). Mean ABG decreased significantly within surgical groups (TOP and POP) and prosthesis material groups (Ti and HA; all P < .001). Ti had statistically higher success than HA in both techniques: POP ( P = .0478) and TOP ( P = .0251). There was a 98% graft take rate. Conclusion Planned malleus removal during ossicular chain reconstruction, regardless of disease extent, allows for simpler reconstruction and comparable favorable results to preservation of the malleus and should be considered during surgical planning.

Open Reduction Internal Fixation of Condylar Head/Diacapitular Fracture of Mandible: Case Series

2020 ◽  
Author(s):  
Indu Palanivel ◽  
Vivek Narayanan ◽  
Saravanan Chandran ◽  
Karthik Ramakrishnan ◽  
Prashanthi Gurram
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Open Reduction Internal Fixation ◽  
Condylar Head
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