Complications of Intra-articular Calcaneal Fractures in Adults

2016 ◽  
Vol 9 (6) ◽  
pp. 534-542 ◽  
Author(s):  
Christos Koutserimpas ◽  
George Magarakis ◽  
Grigoris Kastanis ◽  
George Kontakis ◽  
Kalliopi Alpantaki
Keyword(s):  
Present Article ◽  
Specific Treatment ◽  
Complication Rates ◽  
Calcaneal Fractures ◽  
Levels Of Evidence ◽  
Proper Management ◽  
Evidence Level ◽  
Pubmed Database ◽  
Prevention Methods ◽  
Complex Injuries

Calcaneal fractures are complex injuries with high complication rates and they can lead to serious disability. The proper management remains controversial and complications may occur regardless of the chosen type of treatment (operative or nonoperative). The present article reviews the studies that are related to the complications of calcaneal fractures. The incidence, the diagnosis, the prevention and the treatment of these complications were researched and analyzed, with the use of PubMed database, abstracts and original articles in English than investigate the etiology. The aim of the article is to discuss the most suitable management of the complications of calcaneal fractures and recommend a specific treatment as well as prevention methods. Levels of Evidence: Level IV

scholarly journals Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 710
Author(s):  
Abel Botelho Quaresma ◽  
Fernanda da Silva Barbosa Baraúna ◽  
Fábio Vieira Teixeira ◽  
Rogério Saad-Hossne ◽  
Paulo Gustavo Kotze
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Randomized Studies ◽  
Pubmed Database ◽  
Increased Risk ◽  
The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

scholarly journals 168 Interprosthetic Fractures of The Femur: A Literature Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Marzano ◽  
V Pace ◽  
F Milazzo ◽  
A Caraffa ◽  
P Antinolfi
Keyword(s):  
Femur Fracture ◽  
Classification Systems ◽  
Surgical Approaches ◽  
High Morbidity ◽  
Complication Rates ◽  
Management Guidelines ◽  
Stress Risers ◽  
Pubmed Database ◽  
Common Diagnosis ◽  
Surgical Options

Abstract Increasing age expectations and number of joint replacement procedures have made interprosthetic femoral fractures (IFF) a progressively more common diagnosis and a challenge for surgeons. A gold standard and universally accepted classifications and guidelines do not exist yet. Customized structured electronic searches performed in PubMed database. Relevant key terms: IFF, classification interprosthetic fracture, peri-implant femoral fracture, biomechanics interprosthetic femur fracture, radiographic femur fracture, risk factor IFF. 42 articles finally included (up to 2019). High morbidity and mortality linked to IFF. Standardised classifications, management guidelines and surgical approaches are not available yet. Periprosthetic classification systems are still utilized even if not entirely appropriate. High rate of failure is related to thinner cortical bone, larger medullary canals and variable stresses depending on the distance among implants. High complication rates in all studies. Stress risers and implant stability based on fracture patterns and stress forces. Several surgical options with no uniformity. Less invasive surgical procedures are associated to reduction of metalwork failure rate, better preservation of vascularization and better functional-clinical outcomes. Lack of specific classification systems and management guidelines. Several surgical options are available with no uniformity of results. Attention to stress risers and preservation of bone stock and vascularization are key aspects for better results.

scholarly journals Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

2021 ◽  
Author(s):  
Istvan Bence Balint ◽  
Ferenc Csaszar ◽  
Krisztian Somodi ◽  
Laszlo Ternyik ◽  
Adrienn Biro ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Surgical Procedures ◽  
Risk Level ◽  
Jejunal Mucosa ◽  
Complication Rates ◽  
Pubmed Database ◽  
Significant Difference ◽  
Weight Loss Outcomes ◽  
Jejunal Bypass

Abstract Purpose Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. Methods A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. Results A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): −0.03 and confidence interval (CI): −0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01–0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: −0.03, CI: −0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74–1.59 for BMI changes). Conclusion Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors’ hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.

scholarly journals Sinus Tarsi Approach for Open Treatment and Internal Fixation of Displaced Intra-articular Calcaneal Fractures in High-Risk Patients: The New Gold Standard?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
James P. Davies ◽  
W. Bret Smith ◽  
Steven Steinlauf ◽  
Mary Millikin
Keyword(s):  
High Risk ◽  
Gold Standard ◽  
Wound Complication ◽  
Lateral Approach ◽  
Wound Complications ◽  
Complication Rates ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach

Category: Ankle, Diabetes, Hindfoot, Trauma Introduction/Purpose: Intra-articular calcaneal fractures offer unique challenges. Wound problems and infection are significant complications in the surgical treatment of calcaneal fractures which in turn can be debilitating to patients and outcomes. The literature suggests varying wound complication rates but 21% up to 33% using the traditional extensile lateral approach in some studies. The extensile lateral approach has historically been accepted as the gold standard for fixation and treatment of these fractures. Recently there has been resurgent interest in alternative approaches to the fixation of intra-articular calcaneal fractures. Of interest is the potential of the sinus tarsi approach to decrease wound complications while having comparable reduction quality to the higher wound risk extensile lateral approach. Methods: A multi-center retrospective chart review study was implemented. The study objective was to review wound complication of the sinus tarsi approach compared with outcomes from the traditional extensile approach for fixation of displaced intra-articular calcaneal fractures. Specifically; examining a population of patients considered at high risk for wound issues, comparing radiographic and clinical outcomes. Results: In the high-risk group, only one primary complications resulted, including one patient with a history of an open fracture. All fractures healed with adequate maintenance of alignment. Chi- squared analysis resulted in a statistically significant difference in complication rates between sinus tarsi and the traditional extensile lateral approach at the 95% confidence level. Conclusion: In both high-risk and lower-risk cohorts of patients, a low rate of infection and wound problems was encountered. A limited approach through a sinus tarsi incision provides a viable option to treat displaced intra-articular calcaneus fracture patients with risk factors for wound issues. The patients all healed both their soft tissue wounds and fractures. Functional return was consistent with other study populations. Our study adds another cohort of patient data demonstrating the advantage of the sinus tarsi approach when compared to the extensile lateral in terms of decreased wound complications while maintaining quality of reductions and clinical outcomes.

scholarly journals Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
T. A. G. van Vugt ◽  
J. Geurts ◽  
J. J. Arts
Keyword(s):  
Bone Graft ◽  
Clinical Studies ◽  
Local Treatment ◽  
Complication Rates ◽  
Success Rates ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Systemic Antibiotic Therapy ◽  
Eradication Of Infection ◽  
Bone Graft Substitutes

Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.

Preventing and managing aberrant drug-related behavior in primary care: Systematic review of outcomes evidence

2014 ◽  
Vol 10 (2) ◽  
pp. 119 ◽  
Author(s):  
Charles E. Argoff, MD ◽  
Meldon Kahan, MD ◽  
Edward M. Sellers, MD
Keyword(s):  
Systematic Review ◽  
Risk Mitigation ◽  
Preliminary Evidence ◽  
Mitigation Strategies ◽  
Screening Tools ◽  
Dose Titration ◽  
Supporting Evidence ◽  
Opioid Dose ◽  
Levels Of Evidence ◽  
Evidence Level

Several strategies for preventing, identifying, and responding to aberrant opioid-related behaviors are recommended in pain management guidelines. This systematic review evaluated data supporting basic strategies for addressing aberrant opioid- related behaviors. Risk reduction strategies were identified via a review of available guidelines. Systematic literature searches of PubMed (May 1, 2007- January 18, 2013) identified articles with evidence relevant to nine basic strategies. Reference lists from relevant articles were reviewed for additional references of interest. Levels of evidence for articles identified were graded on a four-point scale (strongest evidence = level 1; weakest evidence = level 4) using Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria. Weak to moderate evidence supports the value of thorough patient assessment, risk-screening tools, controlled substance agreements, careful dose titration, opioid dose ceilings, compliance monitoring, and adherence to practice guidelines. Moderate to strong evidence suggests that prescribing tamper-resistant opioids may help prevent misuse but may also have the unintended consequence of prompting a migration of users to other marketed opioids, heroin, or other substances. Similarly, preliminary evidence suggests that although recent regulatory and legal efforts may reduce misuse, they also impose barriers to the legitimate treatment of pain. Despite an absence of consistent, strong supporting evidence, clinicians are advised to use each of the available risk-mitigation strategies in combination in an attempt to minimize the risk of abuse in opioid treatment patients. Physicians must critically evaluate their opioid prescribing and not only increase their efforts to prevent substance

Literature Review of Idiopathic Toe Walking: Etiology, Prevalence, Classification, and Treatment

2017 ◽  
Vol 10 (4) ◽  
pp. 337-342 ◽  
Author(s):  
David Pomarino ◽  
Juliana Ramírez Llamas ◽  
Stephan Martin ◽  
Andrea Pomarino
Keyword(s):  
Differential Diagnosis ◽  
Literature Review ◽  
Case Studies ◽  
Therapeutic Approach ◽  
Therapeutic Approaches ◽  
Levels Of Evidence ◽  
Evidence Level ◽  
Idiopathic Toe Walking ◽  
Classification And Treatment ◽  
Toe Walking

Purpose: The main objective of this review is to gather the information available about idiopathic toe walking (ITW), its prevalence and classification, and possible therapeutic approaches. In addition, this review aims to clarify the differences between idiopathic toe walkers and tiptoe walkers with underlying neurological or muscle deficiency as primary conditions. Understanding its causes and learning to make a differential diagnosis will help determine the adequate therapeutic approach. Methods: This is a review of different articles and case studies from 1967 to 2016. The information was gathered to update and unify all the information about ITW that has been published. Conclusion: The literature offers limited research regarding the possible etiology, prevalence, classification, and evaluation of ITW. This review puts together all the information regarding the etiology, prevalence, classifications, evaluation, and treatment of ITW. Levels of Evidence: Level IV

Technique Tip: Single-Incision Endoscopic Plantar Fasciotomy

2016 ◽  
Vol 10 (3) ◽  
pp. 240-241
Author(s):  
Zachary M. Thomas ◽  
Kristin J. Thomas
Keyword(s):  
Surgical Technique ◽  
Expert Opinion ◽  
Plantar Fasciitis ◽  
Single Incision ◽  
Smooth Transition ◽  
New Technique ◽  
Foot And Ankle ◽  
Levels Of Evidence ◽  
Evidence Level ◽  
Plantar Fasciotomy

Two-incision endoscopic plantar fasciotomy (EPF) is an accepted surgical technique in the treatment of recalcitrant plantar fasciitis. Single-incision plantar fasciotomy is a relatively new technique in the surgeons’ armamentarium; however, it is not without pitfalls, specifically poor visualization. This article aims to help the foot and ankle surgeon make a smooth transition from 2-incision EPF to single-incision EPF while maintaining optimum visualization. Levels of Evidence: Level V: Expert opinion

scholarly journals Calcaneal fractures: a management dilemma-minimally invasive approach for intra and extra articular calcaneal fractures

2019 ◽  
Vol 7 (3) ◽  
pp. 756
Author(s):  
Kawade M. S. ◽  
Madan H. S. ◽  
Shailesh Khachane ◽  
Manjeet Singh Dhanda
Keyword(s):  
Minimally Invasive ◽  
Open Reduction ◽  
Wound Complications ◽  
Walking Ability ◽  
Complication Rates ◽  
Ct Reconstruction ◽  
Minimally Invasive Approach ◽  
Calcaneal Fractures ◽  
Invasive Approach ◽  
Minimally Invasive Methods

Background: Calcaneal fractures which constitutes 2% of total fractures are frequent and very debilitating if not treated properly. Calcaneal fractures generally affect younger population leading to significant man-days loss(around 2-5 years3) and in-turn leading significant economic burden on the society. The goal of treatment for calcaneal fractures is elimination of pain and restoration of normal foot shape, biomechanics, and walking ability. Wound related complications are common with open surgeries. After open reduction internal fixation with perimeter plates for displaced calcaneal fractures, wound edge necrosis is commonly observed with the extended lateral approach. Because of such high incidence of wound complications in open reduction of calcaneum fractures, minimally invasive approach takes priority over open reduction of these fractures.Methods: The study aimed to evaluate the results of minimally invasive approach for calcaneal fractures. To reduce the operative complications, 30 patients were treated with minimally invasive methods in both extra articular and intra-articular calcaneal fractures and the results were evaluated. All patients were evaluated clinically , functionally and radiologically 3D- CT reconstruction images.Results: All cases were followed up for 2 years at specified intervals. The outcome measures were evaluated by AOFAS scores10 with excellent result in 13 cases and good to fair results in the rest. Operated patients had no wound infection, no skin necrosis, 5 patients had mild subtalar arthrosis and 3 patients complained slight difficulty in wearing shoes. None of them have any gait abnormalities.Conclusions: Our study suggests that the minimally invasive methods will reduce the operative complication rates. The minimally invasive surgical intervention in an expert hand can yield better results with less complication rates.

scholarly journals Sistema de rehabilitación física con 2 CH, basado en electroterapia con software de seguimiento y control de paciente

2019 ◽  
pp. 7-15
Author(s):  
Arnulfo Cruz-Garrido ◽  
Gregorio Castillo-Quiroz ◽  
Elisa Gonzaga-Licona ◽  
Juan Alfonso Perez-Luna
Keyword(s):  
Present Article ◽  
Specific Treatment ◽  
Clinical History ◽  
Physical Rehabilitation ◽  
Human Organism ◽  
Electromagnetic Spectrum ◽  
Special Equipment ◽  
Biological Responses

The Physiotherapist uses special equipment for electrotherapy, based on the generation and management of interferential currents, voltage and frequencies (sine waves, sawtooth and square), applying energy from the electromagnetic spectrum to the human organism, generating on the tissues, desired biological responses and therapeutic. In the present article, a viable reengineering proposal was developed for teams dedicated to the application of electrotherapy as a means of physical rehabilitation, based on the analysis, emphasizing the improvements to be implemented, to give timely follow-up to the patient and fundamental support to the physiotherapist. The design was contemplated and integrated a system for physical rehabilitation (2 CH), based on electrotherapy and thermotherapy, with software for control and punctual patient follow-up, creating a folder of clinical history since the patient arrives, plotting the progress or setbacks for the generation of reports, allowing the software to suggest changes or continuation with the treatments always with the corresponding medical authorization. The existing professional teams for this area are very expensive, the most complete incorporate an interface in the instrument, but there is no software that relates the patient to the medical part, they do not provide patient follow-up, much less suggest a specific treatment based on the history.

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