One-Stage Metatarsal Interposition Lengthening With an Autologous Fibula Graft for Treatment of Brachymetatarsia

Objective: Brachymetatarsia is defined as the pathological shortening of a metatarsal bone, which can cause cosmetic problems and pain in the forefoot. The main surgical treatment options are: extension osteotomy, interposition of a bone graft, and callus distraction. Usually, a bone graft from the iliac crest is used for the interposition osteotomy. The operative technique of graft extraction from the fibula has not been described in the literature yet. Methods: Eight feet with brachymetatarsia in 5 patients were evaluated retrospectively. The minimum follow-up period was 2 years. Via a dorsal V/Y skin incision, a central osteotomy on the metatarsal bone was done. A graft was obtained from the anterior fibula. The graft was inserted and fixed by a locking plate. Additional soft tissue procedures were done. Results: We had bony consolidation in all cases. The mean extension was 9.01 mm (5.49 to 12.54 mm). This corresponded to a mean 20.3% extension of the entire metatarsal. High patient satisfaction as well as high satisfaction regarding the cosmetic results were achieved. There were no postoperative complications. The range of motion of the metatarsal-phalangeal joint IV was 20% less preoperative in terms of plantar flexion. Standing up on tiptoes was possible in all patients postoperatively. One patient reported mild symptoms after sports activities. Conclusions: Because of its anatomy the graft adapts to the metatarsal IV bone. As our study showed, harvesting from the distal fibula causes no functional restriction. In terms of wound and bone healing as well as pain symptoms, this method should be considered as an alternative to the standard iliac graft.

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A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa274 ◽

2020 ◽

Author(s):

Akshar Jaglan ◽

Tarek Ajam ◽

Steven C Port ◽

Tanvir Bajwa ◽

A Jamil Tajik

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Kawasaki Disease ◽

Treatment Options ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Coronary Artery Ectasia ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

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The ENDOPAIN 4D Questionnaire: A New Validated Tool for Assessing Pain in Endometriosis

Journal of Clinical Medicine ◽

10.3390/jcm10153216 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3216

Author(s):

Anne Puchar ◽

Pierre Panel ◽

Anne Oppenheimer ◽

Joseph Du Cheyron ◽

Xavier Fritel ◽

...

Keyword(s):

Minimal Clinically Important Difference ◽

Patient Reported Outcome ◽

Measurement Properties ◽

Dimensional Structure ◽

Clinically Important Difference ◽

Urinary Tract Symptoms ◽

New Instrument ◽

Patient Reported ◽

Good Internal Consistency ◽

Pain Symptoms

Objectives: To study the measurement properties, the responsiveness and the minimal clinically important difference of the ENDOPAIN-4D: a new questionnaire for assessing pain in endometriosis. Methods: A prospective, observational, multicentre study was conducted including all women ≥18 years consulting for symptomatic proven endometriosis between 1 January 2017 and 30 June 2018 and volunteering to participate. Each patient had to answer a new self-administered patient-reported outcome (PRO) questionnaires (the ENDOPAIN-4D) at inclusion (T0) and 12 months after medical or surgical treatment (T1). Criteria defined by COSMIN were used to validate the questionnaire's measurement properties. The minimal clinically important difference was estimated by the anchor-based method. Results: The study included 199 women. The ENDOPAIN-4D score had a four dimensional structure with good internal consistency (measured by Cronbach α): I) pain-related disability (α = 0.79), II) painful bowel symptoms (α = 0.80), III) dyspareunia (α = 0.83), and IV) painful urinary tract symptoms (α = 0.77). They produced four subscores that can be summed to obtain a single score (α = 0.61). The ENDOPAIN-4D total score ranged from 0 to 94.00 (mean ± SD: 46.7 ± 22). The total score was significantly correlated with the PROs used in endometriosis. Sensitivity to change was good with large effect sizes (ES) (mean of the differences: 36.3 p = 1.8 10−7, ES 0.76). The minimal clinically important difference of the global score was determined to be 10.9. Conclusions: The ENDOPAIN-4D questionnaire is easy to use, valid, and effective in assessing patient reported pain symptoms in women treated for endometriosis. This new instrument can be used as the primary outcome for future clinical trials and as a tool for routine patient follow-up.

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The Public’s Perception of Interventions for Migraine Headache Disorders: A Crowdsourcing Population-Based Study

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojz007 ◽

2019 ◽

Vol 1 (2) ◽

Cited By ~ 5

Author(s):

Orr Shauly ◽

Daniel J Gould ◽

Ketan M Patel

Keyword(s):

Migraine Headache ◽

Treatment Options ◽

The United States ◽

Cost Of Care ◽

Adverse Outcomes ◽

Amazon Mechanical Turk ◽

Cross Sectional ◽

Economic Productivity ◽

Migraine Headaches ◽

Patient Reported

Abstract Background Migraine disorders are a leading cause of morbidity and decreased economic productivity in the United States among both men and women. As such, it is important to consider patient opinions, and have an accurate representation of the burden and sentiment toward currently available interventions among those suffering from migraines. Objectives The aim of the study was to assess patient options regarding adverse outcomes of the various treatment options available for migraine headaches. Methods A prospective cross-sectional study of volunteers recruited through an internet crowdsourcing service, Amazon Mechanical Turk©, was conducted. Surveys were administered to collect patient-reported opinions regarding adverse outcomes of both surgical and nonsurgical treatment options for migraine headaches. Results The prevalence of migraine headache across all study participants was 15.6% and varied slightly across participant demographics. Individuals ages 35–44 (2.73 migraines per month) experienced the fewest migraine and with the lowest severity. Those individuals ages 45+ experienced the most severe headaches (Visual Analog Scale = 44.23 mm). Additionally, the greatest migraine frequency and severity existed among those households with yearly income of $75,000–$100,000. The lowest injection therapy utility scores were obtained for adverse outcomes of hematoma (47.60 mm) and vertigo (54.40 mm). Conclusions Migraine headaches remains a significant problem among the US population, with an overall prevalence of 15.6% (approximately 50 million Americans). Additionally, physicians interesting in offering minimally invasive or surgical treatment for migraine headaches should focus on mitigating patient fears regarding clinical outcomes and cost of care.

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Metatarsophalangeal Hyperextension Movement Pattern Related to Diabetic Forefoot Deformity

Physical Therapy ◽

10.2522/ptj.20150361 ◽

2016 ◽

Vol 96 (8) ◽

pp. 1143-1151 ◽

Cited By ~ 5

Author(s):

Victor A. Cheuy ◽

Mary K. Hastings ◽

Michael J. Mueller

Keyword(s):

Diabetic Neuropathy ◽

Plantar Flexion ◽

Metatarsophalangeal Joint ◽

Movement Pattern ◽

Cross Sectional Study ◽

Ankle Dorsiflexion ◽

Cross Sectional ◽

3 Dimensional ◽

Foot Motion ◽

Standing Up

Abstract Background Metatarsophalangeal joint (MTPJ) hyperextension deformity is common in people with diabetic neuropathy and a known risk factor for ulceration and amputation. An MTPJ hyperextension movement pattern may contribute to the development of this acquired deformity. Objective The purpose of this study was to determine, in people with diabetes mellitus and peripheral neuropathy (DM+PN), the ankle and MTPJ ranges of motion that characterize an MTPJ hyperextension movement pattern and its relationship to MTPJ deformity severity. It was hypothesized that severity of MTPJ deformity would be related to limitations in maximum ankle dorsiflexion and increased MTPJ extension during active ankle dorsiflexion movement tasks. Design A cross-sectional study design was used that included 34 people with DM+PN (mean age=59 years, SD=9). Methods Computed tomography and 3-dimensional motion capture analysis were used to measure resting MTPJ angle and intersegmental foot motion during the tasks of ankle dorsiflexion and plantar flexion with the knee extended and flexed to 90 degrees, walking, and sit-to/from-stand. Results The MTPJ extension movement pattern during all tasks was directly correlated with severity of MTPJ deformity: maximum ankle dorsiflexion with knee extended (r=.35; 95% confidence interval [CI]=.02, .62), with knee flexed (r=.35; 95% CI=0.01, 0.61), during the swing phase of gait (r=.47; 95% CI=0.16, 0.70), during standing up (r=.48; 95% CI=0.17, 0.71), and during sitting down (r=.38; 95% CI=0.05, 0.64). All correlations were statistically significant. Limitations This study was cross-sectional, and causal relationships cannot be made. Conclusions A hyperextension MTPJ movement pattern associated with limited ankle dorsiflexion has been characterized in people with diabetic neuropathy. Increased MTPJ extension during movement and functional tasks was correlated with severity of resting MTPJ alignment. Repetition of this movement pattern could be an important factor in the etiology of MTPJ deformity and future risk of ulceration.

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Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1667364 ◽

2018 ◽

Vol 35 (02) ◽

pp. 108-116 ◽

Cited By ~ 5

Author(s):

Lucas Ritschl ◽

Rali Georg ◽

Andreas Kolk ◽

Marco Kesting ◽

Klaus-Dietrich Wolff ◽

...

Keyword(s):

Cancellous Bone ◽

Area Under The Curve ◽

Perfusion Index ◽

Segment Length ◽

Mandible Reconstruction ◽

Distal Fibula ◽

Fibula Graft ◽

Time To Peak ◽

Perfusion Studies ◽

Free Fibula

Background Indocyanine green (ICG) videoangiography is routinely used to evaluate skin and organ perfusion and to assess patency rates of microvascular anastomoses. This study uses ICG angiography as a novel approach to qualitatively and quantitatively evaluate bone perfusion of microvascular fibula grafts intraoperatively and to assess the effect of fibula segment length and number of osteotomies on bone perfusion. Methods All patients planned for mandible reconstruction using a microvascular fibula graft between January 2013 and May 2017 were considered for this study. ICG videoangiography of cancellous bone perfusion was performed using a handheld ICG camera. Videos were analyzed, and a perfusion curve was generated. Peak enhancement, time to peak, slope, and wash-in area under the curve were extracted; rise time, wash-in rate (WiR), and wash-in perfusion index were calculated. Results were statistically analyzed with regard to distal fibula segment length and number of osteotomy sites. Results Thirty-nine patients (age 59 ± 8 years) were included in the study. Mandible reconstruction was achieved with 1 (n = 15), 2 (n = 13), or 3 (n = 11) fibula segments. The WiR was 6.4 ± 2.3 and 4.4 ± 0.2 before and after proximal osteotomy, respectively. The wash-in perfusion index was 114.2 ± 48.4 before and 84.4 ± 20.0 after proximal osteotomy. Bone perfusion was significantly reduced after additional proximal osteotomies. Both the segment length and number of proximal osteotomies correlated with bone perfusion, with longer segments and fewer osteotomies showing higher perfusion. Conclusion This study demonstrates the feasibility of cancellous bone perfusion analysis using ICG and can serve as a basis for future bone perfusion studies. Additional osteotomies and short segment length negatively affects cancellous bone perfusion of the distal fibula segment in free fibula flaps. The extent to which the observed decrease in arterial inflow to the distal fibula segment affects the further course of healing needs to be addressed in future studies.

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TREATMENT OPTIONS FOR NEGLECTED ACHILLES TENDON RUPTURED: WETHER SPONTANEOUS HEALING IS POSSIBLE?

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2018-24-2-59-69 ◽

2018 ◽

Vol 24 (2) ◽

pp. 59-69

Author(s):

A. P. Sereda

Keyword(s):

Surgical Treatment ◽

Achilles Tendon ◽

Treatment Outcomes ◽

Plantar Flexion ◽

Treatment Options ◽

Tendon Healing ◽

Spontaneous Healing ◽

Minimal Incision ◽

Better Than

The paper considers cases of spontaneous healing of achilles tendon with elongation. In such condition the tendon defect is not palpable, active plantar flexion is preserved and patients are complaining for strength diminution.Purpose— to study features of spontaneous achilles tendon healing with elongation and to analyze the shortening tenoplasty option as a procedure primarily aimed at restoration of strength for gastrocnemius-soleus complex.Material and Methods.The paper presents features and outcomes of surgical treatment of 25 patients who underwent a shortening tenoplasty of various types: crimping (3 patients), Z-type (2 patients), oblique (1 patient) and transverse (19 patients).Results.No re-ruptures or other serious complications were observed in the patients of the present study. Treatment outcomes were evaluated by j. leppilahti scale in 304,7±8,9 days after the procedure. postoperative leppilahti scores were statistically significantly better than prior to surgery — 82,4±5,6 and 62,2±7,7, respectively, (p<0,0001). Conclusion. Shortening tenoplasty can be indicated in cases of spontaneous achilles tendon healing with elongation. at relatively early stages of the injury with rather elastic scars the crimping tenoplasty can be applied. At later stages a resection shortening tenoplasty is recommended through a minimal incision with transverse resection of tendon and removal of scar block.

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Associations between patient knowledge of others' experiences and treatment choice in men with localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6578 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6578-6578

Author(s):

Aaron J. Katz ◽

Ying Cao ◽

Xinglei Shen ◽

Deborah Usinger ◽

Sarah Walden ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

North Carolina ◽

Cancer Patients ◽

Treatment Options ◽

Population Based ◽

Treatment Choice ◽

Localized Prostate Cancer ◽

The North ◽

Patient Reported

6578 Background: Men with localized prostate cancer must select from multiple treatment options, without one clear best choice. Consequently, personal factors, such as knowing other prostate cancer patients who have undergone treatment, may influence patient decision-making. However, associations between knowledge about others’ experiences and treatment decision-making among localized prostate cancer patients has not been well characterized. We used data from a population-based cohort of localized prostate cancer patients to examine whether patient-reported knowledge of others’ experiences is associated with treatment choice. Methods: The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) is a population-based cohort of localized prostate cancer patients enrolled from 2011-2013 throughout the state of North Carolina in collaboration with the North Carolina Central Cancer Registry. All patients were enrolled prior to treatment and followed prospectively. Patient decision-making factors including knowledge of others’ experiences with prostate cancer treatment options were collected through patient report. Patient treatment choice was determined through medical record abstraction and cancer registry data. Results: Among 1,202 patients, 17% reported knowing someone who pursued active surveillance (AS) while 28%, 46%, and 59% reported knowing someone who received brachytherapy, external beam radiation (EBRT), or radical prostatectomy (RP), respectively; 26% underwent AS, 9% brachytherapy, 21% EBRT, and 39% RP as their initial treatment. In unadjusted analyses, patients with knowledge of others’ experiences with brachytherapy, EBRT or RP had more than twice the odds of receiving that treatment compared to patients who did not. Knowledge of others’ experience with AS was not associated with choice to undergo AS. Multivariable analysis adjusting for age, race, risk group, and patient-reported goals of care showed knowledge of others’ experiences with brachytherapy (OR 4.60, 95% confidence interval [CI] 2.76 to 7.68), EBRT (OR 2.38, 95% CI 1.69 to 3.34), or RP (OR 4.02, 95% CI 2.84 to 5.70) was significantly associated with odds of receiving that treatment. The odds of receiving a particular treatment option were further increased among patients who reported knowing someone who had a “good” experience with the treatment in question. Conclusions: This is the first population-based study to directly demonstrate the impact of a patient’s knowledge of others’ experiences on treatment choice in prostate cancer. These data provide a new consideration to clinicians in their counseling of patients with newly diagnosed prostate cancer, and also impacts research into the informed decision-making process for this disease.

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Treatment options for aseptic tibial diaphyseal nonunion: A review of selected studies

EFORT Open Reviews ◽

10.1302/2058-5241.5.190077 ◽

2020 ◽

Vol 5 (11) ◽

pp. 835-844

Author(s):

Elena Gálvez-Sirvent ◽

Aitor Ibarzábal-Gil ◽

E. Carlos Rodríguez-Merchán

Keyword(s):

Bone Graft ◽

Bone Defect ◽

Treatment Options ◽

Bone Transport ◽

Iliac Crest Bone Graft ◽

Non Invasive ◽

Recommended Treatment ◽

Bone Autograft ◽

Surgical Treatments ◽

Rate Of Success

In aseptic tibial diaphyseal nonunions after failed conservative treatment, the recommended treatment is a reamed intramedullary (IM) nail. Typically, when an aseptic tibial nonunion previously treated with an IM nail is found, it is advisable to change the previous IM nail for a larger diameter reamed and locked IM nail (the rate of success of renailing is around 90%). A second change after an IM nail failure is also a good option, especially if bone healing has progressed after the first change. Fibular osteotomy is not routinely advised; it is only recommended when it interferes with the nonunion site. In delayed unions before 24 weeks, IM nail dynamization can be performed as a less invasive option before deciding on a nail change. If there is a bone defect, a bone graft must be recommended, with the gold standard being the autologous iliac crest bone graft (AICBG). A reamer-irrigator-aspirator (RIA) system might also obtain a bone autograft that is comparable to AICBG. Although the size of the bone defect suitable to perform bone transport techniques is a controversial issue, we believe that such techniques can be considered in bone defects > 3 cm. Non-invasive therapies and biologic therapies could be applied in isolation for patients with high surgical risk, or could be used as adjuvants to the aforementioned surgical treatments. Cite this article: EFORT Open Rev 2020;5:835-844. DOI: 10.1302/2058-5241.5.190077

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Monostotic fibrous dysplasia at C7 treated with vertebroplasty: a case report and review of the literature

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1717-2 ◽

2019 ◽

Vol 17 (1) ◽

Author(s):

Xin Xin ◽

Jianhong Feng ◽

Chen Yue ◽

Tao Jin ◽

Xinxin Liu

Keyword(s):

Neck Pain ◽

Fibrous Dysplasia ◽

Clinical Symptoms ◽

Treatment Options ◽

Complete Removal ◽

Posterior Fusion ◽

Compression Injury ◽

Laboratory Findings ◽

Fusion Procedure ◽

Patient Reported

Abstract Background Monostotic fibrous dysplasia (MFD) involving the spine is rare, and the treatment options are controversial. Surgery is needed when patients suffer from persistent pain, spinal cord compression/injury, and vertebral collapse/instability. Treatment methods include biopsy/observation, corpectomy with instrumented fusion, posterior fusion, vertebroplasty (VP), curettage and bone graft, and complete removal of the vertebra with a combined anterior and posterior fusion procedure. Case presentation The patient was a 56-year-old woman with a 2-year history of neck pain. No obvious abnormalities were detected on neurological or physical examination, and laboratory findings were all within normal limits. An imaging examination suggested a C7 vertebral bone tumor. The patient refused to continue conservative observation treatment and requested surgery. Open VP of the C7 vertebral body was carried out, and her postoperative neck pain was completely relieved. The postoperative pathological results supported the diagnosis of fibrous dysplasia, and the patient was ultimately diagnosed with MFD. At the 12-month follow-up visit, the patient reported no clinical symptoms, and no signs of tumor recurrence were detected. Conclusion VP can relieve pain while stabilizing the spine. Thus, the surgical treatment of MFD vertebral lesions by VP is a valuable option.

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Composer—Visual Cohort Analysis of Patient Outcomes

Applied Clinical Informatics ◽

10.1055/s-0039-1687862 ◽

2019 ◽

Vol 10 (02) ◽

pp. 278-285 ◽

Cited By ~ 1

Author(s):

Jen Rogers ◽

Nicholas Spina ◽

Ashley Neese ◽

Rachel Hess ◽

Darrel Brodke ◽

...

Keyword(s):

Decision Making ◽

Patient Outcomes ◽

Visual Analysis ◽

Treatment Options ◽

Cohort Analysis ◽

Analysis Tool ◽

Electronic Health Record Data ◽

Patient Cohort ◽

Orthopedic Surgeons ◽

Patient Reported

Objective Visual cohort analysis utilizing electronic health record data has become an important tool in clinical assessment of patient outcomes. In this article, we introduce Composer, a visual analysis tool for orthopedic surgeons to compare changes in physical functions of a patient cohort following various spinal procedures. The goal of our project is to help researchers analyze outcomes of procedures and facilitate informed decision-making about treatment options between patient and clinician. Methods In collaboration with orthopedic surgeons and researchers, we defined domain-specific user requirements to inform the design. We developed the tool in an iterative process with our collaborators to develop and refine functionality. With Composer, analysts can dynamically define a patient cohort using demographic information, clinical parameters, and events in patient medical histories and then analyze patient-reported outcome scores for the cohort over time, as well as compare it to other cohorts. Using Composer's current iteration, we provide a usage scenario for use of the tool in a clinical setting. Conclusion We have developed a prototype cohort analysis tool to help clinicians assess patient treatment options by analyzing prior cases with similar characteristics. Although Composer was designed using patient data specific to orthopedic research, we believe the tool is generalizable to other healthcare domains. A long-term goal for Composer is to develop the application into a shared decision-making tool that allows translation of comparison and analysis from a clinician-facing interface into visual representations to communicate treatment options to patients.

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