The Safety and Effectiveness of the Percutaneous Flexor Tenotomy in Healing Neuropathic Apical Toe Ulcers in the Outpatient Setting

2019 ◽  
Vol 13 (2) ◽  
pp. 123-131
Author(s):  
Simon E. Smith ◽  
Julie Miller
Keyword(s):  
Patient Satisfaction ◽  
Ulcer Healing ◽  
Case Series ◽  
Outpatient Setting ◽  
The Mean ◽  
Prospective Case Series ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Mean Time ◽  
Flexor Tenotomy

Percutaneous flexor tenotomy is a minimally invasive procedure that involves cutting one or both flexor digitorum tendons underneath the toe. It is an alternative to open surgical procedures performed in an operating theatre. This project is a prospective case series investigating the utility, effectiveness, and participant satisfaction of the percutaneous flexor tenotomy when performed in the outpatient setting. People with diabetes, digital flexion deformity, and loss of protective sensation with an apical ulcer or preulcerative lesion presenting to the Austin Health Foot Ulcer Specialist Outpatient Clinic were enrolled in the study. The procedure was performed under sterile technique with an 18-gauge needle or fine scalpel blade. Participants were reviewed weekly until the incision and/ or ulcer healed. Participants were then followed up at 3 and 6 months. Time to ulcer healing, reulceration rate, frequency of complications, and patient satisfaction were recorded. There were 11 toe ulcers and 41 preulcerative lesions. A total of 76 tenotomy procedures were performed on the 23 participants across 35 episodes of care. The mean time to ulcer healing following tenotomy was 10.2 ± 4.3 days. There were no recurrences of ulceration. The infection rate per episode of care was 2.8%. There were 11 toes (14.5%) that sustained a transfer lesion post the index procedure. The mean time to development of a transfer lesion was 95.5 ± 98.1 days. All participants strongly agreed that they were satisfied with the outcome of the procedure. The flexor tenotomy is an effective procedure to expedite the healing of apical toe ulcers in people with loss of protective sensation and flexion digital deformity. It has a low infection rate and high patient satisfaction rate when performed in the outpatient setting. There is a moderate risk of transfer preulcerative lesions to an adjacent digit. Levels of Evidence: Level IV: Prospective case series

scholarly journals DISTAL FEMORAL SHAFT FRACTURES

2018 ◽  
Vol 25 (03) ◽  
pp. 359-363
Author(s):  
Tawfeeq Safi Sarraj ◽  
Jehan Zaib Shah
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Femur Fractures ◽  
Supracondylar Femoral Fractures ◽  
The Mean ◽  
Prospective Case Series ◽  
Mean Time ◽  
Supracondylar Femur Fractures

Objectives: To assess the functional outcome in supracondylar femur fracturesfixed with intramedullary tibial nail. Study Design: Prospective case series. Setting: Al Noorspecialist hospital, Makkah, Saudi Arabia. Period: Four years (2009-2013). Methods: 25patients with closed supracondylar femoral fractures operated with tibial intramedullary nail. Thefunctional outcome was measured by Tegner Lysholm criteria during and after 4 years. Results:Out of 25 patients 20 were male and 5 were female. The mean time of healing was 15.80(2.646)weeks. 6(24%) patients showed excellent results, 12(48%) patients showed good results and7(28%) patients showed fair results. There were no poor results in our study. Conclusions:Retrograde tibial nails are cheaper, convenient and lead to good functional outcome in patientswith supracondylar femur fractures.

scholarly journals Epidemiological Features of Patients with Subdural Hygroma in a Prospective Case Series

2017 ◽  
Vol 36 (04) ◽  
pp. 203-206
Author(s):  
Pedro Hamamoto Filho ◽  
Tamara Pereira ◽  
Marco Zanini
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Elderly Patients ◽  
Case Series ◽  
Chronic Subdural Hematoma ◽  
Subdural Hygroma ◽  
Male Predominance ◽  
The Mean ◽  
Prospective Case Series ◽  
Mean Time

AbstractSubdural hygroma is an accumulation of a cerebrospinal fluid-like fluid in the subdural space. It is a common epiphenomenon after a traumatic brain injury (TBI), but it may also occur after brain surgeries. A total of 17 patients in a prospective case series with subdural hygromas were analyzed. A male predominance (82.4%) was found. The mean age was 58.6 years. Traumatic brain injury was the main mechanism (76.5%); however, other mechanisms, such as post-craniotomy (17.6%), post-chronic subdural hematoma drainage (5.9%), and post-ventricle shunt (5.9%), were also observed. Incidental findings were diagnosed in 11.8% of the cases (mainly in elderly patients). Four patients required subdural shunt (23.5%)—all of them had TBI. Small subdural effusions were present in 35.5% of the cases. The mean time from admission to diagnosis was 6.1 days. The majority of the cases must have involved lesions of the dura–arachnoid interface since TBIs were the main causes of hygroma. The findings of incidental hygroma in elderly patients and its development after a ventricle shunt suggest that brain atrophy also plays a significant role in subdural hygroma formation.

scholarly journals Surgical technique for biological fixation of closed segmental tibial fractures by the Less Invasive Stabilization System (LISS)

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 48 ◽  
Author(s):  
Osama Gamal ◽  
Ahmed Shams
Keyword(s):  
Surgical Technique ◽  
Case Series ◽  
Tibial Fractures ◽  
Stabilization System ◽  
Less Invasive ◽  
The Mean ◽  
Prospective Case Series ◽  
Distal Fracture ◽  
Mean Time

Introduction: This prospective case series study aimed to assess the value of the Less Invasive Stabilization System (LISS) to treat closed Segmental Tibial Fractures (STFs) using a proposed surgical technique.Materials and methods: Between August 2010 and January 2014, 21 consecutive recently (within 1 week) closed STFs that matched the inclusion criteria were enrolled. Patients were treated with the 13-hole LISS plate. All patients were followed up every 2 weeks for the first 2 months, then every month for the rest of the first 6 months and then every 6 months thereafter. Patients were assessed radiologically during the follow-up appointments and clinically at the final visit by the Lower Extremity Functional Scale (LEFS) to evaluate the result.Results: The mean time to union of the proximal fracture was 15.72 ± 2.78 (range: 12–20) weeks and for the distal fracture was 20 ± 2.22 (range: 16–24) weeks, excluding delayed union in three patients. All patients except the three showed radiological observable callus in a mean duration of 4.95 (range: 3–7) weeks. The mean final follow-up LEFS was 72.4 (range: 60–80).Conclusion: The mean time to union of the proximal fracture was shorter than the distal fracture. The use of LISS to treat closed STFs using the proposed surgical technique has proved to give favorable results. Further studies using the described technique are needed to justify the achieved results.Level of evidence: IV (Prospective case series).

scholarly journals Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110108
Author(s):  
Andrea Bardos ◽  
Sanjeeve Sabhrawal ◽  
Graham Tytherleigh-Strong
Keyword(s):  
Ct Scan ◽  
Constant Score ◽  
Case Series ◽  
Sternal Fracture ◽  
Elite Level ◽  
The Mean ◽  
Mean Time ◽  
Time From Injury ◽  
Sternal Fractures

Background: Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported. Purpose: To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture. Study Design: Case series; Level of evidence, 4. Methods: Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan. Results: Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ P < .05]), Constant score (from 84 to 96.4 [ P < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ P < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications. Conclusion: Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.

scholarly journals Our comprehensive experience with tracheostomy in tertiary multi-speciality hospital over four years

2021 ◽  
Vol 7 (10) ◽  
pp. 1649
Author(s):  
Parth B. Kapadia ◽  
Manit M. Mandal ◽  
Ajay J. Panchal ◽  
Rakesh Kumar ◽  
Neel Parmar ◽  
...  
Keyword(s):  
Medical Education ◽  
Retrospective Study ◽  
Surgical Procedure ◽  
Case Series ◽  
Final Outcome ◽  
Patient Age ◽  
Significant Case ◽  
Surgical Emphysema ◽  
The Mean ◽  
Mean Time

<p class="abstract"><strong>Background:</strong> Tracheostomy is a common surgical procedure used to achieve a secure airway in patients in elective as well as emergency conditions. Our study accounts for our first-hand experience with the procedure in our tertiary multi-speciality hospital.</p><p class="abstract"><strong>Methods:</strong> It is a four year (January 2017 to February 2021) retrospective study in which all the 246 cases of tracheostomies were taken into account which were performed during this study period in the department of otorhinolaryngology (ENT), Surat Municipal Institute of Medical Education and Research (SMIMER), Surat (India). The patients were thoroughly followed up until the final outcome of the tracheostomy was established.  </p><p class="abstract"><strong>Results:</strong> A total of 246 tracheostomies were performed, 63.82% of which were in men. The mean patient age was 42 years. The majority (76%) were elective, performed for various indications, while the remaining 24% were emergency tracheostomies. All tracheostomies were performed by otorhinolaryngologists. Complications relating to tracheostomy were documented in 40 patients (16%) intra-operatively and/or post-operatively which included bleeding, surgical emphysema, granulations along the stomal site and rarely shock. The mean time to decannulation was 13.48 days.</p><p class="abstract"><strong>Conclusions:</strong> Our study takes into account and discusses the findings of all the 246 tracheostomies which were performed during the study period of 4 years. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies.</p><p class="Default"> </p>

scholarly journals Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141879007 ◽  
Author(s):  
Pablo Wagner ◽  
Emilio Wagner
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Reliable Technique ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
The Mean ◽  
Prospective Case Series

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

Kingella kingae septic arthritis

2021 ◽  
Vol 103-B (3) ◽  
pp. 584-588
Author(s):  
Mohammed Khattak ◽  
Sujith Vellathussery Chakkalakumbil ◽  
Robert A. Stevenson ◽  
David J. Bryson ◽  
Michael J. Reidy ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Young Patients ◽  
Case Series ◽  
Blood Parameters ◽  
Pcr Analysis ◽  
Kingella Kingae ◽  
Patient Demographics ◽  
The Mean ◽  
Polymerase Chain ◽  
Prospective Case Series

Aims The aim of this study was to determine the extent to which patient demographics, clinical presentation, and blood parameters vary in Kingella kingae septic arthritis when compared with those of other organisms, and whether this difference needs to be considered when assessing children in whom a diagnosis of septic arthritis is suspected. Methods A prospective case series was undertaken at a single UK paediatric institution between October 2012 and November 2018 of all patients referred with suspected septic arthritis. We recorded the clinical, biochemical, and microbiological findings in all patients. Results A total of 160 patients underwent arthrotomy for a presumed septic arthritis. Of these, no organism was identified in 61 and only 25 of these were both culture- and polymerase chain reaction (PCR)-negative. A total of 36 patients did not undergo PCR analysis. Of the remaining 99 culture- and PCR-positive patients, K. kingae was the most commonly isolated organism (42%, n = 42). The knee (n = 21), shoulder (n = 9), and hip (n = 5) were the three most commonly affected joints. A total of 28 cases (66%) of K. kingae infection were detected only on PCR. The mean age of K. kingae-positive cases (16.1 months) was significantly lower than that of those whose septic arthitis was due to other organisms (49.4 months; p < 0.001). The mean CRP was significantly lower in the K. kingae group than in the other organism group (p < 0.001). The mean ESR/CRP ratio was significantly higher in K. kingae (2.84) than in other infections (1.55; p < 0.008). The mean ESR and ESR/CRP were not significantly different from those in the 'no organism identified' group. Conclusion K. kingae was the most commonly isolated organism from paediatric culture- and/or PCR-positive confirmed septic arthritis, with only one third of cases detected on routine cultures. It is important to develop and maintain a clinical suspicion for K. kingae infection in young patients presenting atypically. Routine PCR testing is recommended in these patients. Cite this article: Bone Joint J 2021;103-B(3):584–588.

scholarly journals Risks associated with oral deferiprone in the treatment of infratentorial superficial siderosis

2019 ◽  
Vol 267 (1) ◽  
pp. 239-243 ◽  
Author(s):  
Y. Sammaraiee ◽  
G. Banerjee ◽  
S. Farmer ◽  
B. Hylton ◽  
P. Cowley ◽  
...  
Keyword(s):  
Side Effects ◽  
Case Series ◽  
Iron Chelator ◽  
Superficial Siderosis ◽  
Neutropenic Sepsis ◽  
Favourable Safety ◽  
Favourable Safety Profile ◽  
Life Threatening ◽  
The Mean ◽  
Mean Time

Abstract Objective Deferiprone is an iron chelator that has recently been used to treat patients with infratentorial superficial siderosis (iSS). It is considered to have a generally favourable safety profile but concerns have been raised due to the risk of agranulocytosis. We aimed to evaluate the safety and tolerability of oral deferiprone as a treatment for patients with iSS. Methods We present a case series of 10 consecutive patients presenting with classical iSS treated with deferiprone. Results Ten patients were followed up for a mean period of 2.3 years (range 0.5–5.5 years). Four patients (40%) were withdrawn from treatment because of treatment-related side effects. The reasons for treatment discontinuation were neutropenic sepsis (n = 3) and fatigue (n = 1). In 2 out of the 3 cases of neutropenic sepsis, patients initially developed neutropenia without sepsis. The mean time to neutropenic sepsis following deferiprone was 1.2 years (range 0.3–2.5) with mean neutrophil count of 0.4 (range 0.3–0.5). Six patients (60%) reported no change in neurological function while on treatment, and four patients (40%) reported that their condition deteriorated. Conclusions Deferiprone was poorly tolerated, with 40% of patients withdrawing from treatment, most commonly due to neutropenic sepsis, after an average of 2 years on treatment. This study increases the number of reported cases of agranulocytosis in patients with iSS treated with deferiprone. Clinicians treating iSS patients with deferiprone should be aware that this drug has a potentially life-threatening side effect of neutropenic sepsis, and should ensure that appropriate haematological monitoring is in place.

scholarly journals Comparison of visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses

2020 ◽  
Vol 40 (10) ◽  
pp. 2553-2562
Author(s):  
Wojciech Lubiński ◽  
Karolina Podborączyńska-Jodko ◽  
Marta Kirkiewicz ◽  
Maciej Mularczyk ◽  
Michał Post
Keyword(s):  
Case Series ◽  
Cataract Extraction ◽  
Intraocular Lenses ◽  
Group Differences ◽  
Difficult Situation ◽  
Iol Implantation ◽  
Visual Outcomes ◽  
Defocus Curve ◽  
The Mean ◽  
Prospective Case Series

Abstract Purpose To compare visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses (IOLs). Methods All subjects underwent sequential bilateral cataract extraction with AtLisa tri 839 MP or Symfony IOL implantation. The design is prospective case series. Each group consists of 20 patients (40 eyes). At 1 year postoperatively, the following parameters were analysed: binocular uncorrected visual acuity (log MAR): for distance (UDVA) at 4 m, for intermediate distances (UIVA) at 60, 70, 80 cm and for near (UNVA) at 40 cm, defocus curve, mesopic and photopic contrast sensitivities (CSs), spectacle independence, visual function test questionnaire modified VFQ-25), photopic phenomena and postoperative complications. Results In the AtLisa tri 839 MP group, the mean binocular UNVA and UIVA were significantly better than in the Symfony group (UNVA: − 0.01 ± 0.04 vs. 0.21 ± 0.15; p = 0.000; 60 cm UIVA: − 0.01 ± 0.04 vs. 0.09 ± 0.09, p = 0.001; 70 cm UIVA − 0.05 ± 0.06 vs. 0.11 ± 0.08, p = 0.002; 80 cm UIVA − 0.01 ± 0.06 vs. 0.15 ± 0.08, p = 0.019). There were no significant between-group differences in the mean binocular UDVA and CS, with one exception: the mean binocular distance CS (18 cpd) under mesopic conditions was significantly better in the Symfony group than in the AtLisa tri 839 MP group (1.39 ± 0.22 vs. 1.17 ± 0.27; p = 0.015). The defocus curve analysis revealed significant between-group differences at vergences of 2.0 to − 4.0 D (p < 0.05), except for 2.0, 1.0, 0 and − 1.5. All subjects in AtLisa tri 839 MP group and 18 subjects (90%) in Symfony group were spectacle independent. Patients from both groups highly rated their overall vision quality in the VFQ-25 (1.67 ± 0.47 vs. 1.85 ± 0.5 in the Symfony and AtLisa tri 839 MP group, respectively, p = NS). The scores for daytime driving (1.00 ± 0.00 vs. 1.21 ± 0.36; p = 0.002), night driving (1.57 ± 0.55 vs. 2.13 ± 1.15; p = 0.027) and difficult situation driving (1.14 ± 0.31 vs. 1.53 ± 0.56; p = 0.049) were significantly better in the AtLisa tri 839 MP group than in the Symfony group. The incidence and perception level of halo and glare were significantly reduced (p = 0.00) in the Symfony group as compared to the AtLisa tri 839 MP group. The postoperative course was uneventful in all subjects. Conclusions Visual outcomes achieved with both IOLs are comparable. In both groups, 90% of patients achieved spectacle independence. Whereas the AtLisa tri 839 MP IOL implantation was associated with slightly better intermediate distance VA and significantly better near VA, photic phenomena were less perceived by patients with Symfony IOLs.

scholarly journals Epidemiological and clinical characteristics of 671 COVID-19 patients in Henan Province, China

2020 ◽  
Vol 49 (4) ◽  
pp. 1085-1095
Author(s):  
Yifei Nie ◽  
Jitian Li ◽  
Xueyong Huang ◽  
Wanshen Guo ◽  
Xiaobai Zhang ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Case Series ◽  
Henan Province ◽  
X Rays ◽  
Illness Onset ◽  
Medical Disorders ◽  
History Of ◽  
The Mean ◽  
Wet Market ◽  
Mean Time

Abstract Background Despite many reports on the characteristics of coronavirus disease 2019 (COVID-19) in Wuhan, China, relatively little is known about the transmission features of COVID-19 outside Wuhan, especially at the provincial level. Methods We collected epidemiological, demographic, clinical, laboratory, radiological and occupation information, along with contact history, of 671 patients with laboratory-confirmed COVID-19 reported from January 23 to February 5, 2020, in Henan province, China. We described characteristics of these cases, compared the diagnostic accuracy and features of blood testing, computed tomography (CT) scans and X-rays, and analysed SARS-CoV-2 transmission sources and patients’ occupations in Henan province. Results The mean age of patients in this case series was 43 years, 56.2% were male and 22.4% had coexisting medical disorders. The death rate was 0.3%. Fourteen patients did not show any symptoms. Lymphocyte percentage was associated with disease severity (χ2 = 6.71, P = 0.035) but had a large variation in each sample group. The mean time from illness onset to diagnosis was 5.6 days. A total of 330 patients had ever lived in or visited Wuhan, 150 had contact with confirmed cases, 323 had been to a hospital and 119 had been to a wet market. There were 33 patients who did not have a traceable transmission source, with 21.2% of these being farmers and 15.2% being workmen. Conclusions Lymphocyte percentage was a sign of severe COVID-19 in general but was not a good diagnostic index. Longer time from illness onset to diagnosis was associated with higher COVID-19 severity, older age, higher likelihood of having coexisting cardiovascular diseases including hypertension, and being male. Farming was found to be a high-risk occupation in Henan province, China.

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