scholarly journals Interprosthetic Femoral Fractures Surgical Treatment in Geriatric Patients

2021 ◽  
Vol 12 ◽  
pp. 215145932110137
Author(s):  
Marios Loucas ◽  
Rafael Loucas ◽  
Nico Safa Akhavan ◽  
Patrick Fries ◽  
Michael Dietrich
Keyword(s):  
Surgical Treatment ◽  
Geriatric Patients ◽  
Standard Procedure ◽  
Weight Bearing ◽  
Case Series ◽  
Femoral Fractures ◽  
Full Weight Bearing ◽  
Level Of Evidence ◽  
Type Iv ◽  
Case Series Study

Background: Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods: A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results: We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion: Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence: Level III, Therapeutic study.

scholarly journals TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT

2017 ◽  
Vol 25 (6) ◽  
pp. 283-286
Author(s):  
ROBERTO YUKIO IKEMOTO ◽  
JOEL MURACHOVSKY ◽  
ROGÉRIO SERPONE BUENO ◽  
LUIS GUSTAVO PRATA NASCIMENTO ◽  
ADRIANO BORDINI CARMARGO ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Functional Results ◽  
Terrible Triad ◽  
Level Of Evidence ◽  
Mayo Elbow Performance Score ◽  
Results Of Treatment ◽  
Type Iv ◽  
Flexion Extension ◽  
Elbow Injuries

ABSTRACT Objective: To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). Methods: We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. Results: Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). Conclusion: When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

Posterior Ankle Scope Approach to Symptomatic Os Trigonum Removal

2021 ◽  
pp. 193864002098430
Author(s):  
John M. Thompson ◽  
Travis M. Langan ◽  
Christopher F. Hyer
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Wound Complication ◽  
Full Weight Bearing ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Os Trigonum ◽  
Average Return ◽  
Surgical Options

Introduction Os trigonum can become symptomatic following acute or chronic repetitive compression of the posterior ankle. Following conservative treatment failure, removal is often warranted. Current surgical options include traditional open resection and endoscopic removal. The purpose of this article is to review a population of patients who underwent endoscopic excision of symptomatic accessory os trigonum through a posterior approach and evaluate the outcomes of the procedure. Methods From May 2009 to September 2018, all patients who underwent excision of a symptomatic os trigonum were reviewed. Outcomes of interest were major and minor complications and time to return to full weight-bearing activities. Postoperative protocol included 5 to 7 days non–weight-bearing and 1 to 2 weeks of protected weight-bearing followed by full release to weight-bearing activities. Results Twelve patients who met the inclusion criteria were studied. Mean follow-up was 10.2 (±7.4) months with no major complications and 1 minor wound complication. Average advancement to protected weight-bearing was 7.1 days. Average return to full weight-bearing activities without restriction was 24.4 days. Conclusion The current study describes the technique and results to minimally invasive os trigonum removal with favorable postoperative outcomes. Results demonstrated minimal complications and postoperative pain, also quick return to weight-bearing and full activity. Level of Evidence: Therapeutic, Level IV: Case series

scholarly journals Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

2020 ◽  
Vol 6 (1) ◽  
pp. e000769
Author(s):  
Håkan Alfredson ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Weight Bearing ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Full Weight Bearing ◽  
Bone Pathology ◽  
Level Of Evidence ◽  
Pain Mechanisms ◽  
Painful Condition ◽  
Insertional Achilles Tendinopathy

BackgroundInsertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone.MethodsEleven patients (eight men and three women) with a mean age of 44 years (range 24–62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks.ResultsAt follow-up 21 (median, range 12–108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0–52) to 91 (range 33–100) (p<0.01).ConclusionIn patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.Level of evidenceIV Case series.

scholarly journals A triplanar osteotomy technique in arthroscopy-assisted ankle mosaicplasty

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090505 ◽  
Author(s):  
Ozgur Basal ◽  
Talip Teoman Aslan
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Joint Surface ◽  
Full Weight Bearing ◽  
Osteochondral Lesions ◽  
Partial Weight Bearing ◽  
Level Of Evidence ◽  
Early Return ◽  
Osteotomy Technique ◽  
Partial Weight

Purpose: Osteochondral lesions of the talus are lesions that are seen particularly in the young age group and are often related to sports injuries and trauma. These lesions, which show late symptoms radiologically, can be determined in the early stages with magnetic resonance imaging. The aim of this study was to present a new osteotomy technique to reduce the complications of mosaicplasty surgery to a minimum and provide an early return to work. Methods: A total of 11 patients who had cartilage lesions due to osteochondritis dissecans in the medial aspect of the talus underwent mosaicplasty after a triplanar osteotomy. The dimensions of the lesion and the depth of the triplanar osteotomy were determined preoperatively. Coronal, sagittal and transverse cuts were made at the depth defined arthroscopically. Following the osteotomy, an osteochondral graft taken from the ipsilateral knee was placed in the prepared area. Osteotomy side was fixed with one or two cannulated screws following mosaicplasty. Results: With this technique, weight-bearing can be immediate in cases with no need for osteotomy in the joint surface. In cases including the joint surface, partial weight-bearing is permitted after 4 weeks and can be increased as tolerated. In the 11 cases treated with this technique, full weight-bearing was achieved at mean 5 weeks (range, 5–8 weeks). No shift (upward displacement of osteotomized fragment) or non-union was seen in any patient. Conclusion: With the triplanar osteotomy technique described here, potential shift complications can be reduced to a minimum. As only the lesion region is targeted, the osteochondral surface formed by the fracture is much less. Study design: Case Series; Level of Evidence, 4.

scholarly journals Mobilization protocol and early postoperative weight-bearing in transyndesmal ankle fractures

2021 ◽  
Vol 15 (2) ◽  
pp. 100-104
Author(s):  
Diego Yearson ◽  
Ignacio Melendez ◽  
Federico Anain ◽  
Santiago Siniscalchi ◽  
Juan Drago
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Early Mobilization ◽  
Lateral Approach ◽  
Full Weight Bearing ◽  
Level Of Evidence ◽  
Rehabilitation Protocol ◽  
Joint Mobilization ◽  
Everyday Activities ◽  
Early Return

Objective: To disseminate a rehabilitation protocol with early mobilization and ambulation, with no external supports, reducing the time until full weight-bearing and providing greater postoperative comfort. Methods: We prospectively assessed a series of 68 patients, with level of evidence IV, mean age of 33.3 years. We performed open reduction with ankle lateral approach (Kocher) and internal fixation with an interfragmentary compression screw and a one-third locked tubular plate for neutralization. All patients were subjected to a rehabilitation protocol with early mobilization and weight-bearing. Results: No fracture displacements were observed on the postoperative radiographic controls, neither loosening nor ruptures of implants. There was no need to change rehabilitation guidelines either due to pain or to other subjective limitation. Conclusion: We can state that early joint mobilization and controlled progressive support, with appropriate osteosynthesis, resulting in an early return to everyday activities, both work and sports ones. Level of Evidence IV; Therapeutic Studies; Case Series.

Force Plate Analysis of Dogs with Bilateral Hip Dysplasia Treated with a Unilateral Triple Pelvic Osteotomy: A Long-term Review of Cases

1998 ◽  
Vol 11 (02) ◽  
pp. 85-93 ◽  
Author(s):  
Joanne R. Cockshutt ◽  
H. Dobson ◽  
C. W. Miller ◽  
D. L. Holmberg ◽  
Connie L. Taves ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Hip Dysplasia ◽  
Weight Bearing ◽  
Force Plate ◽  
Case Series ◽  
Pelvic Osteotomy ◽  
Vertical Force ◽  
Long Term Outcome ◽  
Case Series Study

SummaryA retrospective case series study was done to determine the long-term outcome of operations upon dogs treated for canine hip dysplasia by means of a triple pelvic osteotomy (TPO). Twentyfour dogs with bilateral hip dysplasia, that received a unilateral TPO between January 1988 and June 1995, were re-examined at the Ontario Veterinary College. The assessment included physical, orthopedic and lameness examinations, standard blood work, pelvic radiographs and force plate gait analysis. They were compared to bilaterally dysplastic dogs that had not been treated, and also to normal dogs. Force plate data analysis demonstrated a significant increase in peak vertical force (PVF) and mean vertical force over stance (MVF) in the limb that underwent surgical correction by means of a TPO, when compared to the unoperated hip. It was determined that performing a unilateral TPO on a young dysplastic dog resulted in greater forces and weight bearing being projected through the TPO corrected limb when compared to the unoperated limb.Dogs with bilateral hip dysplasia treated with a unilateral triple pelvic osteotomy (TPO) were assessed by force plate gait analysis, radiographs and orthopedic examination. There was a significant increase in hip Norberg angles over time, although degenerative changes did progress. Limbs that had been operated upon had significantly greater peak and mean ground reaction forces than limbs that had not received an operation.

First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

2021 ◽  
pp. 107110072110345
Author(s):  
Chien-Shun Wang ◽  
Yun-Hsuan Tzeng ◽  
Tzu-Cheng Yang ◽  
Chun-Cheng Lin ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hallux Valgus ◽  
Reconstructive Surgery ◽  
Case Series ◽  
Deformity Correction ◽  
Level Of Evidence ◽  
Factors Affecting ◽  
Radiographic Parameters ◽  
Case Series Study ◽  
Adult Acquired Flatfoot Deformity

Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

Long-term Outcomes of Microfracture for Treatment of Osteochondral Lesions of the Talus

2021 ◽  
pp. 107110072199542
Author(s):  
Daniel Corr ◽  
Jared Raikin ◽  
Joseph O’Neil ◽  
Steven Raikin
Keyword(s):  
Survival Rate ◽  
Case Series ◽  
Return To Sport ◽  
Osteochondral Lesions ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Additional Surgery ◽  
Case Series Study

Background: Microfracture is the most common reparative surgery for osteochondral lesions of the talus (OLTs). While shown to be effective in short- to midterm outcomes, the fibrocartilage that microfracture produces is both biomechanically and biologically inferior to that of native hyaline cartilage and is susceptible to possible deterioration over time following repair. With orthobiologics being proposed to augment repair, there exists a clear gap in the study of long-term clinical outcomes of microfracture to determine if this added expense is necessary. Methods: A retrospective review of patients undergoing microfracture of an OLT with a single fellowship-trained orthopedic surgeon from 2007 to 2009 was performed. Patients meeting the inclusion criteria were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the outcome of the procedure and their likelihood to recommend the procedure to a friend with the same problem using 5-point Likert scales. Patient demographics were reviewed and included for statistical analysis. Results: Of 45 respondents, 3 patients required additional surgery on their ankle for the osteochondral defect, yielding a 10-year survival rate of 93.3%. Of surviving cases, 90.4% (38/42) reported being “extremely satisfied” or “satisfied” with the outcome of the procedure. The VAS score at follow-up averaged 14 out of 100 (range, 0-75), while the FAAM-ADL and FAAM-Sports scores averaged 90.29 out of 100 and 82 out of 100, respectively. Thirty-six patients (85.7%) stated that their ankle did not prevent them from participating in the sports of their choice. Conclusion: The current study represents a minimum 10-year follow-up of patients undergoing isolated arthroscopic microfracture for talar osteochondral defects, with a 93.3% survival rate and 85.7% return to sport. While biological adjuvants may play a role in improving the long-term outcomes of microfracture procedures, larger and longer-term follow-up studies are required for procedures using orthobiologics before their cost can be justified for routine use. Level of Evidence: Level IV, retrospective cohort case series study.

scholarly journals Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Daisuke Takahashi ◽  
Yoshihiro Noyama ◽  
Tsuyoshi Asano ◽  
Tomohiro Shimizu ◽  
Tohru Irie ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Full Weight Bearing ◽  
Loading Test ◽  
Lateral Plate ◽  
Element Analysis ◽  
Periprosthetic Femoral Fractures

Abstract Background Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Methods Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests. Results The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively. Conclusions The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.

Radiographic Correlation of Hallux MP Fusion Position and Plate Angle

2009 ◽  
Vol 30 (9) ◽  
pp. 873-876 ◽  
Author(s):  
J. Thaddeus Leaseburg ◽  
James K. DeOrio ◽  
Shane A. Shapiro
Keyword(s):  
Weight Bearing ◽  
Proximal Phalanx ◽  
Case Series ◽  
Statistical Correlation ◽  
Titanium Plate ◽  
Care Needs ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lower Correlation ◽  
Proper Weight

Background: This study assessed the variability of plate bend in regard to final metatarsophalangeal (MP) fusion angles and toe-to-floor distance. We hypothesized that the final MP angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance would be dictated solely by the magnitude of the bend in the plate. Materials and Methods: This is a retrospective analysis of 35 sequential patients who underwent MP fusion with a low-contour titanium plate. Postoperative weightbearing radiographs were analyzed for plate angle, MP fusion angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance. Results: We found statistical correlation between plate angle and MP angle and between plate angle and the angle of the proximal phalanx to the floor. However, there was low correlation between plate angle and with toe-to-floor distance. In addition, we noted many outliers, which resulted in higher or lower correlation of the MP angle to the expected plate angle and, thus, a relationship between angles that was far from linear. Conclusion: Care needs to be taken when relying solely on the bend in the plate to determine the final position of the toe in MP fusions. Although the association between plate bend and MP angle and proximal phalanx to floor angle was strong, the association between the bend in the plate and weight bearing toe-to-floor distance was variable. This could result in the toe hitting the shoe or the need to vault over the toe. Therefore, the surgeon must match the plate to each patient's anatomy to ensure proper weight bearing toe-to-floor distance and not rely on plate angle exclusively. Level of Evidence: IV, Retrospective Case Series

Sign in / Sign up

Export Citation Format

Share Document