Subtalar arthroscopy and fluoroscopy in percutaneous fixation of intra-articular calcaneal fractures

Introduction: Percutaneous fixation of intra-articular calcaneal fractures is traditionally assisted only by intraoperative fluoroscopy. Previous studies have demonstrated that the additional use of subtalar arthroscopy in anatomical reduction of the posterior calcaneal facet of the subtalar joint for less complex calcaneal fractures yielded positive results up to 2-year follow-up. This study aims to investigate long-term outcomes of these patients using similar evaluation parameters. We hypothesized that this novel technique with dual-imaging can provide sustainable, long-term benefits with good functional outcomes and significant restoration of the Bohler’s angle. Methods: We performed a retrospective study of 15 Sanders II, AO-OTA 83-C2 intra-articular calcaneal fractures in 14 patients who underwent subtalar arthroscopy and fluoroscopy guided percutaneous fracture fixation with a minimum follow-up of 5 years. Outcome measures were assessed using the ankle and hindfoot NPRS, AOFAS ankle–hindfoot score, and SF-36 Physical Function subscale preoperatively and at 3 months, 6 months, 1 year, 2 years and 5–8 years postoperatively. The Bohler’s angle was measured preoperatively, immediately postoperatively and at 5–8 years postoperatively. Results: We report excellent functional outcomes in all scores as well as continued improvements in the majority of patients across all time points with minimal subsidence of the corrected Bohler’s angle over our study time frame. Conclusion: Subtalar arthroscopy with intraoperative fluoroscopy in anatomical reduction of the posterior calcaneal facet of the subtalar joint is most useful in Sanders type II, AO-OTA 83-C2 fractures with excellent functional outcomes and good preservation of the corrected Bohler’s angle on long-term follow-up.

Download Full-text

MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES WIILIZAROV RING FIXATIO

10.36106/6403030 ◽

2021 ◽

pp. 40-43

Author(s):

Nirottam Singh ◽

Jagdish Jagdish ◽

Hemant Jain ◽

Kishore Raichandani

Keyword(s):

Functional Outcomes ◽

Operating Time ◽

Anatomic Reconstruction ◽

X Rays ◽

Calcaneal Fractures ◽

Type Iv ◽

Fall From Height ◽

Pin Tract Infection ◽

Böhler’S Angle

Objective: Calcaneal fractures are caused by a high velocity force to the heel, mostly in road trafc accidents or fall from height. Debate continues regarding the best management of calcaneal fractures. We aim at evaluating the radiological and functional outcomes of displaced intra-articular calcaneal fractures treated with Ilizarov ring xation. Methods: intra-articular calcaneal Eighteen consecutive patients with fractures [Sanders type II (10), Sanders type III(6), and Sanders type IV (2)] were treated with the Ilizarov ring xator from Sep 2017 to June 2020. Patients were evaluated in terms of associated injuries and x-rays of anteroposterior, lateral and axial views of the calcaneus. CT scan was done to assess the amount of comminution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale. Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement of calcaneal height and width. Results: At average follow-up of 18.5 months, average AOFAS score was 80.5 (range 71 to 90), with 6.25% having excellent, 75% having good, 12.5% having fair and 6.25%having poor results. All patients had stable ankle joint with all having dorsiexion and plantar exion more than 30°. All patients are able to wear their previous size shoes. The mean Bohler's angle, mean Gissane's angle, calcaneal height and width were 21.5°, 126.3°, 4.36 cm and 3.80cm respectively at nal follow-up. Four patients had supercial pin tract infection. One patient had collapse of posterior facet after removal of xator with peroneal tendinitis. All fractures united and none needed secondary bone grafting. Patients returned to work on an average of 5.5 months. Conclusion: Ilizarov external ring xation gives good functional outcomes, manifested by restoring near normal anatomic reconstruction of morphology and alignment of the calcaneus. The added advantages of these procedures are the considerably shortened operating time and hospital stay, no need of highly equipped operation theatres and the reduced risk of complications related to surgical exposure.

Download Full-text

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.6.peds18716 ◽

2019 ◽

Vol 24 (5) ◽

pp. 549-557

Author(s):

Malia McAvoy ◽

Heather J. McCrea ◽

Vamsidhar Chavakula ◽

Hoon Choi ◽

Wenya Linda Bi ◽

...

Keyword(s):

Conservative Management ◽

Functional Outcomes ◽

Pediatric Patients ◽

Clinical Presentation ◽

Case Series ◽

Csf Leak ◽

Single Institution ◽

The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Download Full-text

Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211032977 ◽

2021 ◽

pp. 154596832110329

Author(s):

Margaret J. Moore ◽

Kathleen Vancleef ◽

M. Jane Riddoch ◽

Celine R. Gillebert ◽

Nele Demeyere

Keyword(s):

Functional Outcomes ◽

Stroke Severity ◽

Visuospatial Neglect ◽

Recovery Pattern ◽

Stroke Impact Scale ◽

Impact Scale ◽

Significant Difference ◽

Initial Severity

Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen’s Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone.

Download Full-text

Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty

Foot & Ankle International ◽

10.1177/10711007211061366 ◽

2021 ◽

pp. 107110072110613

Author(s):

Vinay V. Balesar ◽

Lennard A. Koster ◽

Bart L. Kaptein ◽

Stefan B. Keizer

Keyword(s):

Prospective Study ◽

Clinical Outcomes ◽

Condition Number ◽

Clinical Assessment ◽

Functional Outcomes ◽

Metatarsal Bone ◽

Migration Patterns ◽

Patient Questionnaires

Background: Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). Methods: Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. Results: RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. Conclusion: Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation.

Download Full-text

MP60-04 LONG-TERM ONCOLOGICAL AND FUNCTIONAL OUTCOMES OF HIGH-RISK PROSTATE CANCER FOLLOWING ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY: MINIMUM FOLLOW-UP OF 10 YEARS

The Journal of Urology ◽

10.1097/01.ju.0000556736.15231.52 ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Author(s):

Pratik Gurung* ◽

Elizabeth Ellis ◽

Jasmine Wood ◽

Stephen Hassig ◽

Changyong Feng ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Functional Outcomes ◽

Robot Assisted ◽

Laparoscopic Prostatectomy ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

Download Full-text

Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study

10.21203/rs.2.23611/v4 ◽

2020 ◽

Author(s):

Chenggong Wang ◽

Can Xu ◽

Mingqing Li ◽

Hui Li ◽

Han Xiao ◽

...

Keyword(s):

Internal Fixation ◽

Subtalar Joint ◽

Calcaneal Fracture ◽

Patient Specific ◽

Calcaneal Fractures ◽

Intraoperative Fluoroscopy ◽

Joint Width ◽

Preoperative Plan ◽

Overlap Ratio ◽

Minimally Invasive Internal Fixation

Abstract Background: Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan.Methods: We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available.Results: Mean intraoperative fluoroscopy time was 3.95±1.78 h; IFAU in 16 patients (16 feet) was the same as the preoperative plan; mean surgery time was 28.16±10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2%±2.3%. AOFAS scores increased with time, with significant differences in the score at each time point.Conclusions: The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.

Download Full-text

Long-term follow-up of children with a surgically treated clubfoot: Assessing the multi-segment-foot motions, dynamic plantar pressures, and functional outcomes

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2021.101758 ◽

2021 ◽

pp. 101758

Author(s):

Xue-Cheng Liu ◽

John Thometz ◽

Jonathan Campbell ◽

Channing Tassone

Keyword(s):

Functional Outcomes ◽

Plantar Pressures ◽

Long Term Follow Up

Download Full-text

Correlation of Neotongue Volume Changes With Functional Outcomes After Long-Term Follow-Up of Total Glossectomy

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e3181c46692 ◽

2010 ◽

Vol 21 (1) ◽

pp. 111-116 ◽

Cited By ~ 58

Author(s):

In Sik Yun ◽

Dong Won Lee ◽

Won Jai Lee ◽

Dae Hyun Lew ◽

Eun Chang Choi ◽

...

Keyword(s):

Functional Outcomes ◽

Volume Changes ◽

Long Term Follow Up

Download Full-text

Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546517751683 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1129-1136 ◽

Cited By ~ 33

Author(s):

Daan T. van Yperen ◽

Max Reijman ◽

Eline M. van Es ◽

Sita M.A. Bierma-Zeinstra ◽

Duncan E. Meuffels

Keyword(s):

Knee Osteoarthritis ◽

Functional Outcomes ◽

Cruciate Ligament ◽

Nonoperative Treatment ◽

Pivot Shift Test ◽

Anterior Cruciate ◽

High Level ◽

Nonoperative Group

Background: An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear. Purpose: To compare the long-term treatment outcomes of operative versus nonoperative treatment of ACL ruptures in high-level athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Fifty patients with an ACL rupture were eligible for participation, and they were treated either nonoperatively (n = 25) in 1992, consisting of structured rehabilitation and lifestyle adjustments, or operatively (n = 25) between 1994 and 1996 with an arthroscopic transtibial bone–patellar tendon–bone technique. The patients in the nonoperative group were drawn from those who responded well to 3 months of nonoperative treatment, whereas the patients in the operative group were drawn from those who had persistent instability after 3 months of nonoperative treatment. Both groups were pair-matched and assessed at 10- and 20-year follow-up regarding radiological knee osteoarthritis, functional outcomes (Lysholm, International Knee Documentation Committee [IKDC], Tegner, Knee injury and Osteoarthritis Outcome Score), meniscal status, and knee stability (KT-1000 arthrometer, pivot-shift test, Lachman test, 1-legged hop test). Results: All 50 patients (100%) were included in the current study for follow-up. After 20 years, we found knee osteoarthritis in 80% of the operative group compared with 68% of the nonoperative group ( P = .508). There was no difference between groups regarding functional outcomes and meniscectomy performed. The median IKDC subjective score was 81.6 (interquartile range [IQR], 59.8-89.1) for the operative group and 78.2 (IQR, 61.5-92.0) for the nonoperative group ( P = .679). Regarding the IKDC objective score, 21 patients (84%) in the operative group had a normal or near normal score (A and B) compared with 5 patients (20%) in the nonoperative group ( P < .001). The pivot-shift test finding was negative in 17 patients (68%) versus 3 patients (13%) for the operative and nonoperative groups, respectively ( P < .001), and the Lachman test finding was negative in 12 patients (48%) versus 1 patient (4%), respectively ( P = .002). Conclusion: In this retrospective pair-matched follow-up study, we found that after 20-year follow-up, there was no difference in knee osteoarthritis between operative versus nonoperative treatment when treatment was allocated on the basis of a patient’s response to 3 months of nonoperative treatment. Although knee stability was better in the operative group, it did not result in better subjective and objective functional outcomes.

Download Full-text