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.

scholarly journals Operative management of chondrosarcoma in pelvic region: case series

2019 ◽  
Vol 7 (2) ◽  
pp. 619
Author(s):  
I Gede Eka Wiratnaya ◽  
Made Wirabhawa ◽  
Komang Septian Sandiwidayat ◽  
Aakash .
Keyword(s):  
Weight Bearing ◽  
Bone Tumour ◽  
Case Series ◽  
Full Weight Bearing ◽  
Fibular Graft ◽  
Partial Weight Bearing ◽  
Pelvic Region ◽  
Pubic Rami ◽  
Internal Hemipelvectomy ◽  
Partial Weight

Chondrosarcoma is the second most frequent malignant bone tumour after osteosarcoma. It most often occurs in the pelvis. Treatment of pelvic chondrosarcoma is a difficult problem for the musculoskeletal oncologist. We report 3 patient with chondrosarcoma in pelvic region that undergoing internal hemipelvectomy. First patient, male 28 y.o. with chondrosarcoma in left iliac wing 11.2cm x 10.8cm x 9.2cm. Second, woman, 47 y.o with chondrosarcoma in right superior and inferior pubic rami 13.7cm x 11.5cm x 14.2cm with soft tissue mass around extended to medial part of proximal thigh. Already done A wide excision of the tumor was performed and we use non-vascularized fibular graft (NVFG) to fill the defect. Last patient, pregnant woman 22 y.o. (16weeks gestational age) with chondrosarcoma in right pubic rami 9.8cm x 11.4cm x 13cm. We already done internal hemipelvectomy without terminating the fetus. The second and third patient confirmed with the histopathology result with chondrosarcoma grade II, and the first patient with chondrosarcoma grade I. After 3month post operatively, all of the patients have no pain, no urinary tract complain. The first patient can ambulatory full weight bearing with no crutches or walker. Second patient ambulatory partial weight bearing with crutches. The last patient ambulatory with wheel chair during the pregnancy. Since chondrosarcomas are unresponsive to chemotherapy or radiotherapy, surgical resection was the only therapeutic solution for these patients. It also reinforce the need of a correct diagnose and collaboration between specialities in the treatment of oncological patients.

scholarly journals Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

2021 ◽  
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Matthias Meyer ◽  
Günther Maderbacher ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enhanced Recovery ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Fill Ratio ◽  
Stem Subsidence ◽  
Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

scholarly journals Femoral neck stress fracture in a young female recruit: case report

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 16 ◽  
Author(s):  
Hélder Fonte ◽  
Ricardo Rodrigues-Pinto
Keyword(s):  
Femoral Neck ◽  
Stress Fracture ◽  
Early Recognition ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Imaging Studies ◽  
Partial Weight Bearing ◽  
Military Recruit ◽  
Femoral Neck Stress Fracture ◽  
Partial Weight

Introduction: Femoral neck stress fractures are uncommon and depending on their location, can be at high risk for non-union and significant morbidity.  Their prevalence is higher among runners and military recruits, and women seem to be at higher risk. Methods: A 27-year-old female, who was enrolled in military recruit, reported left side groin pain after a strenuous running exercise. Due to persistent pain an X-Ray was ordered, which revealed no signs of acute lesions. Further imaging studies with CT scan and MRI identified a compression-type femoral neck stress fracture. Results: The patient was submitted to conservative treatment consisting of restricting from full weight-bearing. Six weeks after she initiated partial weight-bearing, becoming asymptomatic at seven months. Follow-up imaging studies revealed union of the fracture. Discussion: This diagnosis should be considered when evaluating military and athlete populations. Early recognition of these injuries is crucial because complication and morbidity rates are high.

scholarly journals Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis

2020 ◽  
Vol 140 (12) ◽  
pp. 1947-1954
Author(s):  
Johannes Becker ◽  
M. Winkler ◽  
C. von Rüden ◽  
E. Bliven ◽  
P. Augat ◽  
...  
Keyword(s):  
Acetabular Fracture ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Acetabular Fractures ◽  
Full Weight Bearing ◽  
Acetabular Cup ◽  
Partial Weight Bearing ◽  
Quadrilateral Plate ◽  
Stable Conditions ◽  
Partial Weight

Abstract Introduction Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. Methods Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch–Schneider reinforcement cage (BSRC) (n = 6). Results During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). Conclusions The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.

scholarly journals Displaced Femoral Neck Stress Fracture in a 7-year-old Child: A Case Report

2020 ◽  
Vol 1 (1) ◽  
pp. 68-72
Author(s):  
Raymond Massaad ◽  
Said El Orra ◽  
Mohammed Dabbous ◽  
Ali Ibrahim ◽  
Antonella Massaad
Keyword(s):  
Case Report ◽  
Femoral Neck ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Radiographic Images ◽  
Femoral Neck Stress Fracture ◽  
Displaced Fracture ◽  
Partial Weight

Background: Stress fracture of the femoral neck is rare in children. Its differential diagnosis includes muscle strain, synovitis, infection, dysplasia, etc. Since physicians rarely see this type of fracture in children, they often overlook it or misdiagnose it.  Case Report: A seven-year-old girl presented to our service with right groin pain following a fall on her right hip 15 days ago. Pelvic and knee radiographs of her right limb showed a fracture line with sclerosis at the femoral neck. Magnetic-resonance imaging (MRI) confirmed the diagnosis of a stress fracture of the femoral neck. We opted for conservative management and gave the patient analgesics and limited weight-bearing with the help of crutches for eight weeks. Three weeks after her first visit, the patient presented with severe limping and inability to bear weight on her right leg. Right hip radiographic imaging showed a varus displaced fracture of the femoral neck, which we managed surgically with an open reduction and internal fixation using plate and screws, followed by immobilization of the right hip with a hip spica cast. Six weeks following the surgery, the patient had no complaints, and the radiographic images showed an appropriate reduction and signs of union. The patient was allowed to start partial weight-bearing for a further six weeks before proceeding to full weight-bearing. Conclusion: Our case emphasizes the importance of considering femoral neck stress fracture in children, through a thorough clinical evaluation and imaging analysis, especially for those carrying classical risk factors. Failure to do so can complicate the disease course and may lead to a displaced fracture requiring more invasive and timely management.

scholarly journals Lateral Plantar Arch Reconstruction Using Vascularized Fibula Osteocutaneous Flap

2021 ◽  
Vol 4 (6) ◽  
pp. 01-05
Author(s):  
Srivatsa M Shet ◽  
Subin Joseph ◽  
Kader Kalathinga ◽  
Hafiz Muhammed Koyappathody ◽  
Srikant Aruna Samantaray ◽  
...  
Keyword(s):  
Road Traffic ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Post Surgery ◽  
Vascularized Fibula ◽  
One Stage Reconstruction ◽  
Arch Reconstruction ◽  
Partial Weight ◽  
Osteocutaneous Flap

A Sixteen-year-old male had a road traffic accident resulting in crush and loss of lateral two metatarsals of the left foot. The Lateral plantar arch was reconstructed with a vascularized fibula osteocutaneous flap. Flap survived and partial weight-bearing was started by 3 months and full weight-bearing was started 6-months post-surgery. At a 16-month follow-up patient had a normal gait and integrity of the lateral plantar arch was maintained. Vascularized fibula osteocutaneous flap is an excellent option for one-stage reconstruction of the lateral arch of the foot and gives satisfactory results in terms of functions of foot and in avoiding long-term morbidity.

scholarly journals Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110466
Author(s):  
Jörg Harrer ◽  
Max Schenke ◽  
Christoph Lutter ◽  
Jörg Dickschas ◽  
Matthias Feucht ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Varus Deformity ◽  
Joint Line ◽  
Full Weight Bearing ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Partial Weight Bearing ◽  
Angle Stable ◽  
Angle Stable Plate ◽  
Partial Weight

Background: Lower extremity alignment-correcting procedures for unicompartmental osteoarthritis are experiencing a rapid rise. Medial open-wedge high tibial osteotomy (MOW-HTO) thereby represents the most common technique among osteotomies but is limited in cases of severe malalignment. Some cases make a double-level osteotomy necessary. Indications: If planning of malalignment correction using a MOW-HTO results in a mechanical medial proximal tibial angle (mMPTA) of more than 93° (causing an oblique joint line), double-level osteotomy is indicated to avoid nonphysiological knee kinematics. Technique Description: After clinical examination and detailed analysis of malalignment (full-weight-bearing long-leg radiograph: hip-knee-angle [HKA], mMPTA, mechanical lateral distal femoral angle [mLDFA], joint line convergence angle [JLCA]), as well as individualized planning of the correction, the surgical procedure starts with an arthroscopy to evaluate the cartilage conditions and eventually treat intraarticular pathologies. Then, the femoral supracondylar correction is performed (closed wedge, biplanar osteotomy [ to increase bony healing]) according to the presurgical planning by resecting the osteotomy wedge with the measured length. K-wires are placed to check the correction. An angle-stable plate is used for osteosynthesis. The wedge taken out will be used as bone stock for the MOW-HTO afterward. The biplanar open-wedge tibial osteotomy is then performed subsequently using a medial tibial approach and an angle-stable plate. Opening of the osteotomy is then performed and double checked with intraoperative fluoroscopy using an alignment rod. Postoperative partial weight bearing for 6 weeks is recommended. Results: In recent literature, only few publications report on results of double-level osteotomies. Babis et al reports that it is a valuable procedure for patients with large varus deformity. Nakayama et al noted a significant improvement in patient-registered clinical outcomes in early postoperative evaluation of 20 patients. Schröter et al reports on 37 knees and findings include good clinical results, despite progressive osteoarthritis. Discussion/Conclusion: In cases of severe malalignment, adequate axis correction may require a double-level osteotomy. Exact preoperative planning is essential. Results reported in recent publications are promising. By splitting 1 large correction into 2 smaller ones, complications like hinge fracture and delayed bone healing are lowered.

scholarly journals A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198998
Author(s):  
Yong Hu ◽  
Cheng Yue ◽  
Xiucun Li ◽  
ZhengXun Li ◽  
Dongsheng Zhou ◽  
...  
Keyword(s):  
Case Series ◽  
High Rate ◽  
Osteochondral Lesions ◽  
Medial Malleolus ◽  
Posterior Tibial Tendon ◽  
The Novel ◽  
Level Of Evidence ◽  
Posterior Tibial ◽  
Medial Malleolar Osteotomy ◽  
Osteotomy Technique

Background: The current techniques for medial malleolar osteotomy may lead to posterior tibial tendon injury and have a high rate of malunion. Purpose: To describe a novel partial step-cut medial malleolar osteotomy technique and evaluate its technical feasibility and its advantages compared with traditional methods. Study Design: Case series; Level of evidence, 4. Methods: The novel technique consisted of osteotomy of the anterior one-third to two-thirds of the medial malleolus. A total of 19 ankles (18 patients) with osteochondral lesions of the talus underwent the novel osteotomy technique before osteochondral reconstruction. All patients were evaluated for more than 2 years. Radiographs were analyzed for postoperative displacement and malunion, and postoperative ankle function was evaluated according to the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the visual analog scale (VAS) for pain. Results: The partial step-cut osteotomy technique was able to provide adequate intra-articular exposure without disturbing the posterior tibial tendon. The 19 ankles healed at a mean of 7.3 ± 1.5 weeks (range, 6-12 weeks). There was slight incongruence in 4 ankles, with a displacement of 1.0 ± 0.1 mm proximally and 0.3 ± 0.1 mm medially. The mean postoperative AOFAS and VAS scores improved compared with preoperatively, from 54.2 ± 12.1 to 84.6 ± 6.6 and from 6.4 ± 1.0 to 1.8 ± 1.3, respectively ( P < .001 for both). No intraoperative tendon injuries were observed. Conclusion: Results indicated that partial step-cut osteotomy is a reliable and effective method for providing enough exposure, avoiding displacement after reduction, and not disturbing the anatomic structures behind the medial malleolus.

Sign in / Sign up

Export Citation Format

Share Document