scholarly journals Conservative treatment of refractures after modified tension band wiring of fifth metatarsal base stress fractures in athletes

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092628
Author(s):  
Kyung Tai Lee ◽  
Ki Chun Kim ◽  
Ki Won Young ◽  
Hyuk Jegal ◽  
Young Uk Park ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Activity Level ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Bone Union ◽  
Lateral Side ◽  
Sports Activity ◽  
Partial Weight

Objective: Recurrent fifth metatarsal base stress fractures (MT5-BSF) in athletes present a challenging problem. The aim of this study was to evaluate the result of conservative treatment for the refracture of MT5-BSF after modified tension band wiring (MTBW). Materials and Methods: The outcomes of 15 elite athletes undergoing conservative treatment for refracture of MT5-BSF after MTBW were retrospectively reviewed. They were instructed to avoid weight-bearing with short leg cast for 6 weeks. After that, they started partial weight with a postop shoe. Stepwise exercise followed bone union by radiographs. Results: Thirteen cases (86.6%) had a complete bone union after a mean of 18.9 ± 8.6 weeks. Twelve cases (80%) returned to their previous activity level and maintained for at least two consecutive seasons. Conclusion: Eighty percent of all athletic patients with the conservative treatment for refractures with healed MT5-BSF after MTBW on the plantar-lateral side could maintain and return to their previous sports activity for at least 2 years.

Stress Fractures of the Medial Great Toe Sesamoids in Athletes

2003 ◽  
Vol 24 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Roland Biedert ◽  
Beat Hintermann
Keyword(s):  
Conservative Treatment ◽  
Ct Scan ◽  
Bone Scan ◽  
Frontal Plane ◽  
Surgical Excision ◽  
Stress Fractures ◽  
Proximal Fragment ◽  
X Rays ◽  
Great Toe ◽  
Sports Activity

The purpose of this study was to determine whether specific symptoms and findings are present in patients with symptomatic stress fractures of the sesamoids of the great toe and, if so, whether partial sesamoidectomy is sufficient for successful treatment. Five consecutive athletes (five females; mean age 16.8 years [range, 13 to 22 years]) with six feet that were treated for symptomatic stress fractures of the sesamoids of the great toe were included in this study. Four athletes (five feet) performed rhythmic sports gymnastics; the fifth athlete was a long jumper. Some swelling to the forefoot and activity-related pain that increased in forced dorsiflexion, but disappeared at rest was found in all patients. While plain X-rays evidenced fragmentation of the medial sesamoid, MRI (n=2) and frontal plane CT scan (n=3) did not always confirm the diagnosis, but bone scan (n=3) and axial as well as sagittal CT scan were useful to detect the pathology. After failure of conservative treatment measures, surgical excision of the proximal fragment was successful in all patients, and there were no complications. All patients were pain free and regained full sports activity within six months (range, 2.5 to six months). At final follow-up which averaged 50.6 months (range, 20 to 110 months), the overall clinical results were graded as good/excellent in all patients, and there was only one patient with of restriction sports activities. The obtained AOFAS-Hallux-Score was 95.3 (75 to 100) points. Apparently, stress fractures occur more often at the medial sesamoid, and females are mainly involved. When a stress fracture is suspected, bone scan and CT scan are suggested as more reliable in confirming the diagnosis than other imaging methods. When conservative treatment has failed, surgical excision of the proximal fragment is recommended.

scholarly journals Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy

2020 ◽  
Author(s):  
Sanne Vogels ◽  
Ewan D. Ritchie ◽  
Henricus PH Hundscheid ◽  
Kim van Someren ◽  
Loes Janssen ◽  
...  
Keyword(s):  
Treatment Group ◽  
Conservative Treatment ◽  
Compartment Syndrome ◽  
Clinical Effectiveness ◽  
Treated Group ◽  
Activity Level ◽  
Sports Activity ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Surgical Group

AbstractThe aim of this nonrandomized cohort study was to compare the clinical effectiveness of an elective fasciotomy with conservative treatment for chronic exertional compartment syndrome of the leg. Patients diagnosed with chronic exertional compartment syndrome who opted for surgery (n=188) completed a preoperative questionnaire and a 12-month postoperative questionnaire. Patients who continued conservative treatments (n=23) served as controls. Gender, age, sports activity or affected compartments were comparable, but intensity of pain was higher in the surgical group (at rest: 2.5±0.1 vs. 2.0±0.2, during exercise: 4.2±0.1 vs. 3.8±0.2; both p<0.05). Following treatment, surgical patients demonstrated a larger drop in intensity levels of pain (surgery 1.6±0.1, conservative 0.9±0.2, p=0.01) and tightness (surgery 1.4±0.1, conservative 0.4±0.3, p=0.00) during exercise. Success (good or excellent treatment effect) was attained in 42% of the surgical group compared to only 17% in the conservatively treated group (p=0.02). However, previous activity level was achieved in a mere 26% in the surgical treatment group and 35% in the conservative treatment group (p=0.33). A fasciotomy for chronic exertional compartment syndrome in the leg results in significantly decreased levels of pain and tightness and better satisfaction compared to patients who continued a conservative treatment regimen.

scholarly journals Treatment of 5th Metatarsal Shaft Fracture using MIPO (Minimally Invasive Plate Osteosynthesis) Technique

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Yoo Jung Park ◽  
Yeokgu Hwang ◽  
Dong-Woo Shim ◽  
Jin Woo Lee ◽  
Seung Hwan Han
Keyword(s):  
Weight Bearing ◽  
Shaft Fracture ◽  
Bone Union ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Anatomic Reduction ◽  
Significant Difference ◽  
Partial Weight

Category: Lesser Toes, Trauma Introduction/Purpose: The standard treatment of 5th metatarsal shaft fracture is still not determined yet. Conservative treatment using cast immobilization can be applied for shaft fractures without displacement, but there are reports that open reduction is indicated for displacement more than 3 mm, rotational displacement, and angular displacement more than 30 degrees. In this study, we report the result of 5th metatarsal shaft fracture using MIPO technique, which can shorten recovery period by reducing soft tissue damage with minimal incision. Methods: This study consists of 25 patients who had undergone surgery for displaced 5th metatarsal shaft fracture from March 2013 to December 2015; 8 males and 17 females. Mean age at the time of surgery was 47.4(29~69) and mean follow period was 15.0(8~25) months. 11 cases were simple oblique fracture and 14 cases were comminuted fracture with fracture fragments. Mean fracture gap was 4.4(3.1~7.6)mm. MIPO technique with LCP Compact Hand Locking Condylar Plate 2.0(Depuy-Synthes, Zuchwil, Switzerland) was used for all cases. Partial weight bearing was allowed until 4th week post-op, then full weight bearing was allowed until 6th week post-op. Clinical and radiological follow-up was made at post-op week 2, 6, 12, 24. Clinical results were obtained using Visual Analogue Scale(VAS) and American Orthopedic Foot and Ankle Society(AOFAS) score. Results: VAS of 24 weeks post-op was decreased from 5.6 ± 0.8 (4~7) preoperatively to 1.2 ± 1.3 (0~4), and AOFAS score of 24 weeks post-op was increased from 42.0 ± 12.8 (24~54) preoperatively to 86.4 ± 7.7 (74~95), both showed significant difference. Anatomic reduction and complete bone union was noted in all cases. Mean union period obtained from follow-up radiograph was 6.0 week post-op. For 15 cases, plate removal was performed at 9.5(7~25) months post-op. Conclusion: Plate fixation can be the preferred option for 5th metatarsal shaft fracture, because 5th metatarsal shaft is surgically easily accessible and more stable fixation can be applied. Since it results complete bone union without any complications and enables early weight bearing, MIPO techinque for displaced 5th metatarsal shaft fracture can be considered as useful surgery technique.

scholarly journals Intraoperative mobilisation of knee and its effect on the final functional outcome in patella fractures: a clinical study

2018 ◽  
Vol 4 (4) ◽  
pp. 642
Author(s):  
Deepak Aher ◽  
Ajay Dandotiya ◽  
Dharmendra Raghuvanshi ◽  
Abhishek Pathak
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Rating Scale ◽  
Road Traffic ◽  
Weight Bearing ◽  
Operation Time ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Early Weight Bearing ◽  
Patella Fractures

<p class="abstract"><strong>Background:</strong> Treatment of patellar fractures depends on its type, integrity of extensor mechanism and fragments size. Operative measures are tension band wiring and partial or total patellectomy. Early weight bearing and then gradual mobilization and finally quadriceps strengthening remains the crux of physiotherapy. Aim of this study was to see for the effect of intraoperative mobilisation of knee on functional outcome of tension band wiring in patella fractures.</p><p class="abstract"><strong>Methods:</strong> 30 patients were included in this study from January 2016 to February 2018. Tension band wiring was performed in all the patients. Intraoperative mobilisation of knee as allowed was done when patient was under effect of anesthesia. Final functional outcome was assessed as per the modified knee-rating scale of the Hospital for Special Surgery and also range of motion noted. Patients were evaluated at 1 month, 2 month, 6 month and 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients aged from 25-65 years with mean age of 40 years. 26 patients were male and 4 female. In 20 cases, Right knee was involved. All had trauma due to road traffic accident. Mean operation time was 1 hour. At the end of 1 year follow up only 2 patients had range of motion &lt;90, 4 patients had range of motion 90-120 degrees and 24 patients had range of motion &gt;120 degrees. After 1 year, functional outcome was, excellent in 24, good in 4, fair in 1 and poor in 1.</p><p class="abstract"><strong>Conclusions:</strong> Intraoperative mobilisation of knee after a stable fixation with tension band wiring of patella can prove to a very effective method for increasing postoperative range of motion and improving functional outcome.</p>

scholarly journals Functional outcome of elastic stable intramedullary nailing of diaphyseal fractures of paediatric long bones

2016 ◽  
Vol 2 (4) ◽  
pp. 359
Author(s):  
Arun Vashisht ◽  
Gaurav Dev Sharma
Keyword(s):  
Conservative Treatment ◽  
Functional Outcome ◽  
Intramedullary Nailing ◽  
Weight Bearing ◽  
Elastic Stable Intramedullary Nailing ◽  
Personal Hygiene ◽  
Long Bones ◽  
Forearm Bones ◽  
Diaphyseal Fractures ◽  
Partial Weight

<p class="abstract"><strong>Background:</strong> After the advent of titanium elastic nails (TENs) and gratifying results of elastic stable intramedullary nailing (ESIN) in diaphyseal fractures of paediatric long bones, not only the parents of patients are opting surgical treatment over conservative, but also more and more orthopaedicians are offering ESIN with TENs to obviate the inherent problems of conservative treatment. We took up this study to evaluate the functional outcome of ESIN with TENs<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 44 patients aged 5-15 years suffering from diaphyseal fractures of femur, tibia, humerus, and forearm bones were treated by ESIN with TENs.<strong></strong></p><p class="abstract"><strong>Results:</strong> All 44 patients showed uneventful union, femur in an average period of 8.3 weeks, tibia in 7.3 weeks, forearm bones within 7 weeks and humerus in 7.5 weeks. Commonest complication was pain at insertion site. 1 femur patient had lengthening of 1.5 cm. 1 femur and 1 forearm patient showed joint stiffness. No patient had delayed/non-union, sagittal/coronal/rotational mal-union, and deep infection. Partial weight bearing (PWB) started from 2<sup>nd</sup>/3<sup>rd</sup> day attaining full weight bearing (FWB) in 6-10 weeks<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> ESIN with TENs appears logical and safe to obviate the inherent problems of conservative treatment, as ESIN is least invasive and allows early PWB/FWB leading to early independence of personal hygiene/toilet use with early social integration/return to school<span lang="EN-IN">.</span></p>

scholarly journals Open reduction and internal fixation using multiple nonabsorbable suture materials in acute patella fracture: comparison of clinical and radiological outcome with tension band wiring

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Kwang Won Lee ◽  
Sang Beom Ma ◽  
Dae Suk Yang ◽  
Seung Hak Oh ◽  
Seong Ho Park
Keyword(s):  
Operation Time ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Bone Union ◽  
Suture Materials ◽  
Nonabsorbable Suture ◽  
Patella Fractures ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract Background For treating displaced patella fractures, tension band wiring is the most widely used technique. However, implant removal surgery is often necessary to alleviate discomfort caused by fixation materials. On the contrary, fixation using nonabsorbable suture materials is anticipated to result in comparable outcomes without need for further implant removal surgery. However, there is a lack of clinical studies comparing the two fixation techniques (wire and nonabsorbable suture materials) for acute patella fractures. Methods From 2014 to 2018, we retrospectively reviewed 60 patients who underwent open reduction with internal fixation for acute patella fracture. Thirty patients (group 1) who received surgery using tension band wiring and 30 patients (group 2) who received surgery using nonabsorbable suture materials were enrolled. The average follow-up period was more than 1 year after operation. Operation time, postoperative bone union time, range of motion (ROM) of the knee joint, postoperative clinical results, and complications were compared between the two groups. Result Operation time, clinical bone union, and radiologic bone union were not statistically different between groups 1 and 2. At 3 months postoperatively, flexion was 120.3 ± 9.4° in group 1 and 110.5 ± 7.7° in group 2, showing statistically significant difference (p = 0.037). At 6 and 12 months postoperatively, the ROM was similar in both groups. Hospital for special surgery score at 3 months postoperatively was 78.4 ± 8.2 in group 1 and 83.7 ± 8.7 in group 2, showing statistically significant differences (p = 0.032). However, at 6 and 12 months postoperatively, there were no statistical differences. Lysholm score at 3 months postoperatively was 73.5 ± 8.1 in group 1 and 80.4 ± 8.2 in group 2, showing statistically significant difference (p = 0.016), but at 6 and 12 months postoperatively, there were no statistical differences. Conclusion Fixation using multiple nonabsorbable suture materials can be an alternative surgical method in managing patella fractures, along with tension band wiring.

scholarly journals Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

2021 ◽  
Author(s):  
Victor Lu ◽  
James Zhang ◽  
Andrew Zhou ◽  
Matija Krkovic
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Weight Bearing ◽  
Bone Union ◽  
Unique Challenge ◽  
Patient Reported ◽  
Post Traumatic ◽  
Partial Weight ◽  
Consolidation Time

Abstract Purpose The management of limb-length discrepancy secondary to traumatic femoral bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular, but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail. Methods Eight patients were included from October 2015 to May 2019 with post-traumatic femoral defects that underwent treatment with monorail fixator-assisted intramedullary nailing. Primary outcome was time to bone union and bone results according to ASAMI classification. Secondary outcomes were lengthening index, consolidation time and index, external fixator index (EFI), time to partial weight bearing(PWB) and full weight bearing (FWB), and complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores (OKS), and Oxford hip scores (OHS) were recorded after recovery. Results Mean follow-up time was 227 weeks. Average bone defect size was 9.69 cm. Average consolidation time and index were 11.35 months and 1.24 months/cm, respectively. Mean lengthening and external fixator index were 20.2 days/cm and 23.88 days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, five patients had pin site infections, and two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p = 0.104, p = 0.238, respectively). Average OKS was 32.17 and OHS was 34.00. Conclusion Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time and returning patients’ quality of life to a level comparable with the normal population.

scholarly journals Unexpected Injury During Jumping Exercise

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0019
Author(s):  
Bahattin Kemah ◽  
Afşar Timuçin Özkut ◽  
İrfan Esenkaya ◽  
Kaya Hüsnü Akan ◽  
İsmail Türkmen
Keyword(s):  
Plantar Flexion ◽  
Weight Bearing ◽  
Joint Stiffness ◽  
Lateral Side ◽  
Second Phase ◽  
Return To Sports ◽  
Aofas Score ◽  
Subtalar Dislocation ◽  
Early Return ◽  
Partial Weight

Objectives: The purpose of this case presentation is to report the results of physical therapy and conservative treatment of a rare clinical entity, isolated subtalar dislocation that occurred during triple jumping during which maximum compression forces act on the foot. Methods: A 20 years old national triple jumping athlete fell during daily sports exercises which consist of jumping to the medial and lateral side trying to catch a sports ball bouncing from the wall while his right foot was inverted and in plantar flexion. The patient was admitted to our emergency service. The physical examination revealed that the hindfoot was displaced medially. The neurological examination was intact and there was no sign of dermal injury. After the radiological examination the diagnosis was isolated subtalar dislocation. The dislocation was reduced with longitudinal traction with the knee was in flexion. The MR imaging did not reveal any chondral damage. The choice of treatment was conservative. After 4 days as the edema subsided, a short leg cast was applied for four weeks. Then, the cast was removed and active range of motion exercises were initiated. The first 25 days consisted of exercises with rubber band, bottle rolling under the foot. The second phase included walking in the pool and the patient was asked to start weight bearing partially. The patient went on with proprioception and strengthening exercises. Later, kinesiologic taping was also added to the therapy. He changed his jumping foot and started his routine training program with the team after 170 days. He participated in his first official competition 16 months after the injury. At the 28. month, he broke the national record in the National Interuniversities Athletics Games. 2 months later, he got the third place in the World Athletics Championship. Results: The follow up period was 4 years. AOFAS score was 76 at second month and 83 at the fourth. At the first and at the fourth year, AOFAS score was 100. No dermal lesions or joint stiffness or signs of arthritis was observed. Avascular necrosis of talus or complex regional pain syndrome was not encountered. Conclusion: Early return to sports activities is of tantamount importance as early reduction. Reduction can be carried out in an open or closed manner. For prevention of joint stiffness, immobilization period has to be short and active ROM exercises has to be initiated with partial weight bearing as soon as the joint stability and strength is adequate.

scholarly journals Return-To-Sport at 5-Year Follow-Up after Non-Operative Treatment of Acute Achilles Tendon Rupture

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Fabian Krause ◽  
Andreas Schwinghammer ◽  
Till Lerch ◽  
Timo Schmid ◽  
Timo Ecker ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Operative Treatment ◽  
Tendon Rupture ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Return To Sport ◽  
Activity Level ◽  
Sports Activity ◽  
Activity Group

Category: Sports Introduction/Purpose: There is a controversy if non-operative or operative treatment for acute Achilles tendon rupture is superior. It is unknown, if young and active patients with acute Achilles tendon rupture, return to previous sports activity level after treatment with standardized non-operative immediate full weight-bearing protocol. The purpose of this was to assess (1) the return-to-sport rate and subjective satisfaction in patients with different activity levels before the rupture, at 1-year, and at 5-year follow-up, (2) the clinical outcome at 1-year follow-up, and (3) re-ruptures and complications. Methods: Out of 171 consecutive patients that were treated nonoperatively, 114 patients were available for 1-year follow-up. Eighty-nine patients responded to questionnaires for sports activity. Non-operative treatment consisted of a combination of an equinus cast and rehabilitation boot, that enables immediate full weight-bearing and early functional rehabilitation. Clinical 1-year follow-up and follow-up with questionnaires at 1-year and 5-year follow-up were evaluated to calculate Tegner Activity Scale (TAS), and Activity Rating Scale (ARS) and were compared to the status before the rupture. Based on the TAS before the rupture, patients were divided into a low-level activity (<5) and high-level activity (>5) group and the return-to-sport rate was compared between those two groups.Clinical assessment at minimum 1-year follow-up included testing of plantarflexion strength and endurance, calf circumference, and subjective parameters to calculate a modified Thermann score. Mean clinical follow-up was 34 ± 23 months (range 12-88 months). Results: (1) A significantly higher proportion (91%) of the patients in the low-level activity group returned to their previous TA at 5-year follow-up compared to patients (67%) in the high-level activity group (p=0.029). A higher proportion (91%) of the patients in the low-level activity group returned to their previous ARS Score at 5-year follow-up compared to patients (82%) in the high- level activity group (p=0,115). (2) The mean Thermann score was not significantly different between the two activity groups at minimum 1-year follow-up: 84 ±12 (range, 41-100) and 82 ±12 (range, 44 -100). (3) There were a total of 17 complications. There were 9,6% reruptures (8 with and 3 without an adequate trauma), 5 deep venous thromboses, 1 complex regional pain syndrome at 1 year follow-up. Conclusion: After 17 years of prospective evaluation, our non-operative treatment protocol for acute rupture of the Achilles tendon leads to good functional outcome, high patient satisfaction and high return-to-sport rate. Most patients return to their previous sports activity level after a standardized nonoperative early full-weightbearing treatment protocol for acute Achilles tendon rupture. Even for patients with a high activity level return to pre-rupture sports level activity was possible in two third of the patients. The re-rupture rate with immediate weight bearing is low and comparable to other non-operative treatment methods.

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