scholarly journals Knee Extension Does Not Reliably Reduce Acute Type II Tibial Spine Fractures: MRI Evaluation of Displacement During Extension Versus Resting Flexion

2019 ◽  
Vol 7 (7) ◽  
pp. 232596711986006
Author(s):  
Peter C. Cannamela ◽  
Noah J. Quinlan ◽  
Travis G. Maak ◽  
Temitope F. Adeyemi ◽  
Stephen K. Aoki
Keyword(s):  
Closed Reduction ◽  
Sagittal Plane ◽  
Statistical Significance ◽  
Case Series ◽  
Knee Extension ◽  
Acute Type ◽  
Type Ii ◽  
Level Of Evidence ◽  
Tibial Spine ◽  
Bony Fragment

Background: Type II tibial spine avulsion (TSA) fractures have traditionally been managed by first attempting to achieve closed reduction with extension and immobilization, with surgical indications reserved for those who fail to reduce within 3 mm. However, the frequency with which appropriate reduction can be achieved is largely unknown. Purpose: To evaluate changes in displacement of type II TSA fractures by comparing magnetic resonance imaging (MRI) scans obtained with the knee in flexion and in extension. Study Design: Case series; Level of evidence, 4. Methods: Ten patients with type II TSA fractures were identified. Fracture displacement was measured using 3 images for each patient: (1) initial lateral view radiography, (2) sagittal-plane MRI of the knee in resting flexion, and (3) sagittal-plane MRI of the knee in passive extension. Maximum displacement of the bony fragment was measured in the 2 MRI studies for all patients, and the corresponding change in displacement was calculated. Displacement in flexion was compared with displacement in extension using a paired-sample t test. Statistical significance was set at P < .05. Results: The displacement distance of the bony fragment was reduced by a mean of 0.97 mm on MRI when the knee was in extension compared with flexion in patients with type II TSA fractures ( P = .02). Mean displacement with extension was 6.14 mm, with no fractures reduced below 4 mm. The largest reduction observed was 2.80 mm. The displacement distance increased in 2 knees with extension. The intermeniscal ligament (IML) was entrapped in 4 of 10 patients; however, the amount of reduction achieved did not differ based on the presence of IML entrapment ( P = .85). Conclusion: While the amount of tibial spine displacement warranting surgical treatment can be debated, the study findings suggest that knee extension is not reliable in obtaining adequate closed reduction for type II TSA fractures. Management decisions may need to be based on the initial displacement distance of the fracture, with a lower threshold for operative treatment than previously recognized.

scholarly journals Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Marta Medetti ◽  
Francesco Benazzo
Keyword(s):  
Revision Surgery ◽  
Case Series ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Type Ii ◽  
Level Of Evidence ◽  
Kaplan Meier ◽  
Prospective Case Series ◽  
Acetabular Components

Abstract Background This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery. Methods Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29–90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect. Results Average follow-up was 91 (range 24–146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25–70; SD 9) preoperatively to 84.4 (range 46–99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan–Meier survivorship was assessed to be 88.54% (95% CI 80.18–93.52%) at 71 months, with failure of the cup for any reason as the endpoint. Conclusion Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects. Level of evidence Level IV prospective case series

Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes

2016 ◽  
Vol 45 (2) ◽  
pp. 462-467 ◽  
Author(s):  
Maximiliano Ranalletta ◽  
Luciano A. Rossi ◽  
Hugo Barros ◽  
Francisco Nally ◽  
Ignacio Tanoira ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Closed Reduction ◽  
Functional Outcomes ◽  
Constant Score ◽  
Case Series ◽  
Return To Sport ◽  
Return To Play ◽  
Short Version ◽  
Level Of Evidence ◽  
The Mean

Background: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. Purpose: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. Results: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. Conclusion: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.

scholarly journals Radiographic assessment of the percutaneous Bianchi system technique for treatment of hallux valgus

2021 ◽  
Vol 15 (2) ◽  
pp. 140-145
Author(s):  
Tércio Manoel de Vasconcelos Silva ◽  
Marcus Vinicius Mota Garcia Moreno ◽  
Janice de Souza Guimarães ◽  
Túlio Eduardo Vieira Marçal ◽  
Thiago Batista Faleiro ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Statistical Significance ◽  
Case Series ◽  
Deformity Correction ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Valgus Angle ◽  
Assessment Period ◽  
System Technique ◽  
Student’S T

Objective: To present initial radiographic results of surgical correction of the hallux valgus angle (HVA) and the intermetatarsal angle (IMA) using the percutaneous Bianchi system (PBS) technique. Methods: Seventeen patients with moderate to severe hallux valgus (HV) were exclusively treated with the PBS technique and assessed radiographically preoperatively and during the postoperative period, from January 2019 to January 2020. The degree of deformity correction was recorded, based on the HVA and the IMA. Stata (v. 14.0) software was used for statistical analyses. Pre-surgical and post-surgical mean HVA and IMA were compared using Student’s t test for paired samples and the McNemar test was used to compare HVA and IMA categories. Statistical significance was set at 5% and 95% confidence intervals were estimated. Results: Both HVA and IMA were reduced significantly during the assessment period. Mean radiographic correction of the HVA was 15.1° and mean radiographic correction of the IMA was 7.3. Conclusions: According to the results presented, use of the PBS technique achieved adequate correction of the radiographic parameters of the patients who underwent the treatment as proposed, although it is necessary to conduct additional studies with longer follow-up to achieve a higher recommendation level. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Retears of the Rotator Cuff: An Ultrasonographic Assessment During the First Postoperative Year

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988904 ◽  
Author(s):  
Giussepe Aguado ◽  
Daniel Vernaza Obando ◽  
Gilberto A. Herrera ◽  
Alejandro Ramirez ◽  
Paulo J. Llinás
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Statistical Significance ◽  
Case Series ◽  
Level Of Evidence ◽  
Double Row ◽  
Initial Surgery ◽  
The Difference ◽  
Clinical Records ◽  
Massive Tears

Background: Surgical repair of rotator cuff (RC) tears is an effective treatment option. However, the prevalence of recurrent ruptures is high. Hypothesis: Recurrent tears are a frequent complication of surgical repair of RC tears. Their incidence might be influenced by factors such as the patient’s age and size of the initial tear. Study Design: Case series; Level of evidence, 4. Methods: Data from 90 adult patients who underwent arthroscopic RC repair between 2014 and 2017 and underwent an ultrasound examination 6 to 12 months after surgery were analyzed retrospectively. Massive tears were repaired using a double-row technique, and nonmassive tears were repaired with a single-row technique. Clinical records were reviewed for demographic information. Results: All patients (57.8% women; 42.2% men) were older than 18 years (mean, 58.9 years). Of these patients, 30.0% (27/90) had massive tears, which were primarily found in patients ≥60 years (74.1%; 20/27). Complete healing was seen in 74.5% of all repairs during follow-up. A total of 23 patients (25.5%) had retears (13 complete; 10 partial), which were diagnosed by ultrasound imaging 6 to 12 months after the initial surgery. The occurrence of retears was more prevalent in patients with massive tears than in patients with nonmassive tears (40.7% vs 19.0%, respectively); the difference was statistically significant ( P = .03). Reruptures occurred in 50.0% of patients older than 60 years with massive tears. Although patients older than 60 years had more recurrent tears (32.6%) compared with younger patients (18.2%), the difference was not statistically significant ( P = .12). Conclusion: One-quarter of the patients who had undergone surgical repair of an RC tear had recurrent ruptures. There was a statistically significant association between the initial massive tear and a retear. Patients older than 60 years showed a higher recurrence rate, but this difference lacked statistical significance. Reruptures occurred in 50.0% of patients older than 60 years with massive tears.

scholarly journals Effects of Short-term Plyometric Training on Countermovement Vertical Jump Height and Kinematics of Take-Off

Thrita ◽  
2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Rasoul Azreh ◽  
Alireza Hashemi Oskouei ◽  
Seyed Amirhossein Emamian Shirazi
Keyword(s):  
Sagittal Plane ◽  
Statistical Significance ◽  
Vertical Jump ◽  
Knee Extension ◽  
Jump Height ◽  
Plyometric Training ◽  
Digital Videos ◽  
Significance Level ◽  
Vertical Jump Height ◽  
Shoulder Flexion

Background: Countermovement vertical jump is a crucial skill in many sports. Plyometric training is a prevalent method to improve athletes' jumping ability. Objectives: The present study aimed to investigate the effect of a 6-week plyometric training on the kinematics of take-off and countermovement vertical jump height. Methods: Fifteen young, healthy male subjects performed plyometric exercises in three sessions per week for six weeks. Digital videos of pre-training and post-training jumps were captured. The Kinovea software was used to measure the kinematic parameters of take-off in the sagittal plane. Pre and post-training values were compared by paired sample t-test with the statistical significance level of P < 0.05. Results: Post-training results showed a higher jump height (P < 0.05), more flexed shoulder, and more extensive hip and knee at take-off (P < 0.05). Also, while hip extension velocity was decreased, shoulder flexion and knee extension velocities were significantly increased (P < 0.05). Conclusions: The 6-week plyometric training, including 720 jumps, improved shoulder flexion, and hip and knee extensions at take-off, resulting in high CMJ height. We employed plyometric training to improve the shoulder flexion and hip and knee extension velocities and increase CMJ height.

Effects of Intravenous Tranexamic Acid During Rhytidectomy: A Randomized, Controlled, Double-Blind Pilot Study

2020 ◽  
Author(s):  
Justin C Cohen ◽  
Robert A Glasgold ◽  
Les M Alloju ◽  
Mark J Glasgold
Keyword(s):  
Tranexamic Acid ◽  
Low Cost ◽  
Statistical Significance ◽  
Case Series ◽  
Skin Incision ◽  
Level Of Evidence ◽  
Double Blind ◽  
Intraoperative Bleeding ◽  
Randomized Controlled ◽  
Surgery Center

Abstract Background Tranexamic acid (TXA) is an antifibrinolytic agent shown to decrease intraoperative bleeding, reduce transfusions, and improve outcomes across multiple specialties. Within plastic surgery, initial reports are encouraging but formal studies are lacking. Objectives The aim of this study was to determine whether intravenous (IV) TXA has any effect on intraoperative bleeding or postoperative sequelae in patients undergoing a deep-plane facelift. Methods This is a prospective, randomized, double-blind, case series in a private practice surgery center. The participants were 44 patients undergoing rhytidectomy with the senior authors (R.A.G. or M.J.G). The treatment group received a 1-g dose of IV TXA prior to skin incision and the same dose 4 hours later (vs saline). Bleeding was rated mild, moderate, or severe. Postoperative ecchymosis and edema were subjectively evaluated by patient and surgeon and scores were aggregated for analysis. Results The TXA group showed decreased intraoperative bleeding but this difference did not reach statistical significance. Postoperative ecchymosis/edema ratings were lower for patients who received TXA, including a statistically significant decrease in surgeon-rated bruising. TXA resulted in a statistically significant decrease in postoperative collections in this study and no major complications occurred. Conclusions TXA is a safe, low-cost addition to any existing surgical protocol and may lead to fewer surgical sequelae and improved satisfaction. Although we did not observe a dramatically different intraoperative experience, postoperative bruising and collections were significantly reduced. TXA acid may have great value in the management of patients undergoing rhytidectomy and its use warrants further study. Level of Evidence: 2

Does Knee Extension Reduce Type II Tibial Spine Fractures: an MRI Evaluation in Extension versus Resting Flexion

2019 ◽  
Vol 35 (12) ◽  
pp. e17
Author(s):  
Stephen K. Aoki ◽  
Peter C. Cannamela ◽  
Noah J. Quinlan ◽  
Travis G. Maak ◽  
Temitope F. Adeyemi
Keyword(s):  
Knee Extension ◽  
Spine Fractures ◽  
Type Ii ◽  
Tibial Spine ◽  
Mri Evaluation

scholarly journals CORRELATION BETWEEN ECCENTRIC TRAINING AND FUNCTIONAL TESTS IN SUBJECTS WITH RECONSTRUCTED ACL

2018 ◽  
Vol 24 (6) ◽  
pp. 471-476
Author(s):  
Heleodório Honorato Santos ◽  
Catarina de Oliveira Sousa ◽  
Christiane Lanatovitz Prado Medeiros ◽  
José Angelo Barela ◽  
Ana Maria Forti Barela ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Control Level ◽  
Case Series ◽  
Peak Torque ◽  
Knee Extension ◽  
Triple P ◽  
Eccentric Training ◽  
Isokinetic Training ◽  
Level Of Evidence

ABSTRACT Introduction: Eccentric training and jump tests are widely used to recover and measure deficits in knee strength and functionality after anterior cruciate ligament (ACL) reconstruction. Objective: To correlate knee extension and flexion torque generated by eccentric isokinetic training, with functional jump tests in subjects with reconstructed ACL. Method: Sixteen men with unilateral ACL reconstruction were assessed before and after 12 weeks of eccentric isokinetic training of knee flexors and extensors (3×10 MVC, 2x/week) at 30°/s for extension and flexion torque (isometric; concentric and eccentric at 30 and 120°/s) and functional jump tests (single, triple, cross and figure of 8). Inter- and intra-limb pre- and post-training mean peak torque (MPT), distance and jump test times were compared along with the correlations between these variables, considering P<0.05. Results: The affected limb (AL) showed significant gain of extension and flexion torque (P<0.01) in the different test categories and velocities evaluated. In the non-affected limb (NAL), this only occurred in the eccentric category (30 and 120°/s), in the extension (P<0.01) and flexion (P<0.05 and P<0.01) torques, respectively. In the jumps, there was an increase in distance (single and triple; P<0.05) and a decrease in time (crossed and figure of 8; P<0.01), however, MPT x Jump correlations were weak (r<0.3) in the pre and post-training period in both limbs. Conclusion: Despite the gain in knee extension and flexion torque and jumping performance, the expected correlation was not satisfactory, suggesting that knee functionality involves other variables inherent to motor control. Level of Evidence IV; Type of study: Case series.

Radiographic Assessment of Relative First Metatarsal Length Following Modified Lapidus Procedure

2020 ◽  
Vol 41 (8) ◽  
pp. 972-977 ◽  
Author(s):  
Wessel Greeff ◽  
Andrew Strydom ◽  
Nikiforos Pandelis Saragas ◽  
Paulo Norberto Faria Ferrao
Keyword(s):  
Hallux Valgus ◽  
Sagittal Plane ◽  
Case Series ◽  
Relative Length ◽  
Long Term Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Patient Reported ◽  
The Mean

Background: The modified Lapidus is a surgical procedure for managing moderate to severe hallux valgus, especially in the presence of first tarsometatarsal joint arthritis or hypermobility. It has good long-term results but reportedly can lead to transfer metatarsalgia due to inherent shortening of the first metatarsal. Methods: A retrospective analysis of all adult patients who underwent a modified Lapidus procedure during a 3-year period was performed. Clinical notes were evaluated to look for nonunion or any other complications related to the surgery. Pre- and postoperative standard weightbearing radiographs were used to establish the relative metatarsal length (RML), intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMMA). A total of 69 modified Lapidus procedures were identified, with 32 included in the study. Results: The mean pre- and postoperative RMLs were −0.8 and −4.9 mm, respectively. The average RML shortening due to the procedure was −4.1 ( P < .0001). The mean pre- and postoperative IMAs were 15 and 5 degrees, respectively ( P < .0001). The mean pre- and postoperative HVAs were 33 and 9 degrees, respectively ( P < .0001). One patient reported transfer metatarsalgia, which was attributed to elevation of the first metatarsal. Conclusion: We found a statistically significant degree of shortening of the relative length of the first metatarsal without any clinically significant metatarsalgia. The low rate of transfer metatarsalgia following the modified Lapidus procedure could be attributed to the sagittal plane correction and stability obtained by performing a first tarsometatarsal fusion. Level of Evidence: Level IV, retrospective case series.

scholarly journals REPRODUCIBILITY OF S2-ALAR ILIAC SCREW MORPHOMETRIC ANALYSIS

2021 ◽  
Vol 29 (2) ◽  
pp. 97-100
Author(s):  
MARIANA DEMÉTRIO DE SOUSA PONTES ◽  
LUCAS AMÉRICO FRANCISCO ◽  
LUCAS KLAROSK ISMAEL ◽  
CARLOS FERNANDO PEREIRA DA SILVA HERRERO
Keyword(s):  
Morphometric Analysis ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Statistical Significance ◽  
Intraclass Correlation ◽  
Intraobserver Reliability ◽  
Axial Plane ◽  
Level Of Evidence ◽  
Screw Length ◽  
Trajectory Angle

ABSTRACT Objective: To evaluate the reproducibility of a S2-alar iliac (S2AI) screw parameters measurement method by inter and intraobserver reliability. Methods: Cross-sectional study, considering computed tomography exams. Morphometric analysis was performed by multiplanar reconstructions. Screw length, diameter and trajectory angles were the studied variables. To analyze the measurements reproducibility, intraclass correlation coefficient (ICC) was used. Results: Interobserver reliability was classified as strong for screw shortest length (ICC: 0.742) and diameter (ICC: 0.699). Interobserver reliability was classified as moderate for screw longest length (ICC: 0.553) and for screw trajectory angles in the axial plane for the longest (ICC: 0.478) and for the shortest lengths (ICC: 0.591). Intraobserver reliability was interpreted as excellent for screw shortest (ICC: 0.932) and longest lengths (ICC: 0.962) and diameter (ICC: 0.770) and screw trajectory angles in the axial plane for the screw longest (ICC: 0.773) and shortest lengths (ICC: 0.862). There were weak interobserver and strong intraobserver reliabilities for trajectory angle in sagittal plane, but no statistical significance was found. Conclusion: Inter and intraobserver reliability of S2AI screw morphometric parameters were interpreted from moderate to excellent in almost all studied variables, except for the screw trajectory angle in the sagittal plane measurement. Level of Evidence IV, Diagnostic Studies - Investigating a Diagnostic Test.

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