scholarly journals SURGICAL MANAGEMENT OF OSTEOCHONDRITIS DISSECANS OF THE ELBOW IN CHILDREN: IS THERE CONSENSUS AMONG EXPERTS?

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0027
Author(s):  
Scott M. LaValva ◽  
Nakul S. Talathi ◽  
Neeraj M. Patel ◽  
Eric W. Edmonds ◽  
Henry B. Ellis ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bone Loss ◽  
Internal Fixation ◽  
Surgical Management ◽  
Subchondral Bone ◽  
Osteochondritis Dissecans ◽  
Treatment Strategies ◽  
Skeletally Immature ◽  
Trap Door ◽  
Marrow Stimulation

Background: Although the available evidence generally supports surgical treatment of unstable osteochondritis dissecans (OCD) lesions of the elbow, the optimal surgical management lacks consensus. Given the myriad of options available for skeletally immature patients, the purpose of this study was to identify preferred surgical procedures based upon patient and OCD characteristics among a group of high volume surgeons. Hypothesis/Purpose: To understand current treatment practices for experts on OCD of the elbow. Methods: A survey evaluating the surgical treatment strategies for twenty-three clinical vignettes of skeletally immature patients with OCD of the elbow was created and distributed electronically to members of the Research on Osteochondritis Dissecans (ROCK) study group using REDCap. Each vignette described an OCD lesion of varying location, size, degree of cartilage involvement, and depth. Multiple-choice answers related to specific treatment strategies and technique were provided for each lesion. Standard descriptive statistics were used to summarize and compare responses for each vignette. Results: Fifteen surgeons treating OCD of the elbow participated in the study. All respondents were attending-level surgeons. One-third of responding surgeons treat elbow OCD weekly, 53% monthly, and 13% every six months. In skeletally immature patients with stable, intact elbow OCD lesions, 80% of surgeons would treat with transarticular (58%), retroarticular (33%), or combined trans/retroarticular (8%) drilling. For full-thickness (FT) osteochondral defects occupying 33% or 66% of capitellar width, the preferred treatment modality varied substantially based on lesion depth. Overall, the preferred strategies for these lesions were (1) debridement with marrow stimulation for FT defects with 1-2 mm subchondral bone loss and (2) internal fixation for trap-door lesions with either trace or > 4 mm of subchondral bone. There was substantial heterogeneity with respect to treatment strategy for FT defects with > 4 mm bone loss. For a lesion occupying 33% of capitellar width, 47% of surgeons would treat with debridement and marrow stimulation, 47% would treat with an osteochondral transfer, and 6% would perform both. For larger lesions of 66% width, slightly more would treat with osteochondral transfer (47% vs. 40%). Ultimately, > 75% agreement was only reached in 19% of the vignettes, highlighting the high degree of variability in the treatment of elbow OCD. Conclusion: For elbow OCD in skeletally immature patients, the greatest agreement exists for (1) the drilling of stable OCD lesions, though there is variability with respect to technique (transarticular/retroarticular/combined) and (2) internal fixation for trap-door lesions with > 5mm of subchondral bone. Nonetheless, high-quality clinical data to guide decision-making is currently lacking for capitellar OCD. Even among a group of experienced experts, there is significant disagreement regarding preferred surgical methods. Our study ultimately highlights the need for multicenter, prospective investigations to evaluate the clinical outcomes of various treatment strategies for OCD of the elbow. [Table: see text][Figure: see text]

Internal Fixation of Osteochondritis Dissecans Lesions in the Patellofemoral Joint

2017 ◽  
Vol 31 (03) ◽  
pp. 206-211 ◽  
Author(s):  
Jack Farr ◽  
Clayton Nuelle
Keyword(s):  
Internal Fixation ◽  
Osteochondritis Dissecans ◽  
Patellofemoral Joint ◽  
Preoperative Planning ◽  
Surgical Intervention ◽  
Skeletally Immature ◽  
Resonance Imaging ◽  
Preoperative Magnetic Resonance ◽  
Difficult Cases ◽  
And Cartilage

AbstractOsteochondritis dissecans (OCD) lesions of the patellofemoral joint can be difficult to identify and treat. Asymptomatic or stable lesions in skeletally immature patients may be treated nonoperatively, but symptomatic lesions often require surgical intervention. Evidence of instability should be carefully evaluated with preoperative magnetic resonance imaging or computed tomography arthrogram. Careful preoperative planning is necessary to ensure the appropriate surgical approach and implants are selected for surgical management. Multiple techniques have been described, but internal fixation of both “classic” and cartilage-only OCD lesions has been shown to have strong outcomes in managing these difficult cases.

The Surgical Management of Osteochondritis Dissecans of the Knee in the Skeletally Immature

2017 ◽  
Vol 37 (7) ◽  
pp. 491-499 ◽  
Author(s):  
Joseph L. Yellin ◽  
Itai Gans ◽  
James L. Carey ◽  
Kevin G. Shea ◽  
Theodore J. Ganley
Keyword(s):  
Surgical Management ◽  
Osteochondritis Dissecans ◽  
Skeletally Immature

Management of bilateral osteochondritis dissecans of the trochlea in a skeletally immature patient

2021 ◽  
Vol 14 (1) ◽  
pp. e239849
Author(s):  
Elizabeth A Eichman ◽  
Benjamin T Harris ◽  
M Tyrrell Burrus
Keyword(s):  
Surgical Treatment ◽  
Operative Treatment ◽  
Osteochondritis Dissecans ◽  
Surgical Intervention ◽  
Skeletally Immature ◽  
Rare Presentation ◽  
Open Physes ◽  
Skeletally Immature Patient ◽  
Over Time

Osteochondritis dissecans (OCD) lesions are injuries that occur more commonly in the skeletally immature population. In most cases, the aetiology is not well understood, but fortunately, many OCD lesions may heal on their own over time, particularly in skeletally immature patients with open physes. Conversely, if the lesion is considered unstable, surgical intervention may be required. This case demonstrates an especially rare presentation of bilateral OCD lesions within the lateral femoral trochlear facet. The lesions became symptomatic approximately 1 year apart without a specific injury. Non-operative treatment was not recommended in either case due to the size and instability of each lesion. The surgical treatment used an augmented microfracture technique. At 12 and 23 months after surgery, both knees remain asymptomatic and the patient has returned to their desired activities.

Internal Fixation of Unstable Osteochondritis Dissecans: Do Open Growth Plates Improve Healing Rate?

2018 ◽  
Vol 46 (10) ◽  
pp. 2394-2401 ◽  
Author(s):  
Isabella T. Wu ◽  
Roel J.H. Custers ◽  
Vishal S. Desai ◽  
Ayoosh Pareek ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Internal Fixation ◽  
Osteochondritis Dissecans ◽  
Independent Risk Factor ◽  
Healing Rate ◽  
Skeletal Maturity ◽  
Skeletally Immature ◽  
Significant Difference ◽  
Patient Reported

Background: Osteochondritis dissecans (OCD) is a disorder of unknown origin that can affect knees in skeletally mature and immature patients. Surgical management is an important cornerstone of treatment for unstable OCD lesions. Purpose: To determine the (1) healing rate after internal fixation of unstable OCD between skeletally immature and mature knees, (2) risk factors for failure, and (3) patient-reported outcomes among healed patients. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective cohort study was conducted with patients who underwent internal fixation of unstable knee OCD lesions from 2000 to 2015. Skeletal immaturity was defined as open or partially open physes. Healing was assessed through clinical findings and imaging. Definitive reoperation for the same OCD lesion was classified as failure. Results: Among 87 patients included, 66 (76%) had healed lesions at ≥2 years postoperatively, while 21 (24%) failed. Skeletal maturity made no significant difference in failure rate (risk ratio, 0.68; 95% CI, 0.29-1.72; P = .40). For skeletally immature patients, lateral versus medial condylar location conferred an increased hazard of 18.2 (95% CI, 1.76-188.07; P < .01). Multivariate analysis factoring in skeletal maturity showed that lateral condylar location was an independent risk factor for failure (hazard ratio, 4.25; 95% CI, 1.47-19.85; P < .01). Mean patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) increased significantly after surgery, except the KOOS symptoms score for the skeletally mature group. Final scores (mean ± SD) were as follows at a mean follow-up of 60 months (range, 24-166): IKDC, 83.5 ± 20.2; KOOS pain, 89.7 ± 14.1; KOOS symptoms, 87.4 ± 18.4; KOOS activities of daily living, 93.9 ± 12.7; KOOS sports, 80.7 ± 25.9; KOOS quality of life, 78.9 ± 23.1. Conclusion: Skeletally immature and mature patients heal at comparable rates after internal fixation of OCD lesions, resulting in functional and subjective improvement. Lateral femoral condylar lesion location is an independent risk factor for failure.

Surgical treatment strategies for secondary peritonitis: Outcome in 278 patients

2001 ◽  
Vol 120 (5) ◽  
pp. A401-A401
Author(s):  
M BOERMEESTER ◽  
E BELT ◽  
B LAMME ◽  
M LUBBERS ◽  
J KESECIOGLU ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Strategies ◽  
Secondary Peritonitis

The use of Integra dermal regeneration matrix in the surgical treatment of a recurrent, extensive malignant skin lesion in the temporal region

2013 ◽  
Vol 154 (6) ◽  
pp. 225-227 ◽  
Author(s):  
Csaba Halmy ◽  
Zoltán Nádai ◽  
Krisztián Csőre ◽  
Adrienne Vajda ◽  
Róbert Tamás
Keyword(s):  
Surgical Treatment ◽  
Skin Lesion ◽  
Surgical Management ◽  
Skin Grafting ◽  
Skin Tumor ◽  
Temporal Region ◽  
Aesthetic Result ◽  
Malignant Skin ◽  
Dermal Regeneration Template ◽  
Dermal Regeneration

Authors report on the use of Integra dermal regeneration template after excision of an extended, recurrent skin tumor in the temporal region. The area covered with Integra was 180 cm2. Skin grafting to cover Integra was performed on the 28th day. Both Integra and the skin transplant were taken 100%. Integra dermal regeneration template can provide good functional and aesthetic result in the surgical management of extended skin tumors over the skull. Orv. Hetil., 2013, 154, 225–227.

Comprehensive Surgical Management of Chronic Suppurative Osteomyelitis Extending to The Lower Border of Mandible – A Case Report

2018 ◽  
Vol 5 (3) ◽  
Author(s):  
Deepak Kaul ◽  
Farahnaz Muddebihal ◽  
Mohammed Anwar Ul Haque Chand
Keyword(s):  
Developing Countries ◽  
Case Report ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Surgical Debridement ◽  
Reconstruction Plate ◽  
Left Posterior ◽  
High Nutrient ◽  
Inferior Border ◽  
Precipitating Factor

Osteomyelitis of maxillofacial skeleton is common in developing countries such as India. This case report describes successful surgical treatment of chronic suppurative osteomyelitis {CSO} of the mandible of a 35yr old female. The precipitating factor was thought to be eventful extraction in the {left } posterior body at the inferior border of mandible. Methods: Presurgical course of antibiotics ( Amoxycillin and metronidazole for 7 days and later followed by doxycycline for 1 month).Surgical debridement of the affected bone and reinforcing it with reconstruction plate using AO principles was done . Patient was kept on a high nutrient diet consisting of proteins. Conclusion: The case report demonstrates the typical features of CSO . The combination of the antibiotics therapy and surgical debridement was successful in the treatment of chronic suppurative osteomylitis.

scholarly journals Surgical Treatment of Internal Fixation Failure of Femoral Peritrochanteric Fracture

2021 ◽  
Author(s):  
Gang Zhong ◽  
Lin Teng ◽  
Hai‐bo Li ◽  
Fu‐guo Huang ◽  
Zhou Xiang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Fixation Failure

scholarly journals Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Michael Ryan ◽  
Benton Emblom ◽  
E. Lyle Cain ◽  
Jeffrey Dugas ◽  
Marcus Rothermich
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Osteochondritis Dissecans ◽  
Surgical Techniques ◽  
The Other ◽  
Return To Play ◽  
Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

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