scholarly journals Megaprosthesis as a treatment modality for persistent distal femoral nonunion in middle aged adults

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0053
Author(s):  
Shashank Agarwal ◽  
Inder Pawar ◽  
Anil Kumar ◽  
Anjul Verma ◽  
Pawan Kumar
Keyword(s):  
Range Of Motion ◽  
Treatment Option ◽  
Knee Society Score ◽  
Distal Femur ◽  
Fracture Site ◽  
Definitive Treatment ◽  
Full Extension ◽  
Non Union ◽  
The Mean

Introduction: Managing distal femur non-union can be a struggle for any orthopedician as it brings along many perplexities which may not lead to satisfactory patient outcome. The target in these cases should be to reduce the morbidity and allow early rehabilitation of the patient and to accomplish this, megaprostheses can be a feasible option. The orthodox use of megaprostheses is in the musculo-skeletal oncologic surgeries but its use can be extended to traumatic etiologies. These can be offered as a single stage definite procedure in patients who have already undergone several previous surgeries. Here we report a series of four cases of persistent non-union of distal femur treated with megaprostheses and recommend this modality for achieving the desired goal but the indication should be meticulously selected. Hypotheses: Megaprosthesis as a definitive treatment option in persistent distal femur non-union and prevention of repeated surgical intervention. Methods: Four cases of persistent distal femur nonunion with failed osteosynthesis were selected who were initially treated with a distal femur locking plate. Results were assessed in terms of range of motion, limb length discrepancy, knee society score and osteointegration of the components. Results: The mean age of the patients at the time of DFEPR was 49 years (42-55). The mean follow up of patients was for approximately 2 years, with the longest follow up being 3.5 years for the first operated case of the series. The range of motion was from full extension to about 105 degrees of flexion with two patients having an extension lag of 10 degrees. Patients were ambulatory without support. Postoperatively, the mean knee society score was 83 (78–88) at last follow-up as compared to 29 (21-36) in the pre-operative period. No case of infection or loosening was reported. There was 1 cm of shortening in one patient in the operated limb which was compensated by giving shoe raise. Good osseointegration of the megaprosthesis was revealed on both anteroposterior and lateral radiographs. Conclusion: Although there are very limited studies on the use of megaprosthesis for traumatic cases, it can be considered as an alternative when we are left with only arthrodesis or amputation as the final option. Despite the operative challenges, there is marked improvement in pain and functional capacity as experienced by these severely limited patients, which are the hallmarks of a successful salvage. The use of distal femur mega-prosthesis is a novel acumen in cases, where bone stock at the fracture site at distal end of femur is so severely compromised that traditional revision osteosynthesis would not provide stable and durable fixation. The indications for this surgery must be rigorously selected and should only complement osteosynthesis procedures, which remain the reference treatment option.

scholarly journals Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

2019 ◽  
Vol 98 (5) ◽  
pp. 291-294 ◽  
Author(s):  
Saudamini J. Lele ◽  
Mickie Hamiter ◽  
Torrey Louise Fourrier ◽  
Cherie-Ann Nathan
Keyword(s):  
Treatment Option ◽  
Case Series ◽  
Complete Response ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Effective Treatment Option ◽  
Patient Reported ◽  
History Of ◽  
The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

Four-Corner Arthrodesis Using the Quad Memory Staple

2009 ◽  
Vol 34 (2) ◽  
pp. 252-255 ◽  
Author(s):  
E. A. VAN AMERONGEN ◽  
A. H. SCHUURMAN
Keyword(s):  
Range Of Motion ◽  
Compressive Property ◽  
Dash Score ◽  
Ulnar Deviation ◽  
Non Union ◽  
Radial Deviation ◽  
Pin Fixation ◽  
The Mean ◽  
Simple Fixation

Range of motion, pain, consolidation and complications were evaluated for nine patients who underwent four-corner arthrodesis using the Quad Memory Staple (QMS) at a mean follow-up of 44 months. The mean pre-operative range of motion was 50° extension, 62° flexion, 9° radial deviation and 24° ulnar deviation. The postoperative range of motion was similar to previous studies at 32° extension, 31° flexion, 15° radial deviation and 20° ulnar deviation. The grip strength was 28 kg pre-operatively and 26 kg postoperatively. The mean pain score improved from 41 to 23 and the Disabilities of Arm, Shoulder, and Hand (DASH) score from 24 to 20. Non-union, haematoma and wound infection were not seen and eventually all four-corner fusions were consolidated. The main advantages of the QMS are its compressive property and the simple fixation technique. It gives good stability, enables early rehabilitation and avoids the risks of pin fixation methods.

scholarly journals Review of patient-reported outcomes in periprosthetic distal femur fractures after total knee arthroplasty: a plate or intramedullary nail?

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Dustin Rinehart ◽  
Tyler Youngman ◽  
Junho Ahn ◽  
Michael Huo
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Intramedullary Nail ◽  
Distal Femur ◽  
Non Union ◽  
Femur Fractures ◽  
Patient Reported ◽  
Total Knee ◽  
The Mean

Abstract Purpose This study reviewed the literature regarding the patient-reported treatment outcomes of using either open reduction and internal fixation (ORIF) with a plate and screw system or intramedullary nail (IMN) fixation for periprosthetic distal femur fractures around a total knee arthroplasty. Methods A total of 13 studies published in the last 20 years met the inclusion criteria. The studies included 347 patients who were allocated to ORIF (n = 249) and IMN (n = 98) groups according to the implants used. The primary outcome measures were the Knee Society Score or the Western Ontario and McMaster Universities osteoarthritis index. The secondary outcome measures included knee range of motion and the rates of complications, including non-union, malunion, infection, revision total knee arthroplasty, and reoperation. Statistical significance was set at P < 0.05. Results The mean Knee Society Scores of ORIF and IMN groups were 83 and 84, respectively; the mean postoperative range of motion of the knee were 99° and 100°, respectively (P < 0.05); the non-union rates were 9.4 and 3.8%, respectively (P > 0.05); the malunion rates were 1.8 and 7.5%, respectively (P < 0.05); surgical site infection rates were 2 and 1.3%, respectively (P > 0.05); the reoperation rates were 9.6 and 5.1%, respectively (P > 0.05); and revision rates of total knee arthroplasty were 2 and 1%, respectively (P > 0.05). Conclusion Based on the patient-reported outcome assessments, both ORIF with a plate and screw system and IMN fixation are well-accepted techniques for periprosthetic distal femur fractures around a TKA, and they produce similar functional outcomes.

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23&deg;; increased proximal articular angle (PAA&gt;8&deg;), and range of motion of the metatarsophalangeal joint in flexion and extension &gt;40&deg;. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8&plusmn;1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7&plusmn;2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1&plusmn;2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6&deg; (pre-operative mean value: 37.5&deg;) which was statistically significant (p&lt;0.01). The IMA improved by an average of 5.96&deg; from a pre-operative mean value of 15.4&deg; (p&lt;0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

scholarly journals Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Using Transfibular Approach

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001 ◽  
Author(s):  
Alexej Barg ◽  
Charles Saltzman
Keyword(s):  
Range Of Motion ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Trabecular Metal ◽  
Non Union ◽  
Early Loosening ◽  
Early Results ◽  
Ankle Replacement ◽  
Patient Reported

Category: Ankle, Ankle Arthritis Introduction/Purpose: In the last two decades, total ankle replacement (TAR) has gained more acceptance as a treatment option in patients with end-stage ankle osteoarthritis. However, there is a lack of literature on TAR using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results of a patient cohort treated with TAR using a lateral transfibular approach by a single surgeon. Methods: Fifty-five primary total ankle arthroplasties using the Zimmer trabecular metal implant were performed in 54 patients (29 men and 25 women; mean age, 67.0 years) from October 2012 to December 2014. Clinical assessment including pain evaluation and measurement of ankle range of motion was done preoperatively and at the latest follow-up. Weight-bearing radiographs were used to determine the angular alignment of the tibial and talar components and to analyze the bone-implant interface. Intraoperative and postoperative complications, revision surgeries, and failures were evaluated. Results: Implant survival was 93% at 36 months follow-up. There were 3 revisions of a tibial component due to aseptic loosening. In 10 of 55 procedures, a secondary procedure was performed during follow-up. Mean follow-up duration was 26.6 ± 4.2 months. No delayed union or non-union was observed for fibula healing. The average VAS pain score decreased significantly from 7.9 ± 1.3 to 0.8 ± 1.2. The average total range of motion increased significantly from 22.9° ± 11.8° to 40.2° ± 11.8°. Conclusion: Early results of Zimmer trabecular metal total ankle replacement demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of one year. In the first 55 consecutive cases, the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening requiring revision due to lack of bony ingrowth was seen in 3 of 55 cases.

scholarly journals Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient

2017 ◽  
Vol 9 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Matthew D. Putnam ◽  
Christy M. Christophersen ◽  
Julie E. Adams
Keyword(s):  
Supportive Care ◽  
Operative Treatment ◽  
Type Ii ◽  
Post Injury ◽  
Active Motion ◽  
Non Union ◽  
The Mean ◽  
Elbow Motion ◽  
Olecranon Fractures

Background We report on the non-operative treatment of Mayo Type II olecranon fractures. Methods Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained. Results At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care. Conclusions In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

scholarly journals Idiopathic retroperitoneal fibrosis: A report on 15 patients

2015 ◽  
Vol 72 (10) ◽  
pp. 928-931 ◽  
Author(s):  
Jovan Hadzi-Djokic ◽  
Tomislav Pejcic ◽  
Dragoslav Basic ◽  
Ivana Vukomanovic ◽  
Zoran Dzamic ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Retroperitoneal Fibrosis ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Omental Flap ◽  
Definitive Treatment ◽  
Pathological Examination ◽  
Idiopathic Retroperitoneal Fibrosis ◽  
The Mean

Background/Aim. Retroperitoneal fibrosis (RPF) represents a chronic pathological process characterized by fibrosis which entraps and compresses the ureters and the great blood vessels in the retroperitoneal space. A specific form of RPF is idiopathic RPF, an uncommon collagen vascular disease of unclear etiology. The series of 15 patients which underwent open surgical repair due to idiopathic RPF is presented herein. Methods. From 1989 to 2012, 11 male and 4 female patients underwent surgery due to primary RPF. The ureters were entrapped unilaterally (7 patients), or bilaterally (8 patients). Major symptoms included low back pain due to hydronephrosis (9 patients), uremia (4 patients), and urinary tract infection (2 patients). The diagnosis was based on intravenous urography (IVU), retrograde ureteropyelography and computed tomography (CT). Results. Surgical procedures included intraperitoneal ureteral displacement (8 patients) and ureteral wrapping with omental flap (6 patients). One patient underwent bilateral ureteral stenotic segments resection and oblique ureterography, followed by wrapping with omental flap. Pathological examination confirmed primary RPF in all patients. The mean operative time was 3.5 h (range 2.5-4.5 h). The average intrahospital stay was 21 days (range 16-26 days). The mean follow up was 32 months (6-46 months). During the follow up, 12 patients had improvement on IVU. Conclusion. Early recognition of signs and symptoms of RPF is of the utmost importance for the outcome. Surgical procedures, including ureteral wrapping with omental flap, or intraperitoneal ureteral displacement, usually represent definitive treatment.

scholarly journals Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail

2019 ◽  
Vol 6 (2) ◽  
pp. 5-11
Author(s):  
Balakrishnan M. Acharya ◽  
Rojan Tamrakar ◽  
Pramod Devkota ◽  
Abhishek K. Thakur ◽  
Suman K. Shrestha
Keyword(s):  
Road Traffic ◽  
Bone Fractures ◽  
Long Bone ◽  
Fracture Union ◽  
Surgical Implant ◽  
Non Union ◽  
Generation Network ◽  
Diaphyseal Fractures ◽  
The Mean

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The follow-up visits were arranged at 6, 12, 24 weeks and one-year post operatively. During follow-up visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications.

Kniegelenksendoprothetik bei hämophiler Arthropathie

2010 ◽  
Vol 30 (S 01) ◽  
pp. S104-S106
Author(s):  
W. Miesbach ◽  
L. M. Sahner ◽  
A. Kurth ◽  
B. Habermann
Keyword(s):  
Quality Of Life ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Society Score ◽  
Normal Population ◽  
Knee Function ◽  
Total Knee ◽  
The Mean

Summary Purpose Purpose of this retrospective study was to evaluate our own results after total knee replacement in patients with haemophilia. Patients, material, method: 30 patients with haemophilia who underwent total knee replacement between 1987 and 2005 were included. We used the clinical and radiological Knee Society Score. Furthermore, the Petterson and the Arnold and Hilgartner score were applied. Results: The mean age at the time of surgery was 43.2 (27–66). At the time of follow- up examination the mean age was 51.6 (30–82) years. The mean follow-up was 7.1 (2–20) years. Preoperative, he mean Arnold and Hilgartner score was 4.17 (± 0.59) and the mean Petterson-Score was 9 ± 2.29. Compared to the preoperative deficiency in knee function (KSS-Score 88.17 ± 33.58) an improvement with 166.67 (± 22.73) points was seen. 1 patient showed an aseptic loosening after 11 years. Discussion: Total knee replacement in patients with haemophilia improves knee function and quality of life. The results of our study represent results in earlier published studies. Compared to a non-haemo-philic normal population the rate of perioper-ative complications was not increased.

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