scholarly journals The Radiologic Change of Distal Tibiofibular Joint Following the Removal of the Transfixing Screw After Syndesmotic Injury

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Bi O Jeong ◽  
Jong Hun Baek ◽  
Wookjae Song
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Syndesmotic Injury ◽  
Anatomic Reduction ◽  
Syndesmosis Injury ◽  
Before And After ◽  
Tibiofibular Joint ◽  
Ankle Trauma ◽  
Axial Ct ◽  
Male Patients

Category: Ankle, Trauma Introduction/Purpose: Transfixing screw fixation is required after anatomic reduction of syndesmosis disruption. An accurate anatomic reduction is related to good functional outcome. However, there is a dispute over whether the transfixing screw should be removed, and little is known about the change of syndesmosis integrity after screw removal. This study aimed to evaluate the effect of transfixing screw removal on syndesmosis integrity with computed tomography (CT) scans. Methods: The study was done prospectively on 28 cases (28 patients) who had transfixing screw fixation for syndesmosis injury from September 2010 to August 2016. Mean age was 31.9 years (range, 17 to 55 years). There were 20 male patients and 8 female patients. Transfixing screws were removed after 3 months, and CT scans were done just before and 3 months after transfixing screw removal. Anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT images for radiological analysis of changes in syndesmosis integrity between before and after screw removal. Results: Malreduction was observed in 7 cases (25%) before transfixing screw removal. All 7 cases were anterior malreductions. Syndesmosis was spontaneously reduced after screw removal in 5 out of the 7 malreduction cases (71.4%). The A/P ratio in the 7 cases decreased from average 1.37 (range, 1.25 to 1.61) before screw removal to average 1.12 (range, 0.96 to 1.25) after screw removal. The decrease was statistically significant (p = 0.016). Syndesmosis malreduction rate decreased from 25% before screw removal to 7.1% after screw removal. All patients with adequate reduction of their syndesmosis continued to have a reduced syndesmosis after transfixing screw removal. However, this difference in malreduction rate was statistically insignificant (p=0.063). Conclusion: Although the malreduction rate is relatively high after transfixing screw fixation in disrupted syndesmosis, the malreduced syndesmosis was spontaneously reduced in 71% of cases after screw removal. Therefore, it is beneficial to remove the transfixing screw a certain period of time after transfixing screw fixation to achieve anatomic reduction of the syndesmosis.

Radiographic Change of the Distal Tibiofibular Joint Following Removal of Transfixing Screw Fixation

2017 ◽  
Vol 39 (3) ◽  
pp. 318-325 ◽  
Author(s):  
Jong Hun Baek ◽  
Tae Yong Kim ◽  
Yoo Beom Kwon ◽  
Bi O Jeong
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Plain Radiographs ◽  
Spontaneous Reduction ◽  
Level Ii ◽  
Anatomic Reduction ◽  
Significant Difference ◽  
Tibiofibular Joint ◽  
Axial Ct

Background: Syndesmosis disruptions in the ankle joint are typically treated with anatomic reduction followed by transfixing screw and/or suture button fixation. The purpose of our study was to analyze the effects of the removal of transfixing screws on syndesmosis integrity using plain radiographs and computed tomography (CT) scans. Methods: Twenty-nine cases (29 patients) who had been treated with transfixing screw fixation for syndesmosis disruptions were studied prospectively. Plain radiographs and CT scans were obtained 1 day before and 3 months after the removal of transfixing screws. The tibiofibular clear space (TCS) and tibiofibular overlap (TFO) were measured on plain radiographs, and the anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT scans to radiographically analyze the effect of the removal of screws on syndesmosis integrity. Results: On plain radiographs, syndesmosis diastasis was not observed before or after the removal of transfixing screws. No statistically significant difference was found in the TCS and the TFO between measurements at prescrew removal and at postscrew removal ( P = .761 and .628, respectively). However, the syndesmosis was found malreduced on CT scans in 7 cases (24.1%) before screw removal. All 7 cases showed anterior malreduction of the syndesmosis, 5 (71.4%) of which spontaneously reduced after screw removal. The A/P ratio of the 7 cases decreased from a mean of 1.37 (range, 1.26-1.61) at prescrew removal to a mean of 1.12 (range, 0.96-1.25) at postscrew removal ( P = .016). Conclusion: Syndesmosis malreduction not observed on plain radiographs after performing transfixing screw fixation was identified with CT scans. Of the cases with a malreduced syndesmosis, 71.4% showed spontaneous reduction after screw removal. Therefore, we believe the removal of transfixing screws is recommended after confirming malreduction on CT scans, although plain radiographs demonstrate anatomic reduction. Level of Evidence: Level II, prospective prognostic study.

scholarly journals A Novel Elastic Wrap for Syndesmotic Reduction with Post-Operative CT Scan Analysis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Daniel R. Schlatterer ◽  
Chet Despande ◽  
Aaron Morgenstein
Keyword(s):  
Clinical Practice ◽  
Ct Scan ◽  
Screw Fixation ◽  
Ct Scans ◽  
Anatomic Reduction ◽  
Ankle Trauma ◽  
Common Clinical Practice ◽  
Ct Scan Analysis ◽  
Uniform Reduction

Category: Ankle, Trauma Introduction/Purpose: Syndesmosis malreductions occur in up to 50% of patients. Several studies concluded that the position of the reduction tines of the periarticular clamp determines the final fibular position. The purpose of this study was to determine if an elastic wrap would provide a more uniform reduction force resulting in an anatomic syndesmosis reduction. We hypothesized that the force applied to the ankle by an elastic wrap would be relatively low and uniform circumferentially around the ankle medially and laterally. Furthermore we thought the ankle wrap would negate the dependency of clamp tine placement and circumferentialy reduce the syndesmosis perfectly. In this series Syndesmotic injuries were treated with the wrap for reduction, screw fixation and post-operative CT scan verification. Methods: Syndesmosis malreductions occur in up to 50% of patients. Several studies concluded that the position of the reduction tines of the periarticular clamp determines the final fibular position. The purpose of this study was to determine if an elastic wrap would provide a more uniform reduction force resulting in an anatomic syndesmosis reduction. We hypothesized that the force applied to the ankle by an elastic wrap would be relatively low and uniform circumferentially around the ankle medially and laterally. Furthermore we thought the ankle wrap would negate the dependency of clamp tine placement and circumferentialy reduce the syndesmosis perfectly. In this series Syndesmotic injuries were treated with the wrap for reduction, screw fixation and post-operative CT scan verification. Results: In a grossly unstable cadaver ankle model the ankle wrap achieved a perfect reduction every time it was trialed. The pressure film component of this study confirmed a uniform reduction force circumferentially at the ankle under the ankle wrap device of 5-9 pounds per square inch. Post-operative CT scans in 5 cases confirmed anatomic reduction of the syndesmosis in those cases treated surgically with the wrap and screw fixation. Conclusion: Malreduction of the syndesmosis can be avoided by using an elastic wrap instead of the standard peri-articular clamp in common clinical practice today.

scholarly journals Overtightening of the Syndesmosis Revisited and the Effect of Syndesmotic Malreduction on Ankle Dorsiflexion

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Mohammad Ghorbanhoseini ◽  
John Y. Kwon ◽  
Tyler Gonzalez ◽  
Brian Velasco ◽  
Aron Lechtig ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Statistical Significance ◽  
Ankle Dorsiflexion ◽  
P Value ◽  
Posterior Displacement ◽  
Syndesmotic Screw ◽  
Anatomic Reduction ◽  
Micro Sensor ◽  
Ankle Trauma ◽  
One Way Anova

Category: Ankle, Trauma Introduction/Purpose: Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: To assess the effect of syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of ankle dorsiflexion. To assess the effect of anterior & posterior syndesmotic malreduction after syndesmotic screw fixation on ankle dorsiflexion. Methods: Fifteen cadaveric leg specimens were utilized for the study. Ankle dorsiflexion was measured utilizing a precise micro- sensor system after application of a consistent load in the intact state, after compression fixation with a syndesmotic screw and after anterior & posterior malreduction of the syndesmosis. Results: Following screw compression of the nondisplaced syndesmosis, dorsiflexion ROM was 99.7±0.87% (mean ± standard error) of baseline ankle ROM. Anterior and posterior displacement of the syndesmosis resulted in dorsiflexion ROM that was 99.1±1.75% and 98.6±1.56% of baseline ankle ROM, respectively. One-way ANOVA was performed showing no statistical significance between groups (p-value =0.88). Two-way ANOVA comparing the groups with respect to both the reduction condition (intact, anatomic reduction, anterior displacement, posterior displacement) and the displacement order (anterior first, posterior first) did not demonstrate a statistically significant effect (p-value= 0.99). Conclusion: Maximal dorsiflexion of the ankle is not required prior to syndesmotic fixation. Anterior or posterior syndesmotic malreduction following syndesmotic screw fixation has no effect on ankle dorsiflexion thus poor patient outcomes after syndesmotic malreduction does not appear to be the result of loss of dorsiflexion due to mechanical block.

scholarly journals Improved Reduction of the Tibiofibular Syndesmosis with Tightrope Compared to Screw Fixation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0012 ◽  
Author(s):  
Michel Taylor ◽  
David Sanders ◽  
Christina Tieszer
Keyword(s):  
Sample Size ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Screw Fixation ◽  
Reduction Rate ◽  
Surgical Techniques ◽  
Secondary Outcome ◽  
Time Interval ◽  
Anatomic Reduction ◽  
Syndesmosis Injury

Category: Trauma Introduction/Purpose: Flexible fixation of the tibio-fibular syndesmosis is designed to allow increased ankle motion and to potentially improve clinical outcomes compared to screw fixation. Flexible fixation has also been suggested to improve the rate of anatomic reduction. This randomized, multi-center study was designed to compare the rate of malreduction following treatment of high fibular fractures associated with syndesmosis injury with open reduction and internal fixation with either two fully threaded screws or one knotless Tightrope device. Methods: 101 patients from eleven sites were randomized and underwent operative fixation of their AO/OTA 44-C injury between June 2015-16. All patients demonstrated radiographic syndesmosis diastasis or instability following malleolar bony fixation. Open syndesmosis reduction was performed in all cases. Fixation was randomized to either Tightrope (T) or screws (S). Surgical techniques and rehabilitation were standardized. Follow-up at 2 and 6 weeks, 3, 6 and 12 months. The primary outcome measure was the rate of malreduction based on bilateral ankle CT scan results at 3 months post fixation. Secondary outcome measures included adverse events, reoperation, and validated functional outcomes including the EQ5D, OM Score, FADI, and WPAI. The estimated sample size required to detect a difference in reduction rate was 72 patients, but the estimated sample size required to detect a difference in functional outcome scores was 240 patients, suggesting the study was adequately powered for radiographic results only. Results: The rate of malreduction was 39% using screws compared to 15% using Tightrope (p = 0.028). Analysis of CT results was performed using a 2 mm translation or 10 degree rotation threshold for malreduction, and included fibular translation, syndesmosis distance, medial compression; and rotation. Patients in Group T had greater anterior translation compared to the contralateral limb (p=0.007) or Group S (p = 0.04). Group T syndesmoses also had greater diastasis compared to control limb (p=.005) and less fibular medialization compared to Group S (p = 0.05). Functional outcome measures demonstrated significant improvements but no differences between groups. FADI scores at each time interval were equivalent. The reoperation rate was higher in the screw group compared to Tightrope (30% vs 4%, p= 0.02). Conclusion: Treatment of tibio-fibular syndesmosis injury with the knotless flexible Tightrope device achieves lower rates of malreduction and reoperation compared to screw fixation.

Anatomic Feasibility of C2 Pedicle Screw Fixation: the Effect of Variable Angle Interpolation of Axial CT Scans

2013 ◽  
Vol 13 (9) ◽  
pp. S48-S49
Author(s):  
Joseph R. O’Brien ◽  
Lauren M. Burke ◽  
Warren D. Yu ◽  
Anthony G. Ho ◽  
Timothy Wagner
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Ct Scans ◽  
C2 Pedicle Screw ◽  
Variable Angle ◽  
Axial Ct

scholarly journals Four-Dimensional CT Analysis of Normal Syndesmotic Motion

2021 ◽  
pp. 107110072110152
Author(s):  
Murray T. Wong ◽  
Charmaine Wiens ◽  
Jeremy Lamothe ◽  
W. Brent Edwards ◽  
Prism S. Schneider
Keyword(s):  
Functional Outcomes ◽  
Sagittal Plane ◽  
Syndesmotic Injury ◽  
Level Of Evidence ◽  
Level Ii ◽  
Anatomic Reduction ◽  
Tibiofibular Joint ◽  
Ct Analysis ◽  
Within Subjects

Background: The syndesmosis ligament complex stabilizes the distal tibiofibular joint while allowing for small amounts of physiologic motion. When injured, malreduction of the syndesmosis is the most important factor that contributes to inferior functional outcomes. Syndesmotic reduction is a dynamic measure, which is not adequately captured by conventional computed tomography (CT). Four-dimensional CT (4DCT) can image joints as they move through range of motion (ROM). The aim of this study was to employ 4DCT to determine in vivo syndesmotic motion with ankle ROM in uninjured ankles. Methods: Uninjured ankles were analyzed in patients who had contralateral syndesmotic injuries, as well as a cohort of healthy volunteers with bilateral uninjured ankles. Bilateral ankle 4DCT scans were performed as participants moved their ankles between maximal dorsiflexion and plantarflexion. Multiple measures of syndesmotic width, as well as sagittal translation and fibular rotation, were automatically extracted from 4DCT using a custom program to determine the change in syndesmotic position with ankle ROM. Results: Fifty-eight ankles were analyzed. Measures of syndesmotic width decreased by 0.7 to 1.1 mm as the ankle moved from dorsiflexion to plantarflexion ( P < .001 for each measure). The fibula externally rotated by 1.2 degrees with ankle ROM ( P < .001), but there was no significant motion in the sagittal plane ( P = .43). No participants with bilateral uninjured ankles had a side-to-side difference in syndesmotic width of 2 mm or greater. Conclusion: 4DCT allows accurate, in vivo syndesmotic measurements, which change with ankle ROM, confirming prior work that was limited to biomechanical studies. Side-to-side syndesmotic measurements are consistent within subjects, validating the method of templating syndesmotic reduction off the contralateral ankle, in a consistent ankle position, to achieve anatomic reduction of syndesmotic injury. Level of Evidence: Level II.

scholarly journals Open syndesmotic repair for open-book type syndesmotic injury

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Young Koo Lee ◽  
Jungwoo Yoo
Keyword(s):  
Treatment Options ◽  
Major Complication ◽  
Standard Technique ◽  
Syndesmotic Injury ◽  
Open Book ◽  
Second Look ◽  
Syndesmosis Injury ◽  
Tibiofibular Joint ◽  
American Orthopaedic

Category: Trauma Introduction/Purpose: Although there are several approaches to the treatment of syndesmosis injury, there is no gold standard technique. Syndesmotic screw fixation is one of commonly used treatment options but there remains debate topics such as implant breakage and the need for device removal. The purpose of this study was to evaluate the clinical, radiologic and arthroscopic outcomes of open syndesmotic repair for open-book type syndesmotic injury as a new treatment option. Methods: We reviewed the clinical, radiographic and arthroscopic results of 20 patients with traumatic injuries to the distal tibiofibular syndesmosis who were treated with open syndesmotic repair. Arthroscopic evaluations including cotton test were performed at the primary and second-look operation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score and visual analog scale (VAS) score were used to evaluate clinical outcomes. The measurement of the tibiofibular clear space and tibiofibular overlap were used to evaluate radiologic outcomes. Both Clinical and radiologic outcome evaluations were performed preoperatively, at 6 weeks and 6 months postoperatively, and at a final follow-up at a minimum 12 months postoperatively. The average follow-up period was 15.3 months. Results: The average AOFAS score improved from 45.4 (range 30-68) preoperatively to 94.12 (range 83-100) at the last follow-up (P < .001). The radiologic parameters of the syndesmosis returned to normal range since the first postoperative follow-up. At second-look arthroscopy, all the patients showed negative cotton test results and the gap of distal tibiofibular joint was remained less than 2 mm in all patients. Conclusion: We had excellent clinical, radiologic and arthroscopic results and there is no major complication. Open syndesmotic repair for open-book type syndesmotic injury is effective in healing and maintaining the injured joint. Therefore this procedure could be a reasonable alternative treatment for traumatic syndesmosis injury of the ankle.

Changes In Prothrombin And Activated Partial Thromboplastin Time During Replacement Therapy With Human Recombinant Growth Hormone In Growth Hormone Deficient Adults

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S102-S103
Author(s):  
Y S Kamel
Keyword(s):  
Growth Hormone ◽  
Replacement Therapy ◽  
Healthy Subjects ◽  
Recombinant Growth Hormone ◽  
Gh Replacement ◽  
Coagulation Tests ◽  
Before And After ◽  
Human Recombinant Growth Hormone ◽  
Male Patients ◽  
One Year

Abstract Introduction/Objective The aim of this study was to investigate the effects of GH administration on basic coagulation parameters: PT, aPTT and fibrinogen concentrations in adult GHD patients before and during one year of GH replacement. Methods Twenty-one adult patients with severe GHD (mean age +/- SE: 38.6 +/- 2.8 years) were included in this hospital based, prospective, interventional study. All patients were treated with rhGH for 12 months (GH dose: 0.4 mg/day for male and 0.6 mg/day for female patients). IGF-1 concentrations were determined using RIA-INEP kits. Basic coagulation tests, i.e. aPTT and fibrinogen concentrations, were measured before and after 3, 6 and 12 months of treatment with rhGH. Control values were obtained from fourteen “healthy” subjects matched by age, sex and body mass index (BMI). Results At baseline, we observed no significant differences in PT, aPTT and fibrinogen values between GHD and healthy subjects. IGF-1 concentrations increased significantly within 3 months of GH therapy (8.2 +/- 1.5 vs. 24.2 +/- 2.9 nmol/l, p &lt;0.05) and remained stable thereafter. A significant increase in PT values, which was more pronounced in female subjects, was noted after 6 and 12 months of treatment with GH. aPTT values increased significantly after 12 months of treatment only in male patients (28.8 +/- 4.6 vs. 39.7 +/- 2.1 s.; p &lt;0.05). No significant changes in fibrinogen concentrations were found during the study. Conclusion Twelve months of GH replacement therapy led to a significant increase in PT and aPTT values in adult GHD patients, while fibrinogen concentrations did not change. Changes in PT were more pronounced in female GHD patients, while an increase in aPTT values was observed only in male patients with GHD. The clinical significance of these changes needs further evaluation.

Spouse Caregivers' Perceptions of Influence of Dementia on Marriage

2002 ◽  
Vol 14 (1) ◽  
pp. 47-58 ◽  
Author(s):  
Ulla Eloniemi-Sulkava ◽  
Irma-Leena Notkola ◽  
Kaija Hämäläinen ◽  
Terhi Rahkonen ◽  
Petteri Viramo ◽  
...  
Keyword(s):  
Behavioral Change ◽  
Intervention Study ◽  
Negative Impact ◽  
Behavioral Changes ◽  
Telephone Interviews ◽  
Before And After ◽  
Spouse Caregivers ◽  
Dementing Illness ◽  
Male Patients ◽  
Patients Experience

Objectives: To investigate what kind of changes spouse caregivers of demented patients experience after the onset of dementia (a) in the general atmosphere, happiness, and relations of marriage and (b) in the sexual side of marriage. Design: Semistructured telephone interviews of spouse caregivers of demented patients. Setting: Community-living demented patients and their spouse caregivers in eastern Finland. Participants: The spouse caregivers of 42 demented patients recruited from a previous intervention study. Measures: The questionnaire covered different areas of marriage from the time before and after the onset of dementia. Results: A statistically significant decline had occured in extent of happiness (p = .012), in equal relations (p = .001), and in patients' expressions of sexual needs (p < .001) when compared the time before and after dementia. Twenty-five (60%) of the caregivers reported that the demented patient had shown at least one negative sexual behavioral change during the course of dementia. Seven male patients (24%) had shown the behavioral symptom of constantly expressing need for making love. One in 10 caregivers had experienced positive sexual behavioral changes. In one third of the patients, the expressions of tenderness towards the caregiver had increased. Dementia did not affect significantly the general atmosphere of the marriage. Out of those still in home care, at 3 years from the onset of dementia, 19 couples (46%) continued to practice intercourse, at 5 years the number was 15 couples (41%), and at 7 years it had declined to 7 couples (28%). Conclusions: Dementing illness has a major negative impact on many dimensions of marriage. However, there are also positive changes and preserved aspects of marriage. Dementia seems to have a surprisingly little impact on whether the couple continues to have intercourse when compared with the general aging population.

Changes in sexual activity of male patients with ankylosing spondylitis undergoing total hip arthroplasty

2018 ◽  
Vol 29 (3) ◽  
pp. 310-315 ◽  
Author(s):  
Jun Fu ◽  
Xiang Li ◽  
Kan Liu ◽  
Jiying Chen ◽  
Ming Ni ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Total Hip Arthroplasty ◽  
Sexual Activity ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Clinical Parameters ◽  
Total Hip ◽  
Flexion Extension ◽  
Before And After ◽  
Male Patients

Introduction: Sexual activity is often an important component of life. To date, no studies have examined sexual activity before and after total hip arthroplasty (THA) in male patients with ankylosing spondylitis (AS). The purpose of the current study was to evaluate the effect of THA on sexual activity and to explore the most commonly reported and comfortable coital position for male AS patients with hip involvement. Methods: Data from 31 male AS patients who underwent THA for hip involvement were retrospectively reviewed. Information from the International Index of Erectile Function (IIEF), the Harris Hip Score (HHS) and other clinical parameters was collected and monitored over time. We compared the above-mentioned parameters before surgery and 2 years after surgery and analysed the correlation between changes on the IIEF and changes in clinical parameters. Results: The domain and total scores of the IIEF, except EF, were significantly higher after surgery than were those before surgery ( p < 0.05). There was a significant positive correlation between changes on the IIEF and improvement in flexion-extension range of motion (ROM), adduction-abduction ROM and HHS ( p < 0.05). Most patients (26/31, 83.9%) resumed sexual activity 5–12 weeks after surgery. The pre- and postoperative distributions of the most commonly reported and comfortable position were not significantly different (p > 0.05). Conclusions: Successful THA may improve sexual activity in male AS patients with hip involvement. Changes in hip ROM show the most significant correlation with improvement in sexual activity. Resumption of sexual activity occurs within 5–12 postoperative weeks.

Sign in / Sign up

Export Citation Format

Share Document