scholarly journals Peri-talar Osteotomy as Part of Treatment of Talar Osteochondral Defect of Varus Ankle

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Bibo Wang
Keyword(s):  
Osteochondral Defect ◽  
Corrective Osteotomy ◽  
Varus Deformity ◽  
Lateral View ◽  
Hindfoot Alignment ◽  
Routine Treatment ◽  
Vas Score ◽  
Radiographic Parameters ◽  
Sf36 Score ◽  
Double Osteotomy

Category: Ankle Introduction/Purpose: The etiology of osteochondral defect (OCD) of talus is not fully understood. Besides trauma, malalignment of ankle or hindfoot may play a role in the development of OCD. The aim of this study is to assess the efficacy of peri-talar osteotomy in addition to routine treatment of OCD of talus. Methods: This is a retrospective study of 52 cases of varus talar OCD during the period of 2009.9 to 2014.12. Micro-fracture or autograft transplantation were applied for the OCD first according to the dimension of the lesion in all cases. Then peri-talar osteotomy were performed to correct ankle or hindfoot mal-alignment in 26 cases according to the position of varus deformity, including 18 supramalleolar osteotomy, 6 calcaneal osteotomy and 2 combined distal tibial and calcaneal double osteotomy. Pre- and post-operative radiographic parameters of TAS, TTS, TLS angles and MoA were measured on mortise view, lateral view and hindfoot alignment view respectively. AOFAS-AH score, VAS score and SF36 score were performed to assess both subjective and objective outcome. Results: For the osteotomy group, there were statistically changes (P < 0.05) radiographically (TAS, TTS, MoA, TLS) after surgery. While the radiographic parameters didn’t change in the group without corrective osteotomy. AOFAS-AH score and VAS score increased significantly (P < 0.05) in both the osteotomy group and the non-osteotomy group. The SF36 scores score increased significantly (P < 0.05) in the osteotomy group while not significant in the non-osteotomy group. The AOFAS-AH and SF36 scores were statistically higher in the osteotomy group after surgery (p<0.05), and the VAS score were not statistically different in two groups. There were 5 out of 26 revised cases in the non-osteotomy group while 2 out of 26 revised cases in the osteotomy group. Conclusion: Peri-talar osteotomy in addition to routine treatment of OCD of talus results in better radiographic and functional outcome and lower recurrence for patients of varus talar osteochondral defect. Mechanical malalignment may contribute to progression of OCD of talus and thus should be corrected simultaneously.

scholarly journals Changes of hindfoot alignment after high or low tibial osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
Jun Young Choi ◽  
Jin Soo Suh ◽  
Dong Joo Lee
Keyword(s):  
Ankle Joint ◽  
Normal Values ◽  
Varus Deformity ◽  
Tibial Osteotomy ◽  
Moment Arm ◽  
Varus Alignment ◽  
Hindfoot Alignment ◽  
Radiographic Findings ◽  
Radiographic Parameters ◽  
Significant Change

Category: Hindfoot Introduction/Purpose: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively (P=0.03 and 0.001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change (P=0.001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased (P=0.001 for each), which represented a hindfoot alignment change to the valgus position. Conclusion: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO.

Changes in Hindfoot Alignment After High or Low Tibial Osteotomy

2018 ◽  
Vol 39 (9) ◽  
pp. 1097-1105 ◽  
Author(s):  
Jun Young Choi ◽  
Si Jung Song ◽  
Sung Jung Kim ◽  
Sang Hee Kim ◽  
Ji Soo Park ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Normal Values ◽  
Varus Deformity ◽  
Tibial Osteotomy ◽  
Moment Arm ◽  
Varus Alignment ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Radiographic Findings ◽  
Radiographic Parameters

Background: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively ( P = .03 and .001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change ( P = .001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased ( P = .001 for each), which represented a hindfoot alignment change to the valgus position. Conclusions: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO. Level of Evidence: Level III, comparative series.

Residual numbness of the upper extremity after cervical surgery in patients with cervical spondylotic myelopathy

2020 ◽  
Vol 33 (6) ◽  
pp. 734-741
Author(s):  
Masayoshi Iwamae ◽  
Akinobu Suzuki ◽  
Koji Tamai ◽  
Hidetomi Terai ◽  
Masatoshi Hoshino ◽  
...  
Keyword(s):  
Neck Pain ◽  
Upper Extremity ◽  
Cervical Spondylotic Myelopathy ◽  
Multivariate Linear Regression Analysis ◽  
Vas Score ◽  
Radiographic Parameters ◽  
Clinical Scores ◽  
Sf 36 ◽  
Cervical Surgery ◽  
Preoperative Factors

OBJECTIVEAlthough numbness is one of the chief complaints of patients with cervical spondylotic myelopathy (CSM), preoperative factors relating to residual numbness of the upper extremity (UE) and impact of the outcomes on cervical surgery are not well established. The authors hypothesized that severe preoperative UE numbness could be a risk factor for residual UE numbness after surgery and that the residual UE numbness could have a negative impact on postoperative outcomes. Therefore, this study aimed to identify the preoperative factors that are predictive of residual UE numbness after cervical surgery and demonstrate the effects of residual UE numbness on clinical scores and radiographic parameters.METHODSThe study design was a retrospective cohort study. The authors analyzed data of 103 patients who underwent cervical laminoplasty from January 2012 to December 2014 and were followed up for more than 2 years postoperatively. The patients were divided into two groups: the severe residual-numbness group (postoperative visual analog scale [VAS] score for UE numbness > 40 mm) and the no/mild residual-numbness group (VAS score ≤ 40 mm). The outcome measures were VAS score, Japanese Orthopaedic Association scores for cervical myelopathy, physical and mental component summaries of the 36-Item Short-Form Health Survey (SF-36), radiographic film parameters (C2–7 sagittal vertical axis, range of motion, C2–7 lordotic angle, and C7 slope), and MRI findings (severity of cervical canal stenosis, snake-eye appearance, severity of foraminal stenosis). Following univariate analysis, which compared the preoperative factors between groups, the variables with p values < 0.1 were included in the multivariate linear regression analysis. Additionally, the changes in clinical scores and radiographic parameters after 2 years of surgery were compared using a mixed-effects model.RESULTSAmong 103 patients, 42 (40.8%) had residual UE numbness. In the multivariate analysis, sex and preoperative UE pain were found to be independent variables correlating with residual UE numbness (p = 0.017 and 0.046, respectively). The severity of preoperative UE numbness did not relate to the residual UE numbness (p = 0.153). The improvement in neck pain VAS score and physical component summary of the SF-36 was significantly low in the severe residual-numbness group (p < 0.001 and 0.040, respectively).CONCLUSIONSForty-one percent of the CSM patients experienced residual UE numbness for at least 2 years after cervical posterior decompression surgery. Female sex and preoperative severe UE pain were the predictive factors for residual UE numbness. The patients with residual UE numbness showed less improvement of neck pain and lower physical status compared to the patients without numbness.

Analysis of Graft Length Change Patterns in Medial Patellofemoral Ligament Reconstruction via a Fluoroscopic Guidance Method

2018 ◽  
Vol 46 (5) ◽  
pp. 1150-1157 ◽  
Author(s):  
Takehiko Matsushita ◽  
Daisuke Araki ◽  
Yuichi Hoshino ◽  
Shinya Oka ◽  
Kyohei Nishida ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Femoral Tunnel ◽  
Length Change ◽  
Lateral View ◽  
Mpfl Reconstruction ◽  
Original Position ◽  
Fluoroscopic Guidance ◽  
Change Pattern ◽  
Radiographic Parameters ◽  
Graft Length

Background: A fluoroscopic guidance method for medial patellofemoral ligament (MPFL) reconstruction has been widely used to determine the anatomic femoral attachment site. Purpose: To examine the graft length change patterns in MPFL reconstruction with a fluoroscopic guidance method. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Forty-four knees of 42 patients who underwent MPFL reconstruction for the treatment of recurrent patellar dislocation were examined prospectively. During surgery, suture anchors were inserted into the proximal one-third and center of the patella. A guide pin for the femoral tunnel was inserted into the position reported by Schöttle et al based on the true lateral view of the knee under fluoroscopic control. Changes in graft length patterns of the proximal and center anchors were examined through 0° to 120° of knee flexion. Favorable changes in length patterns were defined as meeting 2 of 3 criteria: (1) not long during flexion (≤3 mm between 30° and 120° of flexion) and either (2) nearly isometric during flexion between 0° and 90° or (3) slightly long during maximum extension (≤3 mm). Other patterns were considered unfavorable. If the change in length pattern was unfavorable, then the pin for the femoral tunnel was moved to different positions until it was favorable. Knees were separated into the favorable group and the unfavorable group. Differences between the groups regarding radiographic parameters were assessed. Student t test or chi-square test was used for statistical analysis. Results: Of the 44 knees, 31 (70.5%) showed favorable patterns. However, 13 knees (29.5%) showed unfavorable patterns; therefore, the position of the pin was changed. The mean ± SD distance from the original position to the final position was 5.3 ± 1.1 mm distal for 7 patients and 5.2 ± 0.4 mm posterodistal for 6 patients. Technical errors, including a nontrue lateral view and the tip of the wire not being in the determined area, were found for 4 of 13 knees in the unfavorable group. There was no statistical difference in radiographic parameters between the groups. Conclusion: The graft length change pattern could be nonphysiologic at the position determined through the fluoroscopic guidance method; thus, caution may be necessary. The change in length pattern should be checked before graft fixation. If the length change pattern is unfavorable, then it is advisable to move it approximately 5 to 7 mm distally or posterodistally from the first position.

scholarly journals Pain during Cast Wedging of Forearm Shaft and Distal Forearm Fractures in Children Aged 3 to 12 Years—A Prospective, Observational Study

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 229
Author(s):  
Florian Freislederer ◽  
Tobias Berberich ◽  
Thomas O. Erb ◽  
Johannes Mayr
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Forearm Fracture ◽  
Lateral View ◽  
Oxygen Mixture ◽  
Forearm Fractures ◽  
Vas Score ◽  
Fractures In Children ◽  
Before And After ◽  
Multicenter Prospective Observational Study

Background: Although fracture displacement in children is easily treated by cast wedging, no data on pain associated with the procedure are available. We hypothesized that there is no clinically relevant difference in pain before and after cast wedging in children between 3 and 12 years of age. Patients and Methods: This international, multicenter, prospective, observational study included 68 children (39 male, 29 female) aged 3 to 12 years (median age 8 years) with forearm fractures. Cast wedging was performed 5 to 10 days after the injury. Before starting the procedure, we administered a single oral dose of sodium metamizole (10 mg/kg body weight), and the children inhaled a nitrous oxide/oxygen mixture (50%/50%) during the wedging procedure. Pain was rated on a visual analog scale (VAS) 5 to 10 min before incision of the cast as well as 3 to 5 min and 30 min (maximum remembered pain) after inhalation stop. The degree of bending was judged either by the surgeon or was determined on the basis of first signs of pain expressed by the patient. We assessed the effectiveness of the procedure by obtaining X-ray images in two planes after 3 to 9 days. Results: Among the 68 patients, median VAS score before cast wedging was 0. This increased to a score of 1 (p = 0.015) at 3 to 5 min after the procedure. Median VAS score for the maximum remembered pain measured after 30 min was 0. Median differences in angulation between proximal and distal bone fragments before and after the intervention were 0° (p < 0.0001) in the a.p. view and 8.4° (p < 0.0001) in the lateral view. Conclusion: Cast wedging improved the position of forearm fracture fragments at the expense of minimal short-term pain.

scholarly journals The “Diagonal” Lesion: A New Type of Combined Injury Pattern Involving the Impingement Fracture of Anteromedial Tibial Plateau and the Injury of Posterior Cruciate Ligament and Posterolateral Corner

2019 ◽  
Vol 33 (06) ◽  
pp. 616-622
Author(s):  
Xu Li ◽  
Guanyang Song ◽  
Yue Li ◽  
Xin Liu ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Varus Deformity ◽  
Lateral View ◽  
Posterolateral Corner ◽  
Fracture Group ◽  
Fracture Size ◽  
New Type ◽  
Type C ◽  
Grade 3

AbstractThe purpose of this study was to investigate the incidence and clinical characteristics of the “diagonal” lesion. A total of 273 consecutive patients with combined posterolateral corner (PLC) and posterior cruciate ligament (PCL) injuries were retrospectively analyzed. All preoperative knee joint evaluations were reviewed including the computed tomography, the anteroposterior (AP) view, the lateral view, the full-length long-standing AP view, and the physical examination results with the patient under anesthesia. Twenty-six patients (9.5%) were verified as having the “diagonal” lesions. The anteromedial impingement fractures could be categorized into small (small fracture group, n = 7) and large (large fracture group, n = 19). The PCL injuries were classified into grade 2 (n = 22) and grade 3 (n = 4). The PLC injuries could be classified into type A (n = 3), type B (n = 8), and type C (n = 15) according to the Fanelli's classification system. Notably, there were 20 chronic cases. Among them, 14 (70%) had varus deformities. The proportion of patients with varus deformity in the large fracture group was significantly higher than that of the small fracture group (p = 0.026). In this study, the incidence of the “diagonal” lesions was 9.5%. Patients who had larger fracture size tended to develop subsequent varus deformity of the lower extremity. It was important for us to recognize the PCL/PLC injuries and to fully reduce the large bony fracture during the initial treatment of the “diagonal” lesions to prevent the residual instability and varus deformity.

A radiographic analysis of degenerative spondylolisthesis at the L4–5 level

2012 ◽  
Vol 16 (2) ◽  
pp. 130-134 ◽  
Author(s):  
D. Greg Anderson ◽  
Worawat Limthongkul ◽  
Amirali Sayadipour ◽  
Christopher K. Kepler ◽  
James S. Harrop ◽  
...  
Keyword(s):  
Degenerative Spondylolisthesis ◽  
Lateral View ◽  
Disc Height ◽  
Data Set ◽  
Osteophyte Formation ◽  
Radiographic Parameters ◽  
Wide Range ◽  
Flexion Extension ◽  
The Mean ◽  
Flexion And Extension

Object Lumbar degenerative spondylolisthesis (LDS) is common and has generally been characterized as a homogeneous disease entity in the literature and in clinical practice. Because disease variability has not been carefully characterized, stratification of treatment recommendations based on scientific evidence is currently lacking. In this study, the authors analyzed radiographic parameters of patients with LDS at the L4–5 level to better characterize this entity. Methods Demographic data were collected from 304 patients (200 women and 104 men) with LDS at the L4–5 level. Plain radiographs including anteroposterior, lateral, and flexion-extension lateral radiographs were analyzed for disc height, segmental angulation, segmental translation, and osteophyte formation. Correlations were sought between the variables of age, sex, disc height, segmental angulation, segmental translation, and osteophyte formation. Results The mean patient age was 63.8 years (range 40–86 years). The mean mid-disc height was 7 mm (range 0–14 mm) on the neutral lateral view. The mean angulation between the superior endplate of L-5 and the inferior endplate of L-4 was 6° of lordosis (range 13° of kyphosis to 23° lordosis) on the neutral lateral view. The mean angular change between flexion and extension lateral radiographs was 5° (range 0°–17°). The mean translation on the neutral lateral view was 6 mm (range 0–15 mm). The mean change in translational between flexion and extension was 2 mm (range 0–11 mm). Twenty patients (7%) exhibited spondylolisthesis only on the flexion view. A significant positive correlation was found between the change in angulation and the change in translation on flexion and extension views (ρ = 0.18, p = 0.001). No significant correlation was found between anterior osteophyte size and mobility with flexion-extension radiographs. Conclusions The wide range in all radiographic parameters for LDS confirms the heterogeneous nature of this condition and suggests that a grading system to subclassify LDS may be clinically useful. On flexion and extension radiographs, increased translational motion correlated with increased angular motion. Anterior osteophyte size was not found to be predictive of segmental stability. This data set should prove beneficial to those seeking to subcategorize LDS in the future.

scholarly journals Evaluation of surgical outcomes of arthroscopic subtalar arthrodesis performed through two lateral portals

2018 ◽  
Vol 12 (4) ◽  
Author(s):  
Rafael Freitas Villela ◽  
João Murilo Brandão Magalhães ◽  
Rogério de Andrade Gomes ◽  
Anderson Humberto Gomes ◽  
Bernardo Cardoso Pinto Coelho ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Case Series ◽  
Varus Deformity ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Bone Consolidation ◽  
Subtalar Arthrodesis ◽  
Postoperative Score ◽  
Sinus Tarsi ◽  
The Mean

Objective: The purpose of this study is to present the surgical outcomes of twelve patients undergoing arthroscopic subtalar arthrodesis using two lateral portals (anterior and medial) in the sinus tarsi. Methods: A retrospective study was conducted with twelve patients (7 men and 5 women) with a mean age of 55.1 (36-74) years who underwent arthroscopic subtalar arthrodesis through the sinus tarsi between May 2015 and December 2016. The post-surgical follow-up was 12 months. Consolidation time and postoperative complications were evaluated, and a validated functional questionnaire from the American OrthopedicFoot and Ankle Society (AOFAS) and the visual analog scale (VAS) for pain were applied both before and after surgery. Results: The mean bone fusion time was 11.5 weeks. Bone consolidation was observed in all analyzed patients. Four patients developed late complications, three of which were related to screw positioning in the calcaneus, while one was related to residual hindfoot varus deformity. Screw-related complications are common with all subtalar arthrodesis techniques, and such complications are considered less relevant when evaluating the effectiveness of the presented technique. The mean preoperative AOFAS score was 42.3 (27-66) points, while the mean postoperative score was 83 (73-94) points. The mean preoperative VAS score for pain was 8.1 (5-10) points, and the mean postoperative score was 2.1 (0-5) points. The above data are similar to those reported in other published studies and reflect high bone consolidation rates. Conclusion: Arthroscopic subtalar arthrodesis through two lateral portals in the sinus tarsi is a safe and effective technique for the treatment of primary and secondary disorders of the subtalar joint. Correct positioning of screws and hindfoot alignment must be carefully ensured to avoid complications related to the synthesis material and hindfoot varus deformity. Level of Evidence IV; Therapeutic Studies; Case Series.

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