scholarly journals Evans Osteotomy with Locked Plate with Wedge Block for Stage IIB Flat Foot

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Maria Gala Santini Araujo ◽  
Nelly Carrasco ◽  
Pablo Sotelano ◽  
Ana Cecilia Parise ◽  
Leonardo Conti ◽  
...  
Keyword(s):  
Late Complication ◽  
Wound Dehiscence ◽  
Primary Objective ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Flat Foot ◽  
Lateral Column ◽  
Significant Difference ◽  
One Year ◽  
Clinical Records

Category: Hindfoot Introduction/Purpose: Elongation of the lateral column is indicated only in patients who have a flexible deformity Stage 2B of flat foot. The Evans osteotomy is performed 1.5 or 2 cm from the cuboideal calcaneal joint, and in many publications is maintained by different kind of devices. Our hypothesis is that Evans osteotomy, with blocked plates with a wedge block, without the use of bone graft, maintain the correction obtained at one year after surgery. The primary objective was to evaluate the radiological results at the postoperative year of the osteotomy Secondary objectives were to evaluate the persistence of the correction obtained between the 3 months and the year of the postoperative period and to evaluate the functional outcomes with AOFAS score. Methods: We studied a total of 12 patients, 14 feet. with stage 2 B flat foot, in all cases surgery was performed by the same specialist between March of 2011 and March of 2014 in the Service of foot and ankle of our institution. Inclusion criteria were: patients with type 2B flat foot, submitted to external column elongation, with plates blocked with a 6 to 10 mm wedge block, without the use of bone grafting, minimum follow-up of 1 year. Exclusion criteria: revision of previous surgery, another type of material used for elongation of the external column, neurological sequelae. The study was performed retrospectively through clinical records database, data collection and measurements were performed by 2 second-year Foot and ankle fellow trained in the same institution. Statistical analysis was performed with the T-student test. Results: A total of 12 patients / 14 feet were evaluated during the study period, with a diagnosis of flatfoot type 2B. The average age was 57 years (32-65 years), 11 (78.5%) were female. No statistically significant difference was observed in any of the radiographic variables measured, at 3 months and at 12 months postoperatively. The preoperative AOFAS score, was 54 points. At the first year was 93 points. Consolidation was achieved at 3 months in all cases. The complications found were 2 superficial infections and 1 wound dehiscence. As a late complication, there was only 1 case of cuboidal calcaneal osteoarthritis that did not require surgical resolution. Conclusion: Evans osteotomy for elongation of the external column provides a reproducible and reliable method to restore the normal functional stability of the midfoot and hindfoot. According to the results obtained in our work, we can conclude that the blocked plates with a wedge lock manage to preserve the corrections obtained with the Evans osteotomy in patients with type IIB flat foot. There is no need of autograft with the consequent risk of comorbidities produced by a second approach to the grafting as well as the complications that could happen with the use of allografts.

scholarly journals Management of mal-united Pilon fractures with joint-sparing osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Guang-rong Yu
Keyword(s):  
Type Ii ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Vas Score ◽  
Articular Surfaces ◽  
Significant Difference ◽  
The Mean ◽  
American Orthopaedic ◽  
Time From Injury ◽  
Pilon Fractures

Category: Ankle Introduction/Purpose: To explore the effectiveness and operative methods to treat various mal-united Pilon fractures with joint-sparing osteotomy. Methods: Between January 2011 and October 2016, 21 patients with mal-united Pilon fractures were treated with joint-sparing osteotomy. There were 13 males and 8 females with an average age of 38.4 years (range, 22-48 years). 14 were left feet and 7, right. The time from injury to reconstructive operation was 4 months to 10 years. 17 received operative treatment previously, and 4 were treated by plaster fixation. According to Rüedi-Allgöwer classification, 16 were rated as type II (including 6 medial Pilon fractures, 5 anterior, 5 posterior) and 5, type III. All patients received standardized postoperative managements. Results: All patients were followed up for more than 1 year. All the fractures were reunited in an average time of 13.8 weeks (range 9 to 18 weeks). The mean visual analogue scale (VAS) score was 2.42 (range 0 to 5) and the mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 78.81(range 65 to 92) 6 months after operation. The VAS score was 5.27 (range 2 to 7) and the AOFAS score was 57.26 (range 20 to 81) before. Comparing to preoperative data, statistically significant difference was found postoperatively (P<0.05). Conclusion: Results by joint-sparing osteotomy to realign and reconstruct articular surfaces of ankles are acceptable. Functions and symptoms are improved significantly after operation. Joint-sparing osteotomy can be a considerable option for treating mal-united Pilon fractures.

scholarly journals TL 18168 - Effect of obesity on the functional outcome of flexor hallucis longus tendon transfer surgery in patients with Achilles tendinopathy

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 99S
Author(s):  
Henrique Mansur ◽  
Thomás Almeida de Sousa Nogueira ◽  
Juan Benitez ◽  
Isnar Moreira de Castro Júnior
Keyword(s):  
Functional Outcomes ◽  
Tendon Transfer ◽  
Plantar Flexion ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Longus Tendon ◽  
Significant Difference ◽  
Nonobese Patients

Introduction: Several factors, including diabetes and smoking, increase the risk of and predisposition for complications of foot and ankle surgeries; however, studies assessing the effects of obesity remain scarce. The objective of this study is to assess the effects of obesity on functional outcomes of flexor hallucis longus (FLH) tendon transfer surgery in patients with chronic Achilles tendinopathy. Methods: A retrospective study was performed with patients aged 18 years or older who underwent FHL tendon transfer between March 2010 and May 2015. The characteristics recorded were sex, age, body mass index (BMI), American Orthopedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS) and ankle plantar flexion and dorsiflexion strength, assessed using an isokinetic dynamometer. Results: The sample had 24 participants (13 women and 11 men) with a mean age of 55.7 years; among them, 13 were obese (BMI>=30), and 11 were nonobese (BMI<30). After a mean follow-up time of 66 months, the FAOS of the sample increased from 28 to 91 points (p=0.000). No significant difference in the postoperative AOFAS score or FAOS was found between the subgroups (p>0.05), with values of 83 and 86.7 points (AOFAS) and 92.72 and 90 points (FAOS) for obese and nonobese patients, respectively. The comparison of the strength of each motion revealed no significant difference (p>0.05) between subgroups. There was no association between BMI and postoperative functional outcomes (AOFAS score and FAOS) (p>0.05) or correlation between BMI and the strength of the operated ankles. Conclusion: Our findings indicate that flexor hallucis longus tendon transfer surgery in Achilles tendinopathy is effective for obese and nonobese patients based on the AOFAS and FAOS scores and dynamometry results.

scholarly journals A retrospective comparison between transrectal and transperineal prostate biopsy in the detection of prostate cancer

2017 ◽  
Vol 89 (1) ◽  
pp. 55 ◽  
Author(s):  
Carmelo Agostino Di Franco ◽  
Hussein Jallous ◽  
Daniele Porru ◽  
Giovanni Luca Giliberto ◽  
Tiziano Cebrelli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Complication Rate ◽  
Late Complication ◽  
Fisher Exact Test ◽  
Cancer Rate ◽  
Transperineal Prostate Biopsy ◽  
Significant Difference ◽  
Prostate Diseases ◽  
Clinical Records

Background: The aim of this study was to analyze the differences between TRUSguided transrectal prostate biopsy (TR) and transperineal prostate biopsy (TP) in the diagnosis of prostate cancer. The two biopsy methods were evaluated in terms of diagnostic sensitivity and of early and late complications. Methods: This retrospective study was realized through the review of clinical records of 219 men that received a prostate biopsy between 2004 and 2014. The biopsy was performed because of elevated prostate-specific antigen (PSA), abnormal digital rectal examination findings (DRE), abnormal transrectal ultrasound (TRUS) findings and symptoms due to prostate diseases. The cohort study was subdivided in two groups: 108 patients received a transrectal biopsy between 2004 and 2006 and 111 received a transperineal biopsy between 2007 and 2014. In both groups, first biopsy was performed with 12 cores scheme whereas second or third biopsy were performed with 18 cores scheme; in this study we excluded patients who underwent to biopsies with different number cores to reduce the bias. Both groups were evaluated on the basis of age, total PSA, PSA ratio (F/T), DRE/TRUS findings, presence/absence of low urinary tracts symptoms (LUTS), presence/absence of benign prostatic hyperplasia (BPH), histologic findings of biopsy cores and immediate/postoperative complications. Then, it was evaluated the overall cancer detection rate and the stratified cancer rate on the basis of the previous reported parameters. Finally, we analyzed the early and late complication rate in both groups. U Mann-Whitney test was used to evaluate the quantitative variables and χ<sup>2</sup>-test or Fisher exact test for qualitative variables. p &lt; 0.05 was considered statistically significant. Results: 66 cancers were detected in 219 patients of the study; 29 cancers were detected in the TP group and 37 in the TR group. There were no statistically significant differences in the overall cancer rate detected in both groups (26.13% e 34.26% respectively; p = 0.190). However, TP biopsy detected more cancers at first biopsy than TR biopsy (89.7% vs 78.4% respectively; p = 0.021). Moreover, TP biopsy detected more cancers in those patients with low cancer suspect (PSA &lt; 4 ng/ml, F/T &gt; 15%, negative TRUS), instead TR biopsy had more sensitivity in detecting cancer in those patients with high cancer suspect (PSA &gt; 10 ng/ml, F/T &lt; 15%, TRUS with abnormal lesions). The presence of BPH did not influence sensitivity in both cases. There were no significant differences in the early complication rate whereas a statistically significant difference was observed in the late complication rate (4% vs 11% in TP and TR biopsy, respectively; p = 0.019). Conclusions: No statistically significant differences in sensitivity were observed between TP and TR biopsy, but TP biopsy detected more cancers at first time biopsy. Complications rate was lower in the TP group. Therefore, we conclude that the Urologist has the final choice in deciding the most appropriate biopsy technique, considering sensitivity and complications.

scholarly journals Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chien-Cheng Lai ◽  
Ting-Ming Wang ◽  
Chih-Hung Chang ◽  
Jwo-Luen Pao ◽  
Hsu-Wei Fang ◽  
...  
Keyword(s):  
Valgus Deformity ◽  
Osteotomy Site ◽  
Foot And Ankle ◽  
Lateral Column ◽  
Significant Difference ◽  
Significant Correction ◽  
The Mean ◽  
American Orthopaedic ◽  
Ankle Valgus ◽  
Calcaneal Lengthening

Abstract Background Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Methods We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. Results The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). Conclusions Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.

scholarly journals Comparative study between two days versus seven days urethral stenting of distal hypospadias after tubularized incised plate urethroplasty

2021 ◽  
Vol 8 (4) ◽  
pp. 1085
Author(s):  
Tamer Fakhry ◽  
Ahmed Mohammad Amer ◽  
Ahmed Nabil Fawzy
Keyword(s):  
Postoperative Complications ◽  
Wound Dehiscence ◽  
Urethrocutaneous Fistula ◽  
Cosmetic Results ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Operative Complications ◽  
Tubularized Incised Plate Urethroplasty ◽  
Distal Hypospadias ◽  
One Year

Background: The duration of urethral stenting after tubularized incised plate (TIP) urethroplasty for hypospadias varies among surgeons.Methods: Forty male cases with distal hypospadias aging from one year till the age of six years randomly allocated into two groups for undergoing tubularized incised plate urethroplasty with removal of the urethral stent after two days in one group and after seven days in the other one. The rate of postoperative complications such as urethrocutaneous fistula, urinary retention, meatal stenosis and complete wound dehiscence requiring redo and cosmetic results were compared.Results: The prevalence of post-operative complications and cosmetic results in two studied groups were not significantly different.Conclusions: There is no significant difference between removal of the stent after two days or seven days regarding the incidence of postoperative complications and the cosmetic results.

scholarly journals Reverdin-Isham technique with and without fixation

2018 ◽  
Vol 12 (3) ◽  
Author(s):  
Aleksei Dickow Sato ◽  
Ronaldo Muramoto Nakato ◽  
Bruno Cerutti Bolsi ◽  
Thiago Pavani Zigovski ◽  
João Luiz Vieira da Silva
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Intermetatarsal Angle ◽  
Significant Difference ◽  
Proposed Modification ◽  
American Orthopaedic ◽  
Additional Fixation

Objective: This study evaluated the radiographic results of the traditional minimally invasive percutaneous Reverdin-Isham surgical technique for hallux valgus treatment using the American Orthopaedic Foot and Ankle Society (AOFAS) score and compared this result with a proposed modification involving additional osteosynthesis with a cannulated screw. Methods: We retrospectively assessed 22 feet across 15 patients with mild to moderate hallux valgus. All patients underwent surgical treatment using the Reverdin-Isham technique. Eleven feet were fixed with 2.4- or 2.7-mm cannulated screws. A single orthopaedic surgeon performed these procedures between January 2014 and June 2016. The metatarsophalangeal (MTP) angle and intermetatarsal angle (IMA) were evaluated using radiographs, and the AOFAS score was applied before surgery and 90 days after. Results: An improvement was found in the parameters evaluated in both groups, with significant differences shown between the pre- and post-procedure follow-up assessment. No significant difference was found between the groups with regard to fixation; however, the scores were slightly higher for the group where osteosynthesis was used. Conclusions: The Reverdin-Isham procedure is effective and safe for correcting mild to moderate hallux valgus and additional fixation presented with promising results, although without significant difference. Additional studies with larger samples and longer follow-up times are needed to define the role that additional screw fixation plays in the overall scope of treatment.Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Functional evaluation of diabetic patients with foot ulcers

2018 ◽  
Vol 12 (2) ◽  
pp. 136-139
Author(s):  
Thiago Santos Fernando ◽  
Vinicius Quadros Borges ◽  
Gabriel Ferreira Ferraz ◽  
Kelly Cristina Stéfani
Keyword(s):  
Comprehensive Evaluation ◽  
Diabetic Patients ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Plantar Ulcers ◽  
The Mean ◽  
American Orthopaedic

Objective: The objective of this study was to perform a functional evaluation of diabetic patients with plantar ulcers using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Methods: In this prospective cohort study, 50 diabetic patients treated in an outpatient clinic under conservative management were consecutively evaluated for active ulcers on the foot. The ulcer mean progression time, size and classification and the AOFAS score were evaluated. Results: Among the sample, 38 (76%) were men, the mean age was 64 years, and the mean body mass index was 28.27 kg/m2. The mean ulcer progression time was 9 months, and 40 (80%) patients were classified as Wagner grade 1. There was a significant difference in AOFAS scoresbetween ulcer grades. Conclusion: The AOFAS score can be used for functional evaluation in diabetic patients with ulcers. However, due to the peculiarities of this population, it is important to search for new and more comprehensive evaluation instruments. Level of Evidence II; Prognostic Studies; Prospective Study.

scholarly journals Outcomes of plantar fasciotomy to treat plantar fasciitis

2019 ◽  
Vol 13 (1) ◽  
pp. 42-48
Author(s):  
Rodrigo Guimarães Huyer ◽  
Cíntia Kelly Bittar ◽  
Carlos Daniel Candido de Castro Filho ◽  
Carlos Augusto Mattos ◽  
Mário Sérgio Paulillo De Cillo ◽  
...  
Keyword(s):  
Plantar Fasciitis ◽  
Case Series ◽  
Treatment Level ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Patient Health ◽  
Plantar Fasciotomy

Objective: This study sought to evaluate the effectiveness of a surgery (plantar fasciotomy) to treat plantar fasciitis using the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire. Methods: Patients were retrospectively identified using their postoperative orthopedic (medical) records after receiving medial plantar fasciotomy for plantar fasciitis between 1997 and 2009. Results: A significant difference was observed between the pre- and postoperative AOFAS score; this result indicates that patient health improved after the fasciotomy to treat plantar fasciitis. Conclusions: A strength of this study was its long follow-up time of patients undergoing plantar fasciotomy to treat plantar fasciitis. This surgery is indicated for patients with chronic plantar fasciitis after 6 months without response to conservative treatment. Level of Evidence IV; Therapeutic Studies; Case Series.

Comparison of Magnesium Versus Titanium Screw Fixation for Biplane Chevron Medial Malleolar Osteotomy in the Treatment of Osteochondral Lesions of the Talus

2019 ◽  
Author(s):  
Baver Acar ◽  
Ozkan Kose ◽  
Melih Unal ◽  
Adil Turan ◽  
Yusuf Alper Kati ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Screw Fixation ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Medial Malleolar Osteotomy ◽  
Ankle Surgery ◽  
Significant Difference ◽  
Alternative Fixation ◽  
One Year

Background and objectives: The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients who underwent biplane chevron medial malleolar osteotomy (MMO) for osteochondral lesions of the talus (OLT), fixed with either magnesium (Mg) or titanium (Ti) screws. Materials and Methods: A total of 22 patients (12 male, 10 female) with a mean age of 40.6&plusmn;12.5 years (range, 18-56 years) who underwent MMO for OLT treatment were included in this retrospective study. Of the 22 patients, MMO was fixed with bioabsorbable Mg screws (Alloy: MgYREZr) in 11 patients, and in the remaining 11 patients (one bilateral) MMO were fixed with Ti screws.&nbsp; All patients were followed up for at least one year with a mean of 20.7&plusmn;8.9 months (range, 12&ndash;49 months). The American Orthopedic Foot and Ankle Society (AOFAS) scale and the visual analog scale (VAS) were used to evaluate the clinical results. Union of the osteotomy, postoperative displacement, and all other complications were followed and analyzed. Results: An improvement in the AOFAS scale and VAS points were recorded in both groups with no statistically significant difference between the groups (p: 0.079 and 0.107 respectively). Complete union of the osteotomy was obtained in all patients. One patient in the Ti group required implant removal due to pain and irritation. There were no other significant complications in either group. Conclusions: The results of this study showed that bioabsorbable Mg compression screws have similar therapeutic efficacy to Ti screws in respect to functional and radiological outcomes in MMO fixation. Bioabsorbable Mg screw is an alternative fixation material which can be safely used for MMO in ankle surgery.

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 484-489 ◽  
Author(s):  
Tom Barker ◽  
Felicity Evison ◽  
Ruth Benson ◽  
Alok Tiwari
Keyword(s):  
Venous Thromboembolism ◽  
Varicose Vein ◽  
Lower Incidence ◽  
Varicose Veins ◽  
Secondary Data ◽  
Foam Sclerotherapy ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Squared ◽  
One Year

Abstract. Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson’s Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15–0.35 % at 30 days, 0.26–0.50 % at 90 days, and 0.46–0.58 % at one year. At 30 days there was a significantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other significant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments.

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