scholarly journals Peroneal tendon dislocation in Talus fracture and diagnostic value of fleck sign

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Ahmed Attia ◽  
Karim Mahmoud Khamis ◽  
Tarek Taha ◽  
Osama Aldahamsheh ◽  
Mohamed Maged Mekhaimar
Keyword(s):  
Soft Tissue Injuries ◽  
Diagnostic Value ◽  
Senior Author ◽  
Peroneal Tendon ◽  
Inclusion Criteria ◽  
Talus Fracture ◽  
Peroneal Tendons ◽  
Neck Fracture ◽  
Operative Assessment ◽  
Talar Neck Fractures

Category: Trauma Introduction/Purpose: INTRODUCTION: Talus fractures are not uncommon and one of the serious fractures in foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. AIM: To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation. Methods: We retrospectively reviewed 100 consecutive talus fractures in the period between 1/1/2011 to 1/7/2017. Inclusion criteria were: The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and 3 views ankle plain radiographs. 2 independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification if any. Any dispute was resolved by the senior author. Patient records were reviewed for laterality, age, sex, mode of injury, associated injuries and operative interventions. 43 ankles met inclusion criteria. 42 were males, mean age was 31 year and the predominant modes of injury were fall from height or unknown. Results: Peroneal tendon dislocation was found in 9 patients out of 43. (20%). All dislocations were found in talar neck fractures, and up to 67% of Hawkins type III and IV Talar neck fractures were associated with peroneal tendon dislocation. Risk of dislocation increased with severity of the fracture. 5 cases of peroneal tendon dislocation out of 9 were associated with lateral or bimalleolar fractures. Most of the dislocations were missed and no additional procedures were done to address such injury. Fleck sign sensitivity was 44.4% while specificity was 88%. The Negative Predictive Value (PPV) was 86%. Conclusion: Peroneal tendons dislocation is associated with 20% of talus fractures. The incidence of dislocation increases with neck fracture and severity of these fractures. Fleck sign is highly specific radiographic sign and hence we recommend intra-operative assessment of peroneal tendons in patients with fleck sign.

scholarly journals Peroneal tendon dislocation in talus fracture and diagnostic value of fleck sign

2020 ◽  
Vol 44 (5) ◽  
pp. 973-977
Author(s):  
Ahmed Khalil Attia ◽  
Karim Mahmoud ◽  
Tarek Taha ◽  
Osama AlDahamsheh ◽  
Ahmed Hany ElHessy ◽  
...  
Keyword(s):  
Diagnostic Value ◽  
Peroneal Tendon ◽  
Talus Fracture

Chronic Peroneal Tendon Subluxation Produced by an Anomalous Peroneus Brevis: Case Report and Literature Review

Foot & Ankle ◽  
1989 ◽  
Vol 10 (1) ◽  
pp. 45-47 ◽  
Author(s):  
Warren A. Hammerschlag ◽  
J. Leonard Goldner
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Congenital Anomalies ◽  
Present Report ◽  
Peroneal Tendon ◽  
Anatomical Studies ◽  
Peroneal Tendons ◽  
Symptomatic Case ◽  
Peroneus Brevis ◽  
Time Of Operation

Although congenital anomalies of the peroneal muscles have been well documented from anatomical studies, only a single clinically symptomatic case has been previously reported. In the present report, a previously unreported variation of the peroneus brevis, a bifid peroneus brevis, is described. This variation contributed to chronic subluxation of the peroneal tendons. Diagnosis was made at the time of operation, and resection of the duplicated tendon and reinforcement of the peroneal retinaculum relieved the symptoms of the patient.

Cement-in-cement femoral component revision

2021 ◽  
Vol 103-B (7) ◽  
pp. 1215-1221
Author(s):  
John W. Kennedy ◽  
Nigel Y. B. Ng ◽  
David Young ◽  
Nicholas Kane ◽  
Andrew G. Marsh ◽  
...  
Keyword(s):  
Femoral Component ◽  
Short Form ◽  
Demographic Data ◽  
Senior Author ◽  
Inclusion Criteria ◽  
Reliable Technique ◽  
Patient Demographic Data ◽  
Oxford Hip Score ◽  
Component Revision

Aims Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. Results A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. Conclusion Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215–1221.

scholarly journals Effect of Cataract Surgery on Intraocular Pressure in Glaucoma Patients

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Shua Azam ◽  
Abdul Hameed Talpur ◽  
Mahak Shaheen ◽  
Sadia Bukhari
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Angle Closure ◽  
Inclusion Criteria ◽  
Primary Angle Closure Glaucoma ◽  
Closed Angle ◽  
Operative Assessment

Purpose:  To determine the change in intraocular pressure after cataract surgery in patients diagnosed with glaucoma. Study Design:  Interventional case series. Place and Duration of Study:  Glaucoma Clinic. Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2019. Methods:  Thirty-eight patients diagnosed with glaucoma and cataract and registered in glaucoma clinic were recruited for this study. Inclusion Criteria was age > 41 years and patients diagnosed with primary open/closed angle glaucoma and cataract. Patients with secondary glaucoma, history of trabeculectomy and any other ocular diseases were excluded from the study. Pre-operative assessment was done for phacoemulsification. In post-operative examination, first and second follow-up IOP was measured. Data analysis was done on statistical package for social science (SPSS) version 20.0. Statistical changes were present in the form of bar chart, frequency and graphs. The mean standard deviation for pre-operative, post-operative 1st and 2nd follow-up IOP was calculated. Results:  A total of 38 participants and 48 eyes satisfied the inclusion criteria. Out of 48 eyes, 39 (81.3%) eyes were diagnosed with Primary open angle glaucoma and 9 (18.8%) eyes with Primary Angle Closure Glaucoma. The pre-operative mean IOP was 16.56 ± 6.67 mm Hg and post-operative mean IOP at first follow-up was 13.39 ± 4.04 mm Hg. At second follow-up at one-month mean IOP was 12.14 ± 2.28 mm Hg. Conclusion:  Phacoemulsification produces a useful decrease in IOP in glaucoma patients. Key Word:  Glaucoma, Cataract, Phacoemulsification, Intraocular Pressure.

scholarly journals Repair of a Comminuted Talar Neck Fracture using a Cellular Bone Allograft combined with a Textured Allograft Wedge

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Alaa Mansour ◽  
Timothy D. Howard ◽  
Elena Gianulis ◽  
Danielle Scheunemann
Keyword(s):  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Compressive Force ◽  
Bone Allograft ◽  
Unique Challenge ◽  
Subtalar Dislocation ◽  
Neck Fracture ◽  
Cellular Bone ◽  
Cellular Bone Allograft ◽  
Talar Neck Fractures

Category: Trauma; Ankle Introduction/Purpose: Talar neck fractures are uncommon and are characterized by displacement, comminution, and soft tissue injury. Treatment of talar neck fractures while avoiding complications, such as osteonecrosis and long-term morbidity, presents a unique challenge to surgeons. One option for treating talar neck fractures is cellular bone allograft containing viable lineage- committed bone cells (V-CBA), which provides the osteoconductive, osteoinductive, and osteogenic properties needed for bone formation. Additionally, a structural textured allograft (STA) wedge designed to resist migration and sustain compressive force can also be used in repairing talar neck fractures. This case study describes the successful repair of a comminuted talar neck fracture using V-CBA combined with an STA wedge. Methods: A 46-year-old male patient sustained a talar neck fracture following a fall from a 12-foot ladder. Radiographic and computed tomography (CT) imaging revealed significant comminution, consequent varus angulation, and a large bony void, as well as dislocation of the posterior subtalar joint. The patient was otherwise healthy with no comorbidities. Open reduction internal fixation was performed laterally to reduce the posterior subtalar dislocation. Medially, a 6.5mm STA wedge was used to correct the varus deformity and 1cc of V-CBA was used to fill the void. Results: At 6 months, the talar neck fracture had healed with solid osseous consolidation evident on radiographic images. Conclusion: These results demonstrate that an STA wedge, with a textured design that resists migration, used in combination with a V-CBA successfully repaired a comminuted talar neck fracture.

Clinical Outcomes and Complications of Peroneal Tendon Sheath Ultrasound-Guided Corticosteroid Injection

2019 ◽  
Vol 40 (8) ◽  
pp. 888-894 ◽  
Author(s):  
Brianna R. Fram ◽  
Ryan Rogero ◽  
Daniel Fuchs ◽  
Rachel J. Shakked ◽  
Steven M. Raikin ◽  
...  
Keyword(s):  
Pain Relief ◽  
Clinical Outcomes ◽  
Corticosteroid Injection ◽  
Case Series ◽  
Tendon Sheath ◽  
Adverse Outcomes ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Duration Of Symptoms ◽  
Peroneal Tendons

Background: The treatment of symptomatic peroneal tendinopathy and tears traditionally begins with nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization, with surgery typically reserved for those failing nonoperative treatment. Ultrasound-(US)-guided peroneal tendon sheath (PTS) corticosteroid injection is an additional nonoperative modality, but limited data exist on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US-guided PTS corticosteroid injection for chronic tendinopathy or tears. Methods: We retrospectively identified patients who had undergone US-guided PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation at our institution from 2012 to 2018. Underlying diagnosis was based on clinical examination, magnetic resonance imaging (MRI) results, and/or intraoperative findings, when available. Medical record data were supplemented by e-mail or telephone follow-up. Collected information included patient age, sex, body mass index (BMI), smoking status, workers’ compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any adverse outcomes of injection. We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons. Results: Twenty-four of 96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients reported 0-1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) greater than 12 weeks. Preinjection duration of symptoms was associated with postinjection duration of pain relief ( P=.036). There were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression. Conclusion: Our study demonstrates US-guided PTS corticosteroid injection was safe and relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery, and may be considered in a comprehensive protocol of nonoperative management. Level of Evidence: Level IV, case series.

scholarly journals Immunocytochemistry Test of Protein BRAF Expression for Diagnosis of Well Differentiated Thyroid Carcinoma

2018 ◽  
Vol 11 (3) ◽  
pp. 843-849 ◽  
Author(s):  
I. Wayan Sudarsa ◽  
Elvis Deddy Kurniawan Pualillin ◽  
Putu Anda Tusta Adiputra ◽  
Ida Bagus Tjakra Wibawa Manuaba
Keyword(s):  
Positive Predictive Value ◽  
Thyroid Carcinoma ◽  
Negative Predictive Value ◽  
Diagnostic Test ◽  
Predictive Value ◽  
Preoperative Diagnosis ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Differentiated Thyroid Carcinoma ◽  
Inclusion Criteria

Background: Thyroid carcinoma generally has a good prognosis. The main focus of current research on thyroid carcinoma is to increase the accuracy of preoperative diagnosis of thyroid nodules. When the result of fine needle aspiration biopsy (FNAB) is indeterminate, clinicians often have doubts in determining the surgical management. Objective: Protein BRAF expression analysis can help improve the accuracy of FNAB and optimize the management of differentiated thyroid carcinoma. Methods: This study is a diagnostic test performed from October 2016 at Sanglah General Hospital with 38 patients as subjects who fulfilled the inclusion criteria. Data is being presented in descriptive form before diagnostic test is done to determine sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of immunocytochemistry test for BRAF on indeterminate thyroid nodule. Results: Thirty-eight samples met the inclusion criteria during the study period. Three samples were male (7.9%) and 35 samples (92.1%) were female. The mean age of the sample was 45.21 years (SD ±10.910 years) with ages ranging from 23 to 66 years. Of the 12 samples undergoing isthmolobectomy, 7 samples (58.4%) were determined to be malignant from histopathological results. The sensitivity value of BRAF immunocytochemistry test is 45.45% with a specificity value of 81.25%, a positive predictive value of 76.92%, a negative predictive value of 52% and an accuracy of 60.50%. Analysis of the receiver operator (ROC) curve shows the area under the curve (AUC) of 63.4% with a confidence interval of 45.5–81.2%. Conclusion: Immunocytochemistry BRAF test have a reliable diagnostic value and can be taken into consideration in the preoperative diagnosis of thyroid malignancies.

scholarly journals Ultrasound Evaluation of the Peroneal Tendons in an Asymptomatic Elite Military Population: A Prospective Cohort Study

2020 ◽  
Vol 185 (Supplement_1) ◽  
pp. 420-422
Author(s):  
Kevin Martin ◽  
Jeffrey Wake ◽  
J Preston Van Buren
Keyword(s):  
Military Service ◽  
Original Position ◽  
Gravity Inversion ◽  
Neutral Position ◽  
Peroneal Tendon ◽  
Short Axis ◽  
Military Population ◽  
Peroneal Tendons ◽  
Ultrasound Evaluation ◽  
Lateral Ridge

ABSTRACT Introduction The purpose of this study was to identify the location of the peroneal tendons in relationship to the fibular groove in an asymptomatic population of elite U.S. Military Service members. Materials and Methods The peroneal tendons of 41 active duty U.S. Army Rangers were examined. Subjects were placed in a lateral recumbent position with the ankle in a resting neutral position to visualize the tendon in a retromalleolar short-axis view. Maximum active ankle eversion followed by gravity inversion was facilitated while the ultrasound probe was maintained in its original position. Distance from the fibrous lateral ridge of the retromalleolar groove to the anterior aspect of the peroneal brevis was measured in the short axis in neutral, eversion, and inversion. Results The mean sagittal distance and standard deviation was 0.48 ± 0.9 mm. No subjects demonstrated greater than 1 mm difference between positions, and no dislocations were identified. Side-to-side difference and dominant vs nondominant differences were not statistically significant. Conclusion The study demonstrates that the distance between the peroneal brevis and the lateral fibular ridge is consistent throughout extremes of motion. These results further the understanding of peroneal tendon function under dynamic examination. Our findings also establish side-to-side consistency prompting a bilateral examination to help identify abnormal pathology.

scholarly journals Prediction Value of SPECT/CT in Avascular Necrosis of Femoral Head After Femur Neck Fracture

2019 ◽  
Vol 10 ◽  
pp. 215145931987294
Author(s):  
Sung Jun Park ◽  
Bong Seong Ko ◽  
Kyoung Ho Moon ◽  
Minkyung Lee
Keyword(s):  
Computed Tomography ◽  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Single Photon ◽  
Photon Emission ◽  
Diagnostic Value ◽  
Emission Computed Tomography ◽  
Neck Fracture ◽  
Photon Emission Computed Tomography

Introduction: The aim of this study was to determine the diagnostic value of single-photon emission computed tomography/computed tomography (SPECT/CT) in prediction of avascular necrosis (AVN) after femoral neck fracture and to evaluate whether photon defect in femoral head as seen in SPECT/CT can be an index for choice of surgical method. Methods: This study was based on 97 patients who took SPECT/CT after femoral neck fracture from November 2012 to November 2017, with 64 patients with femoral intertrochanteric fracture in which chances of AVN is rare as a comparison group. Among 97 patients with femoral neck fracture, osteosynthesis was conducted in 7 patients with less than 15% of photon defect in damaged femoral head and 7 patients who wanted osteosynthesis, despite photon defect more than 15%, and 83 patients with photon defect more than 25% had arthroplasty. Patient with osteosynthesis was followed up with AVN by conducting magnetic resonance imaging (MRI) in 1 year after the surgery. Results: Quantitative analysis of SPECT/CT in 14 patients who had femoral neck osteosynthesis showed that 7 patients with femoral neck fracture showed photon defect of 15% or more, but less than 25% and 3 patients in these were diagnosed with AVN after 1-year follow-up by MRI. Sensitivity and specificity of SPECT/CT in predicting AVN was 100% and 63.6%, respectively, with prediction accuracy of 71.4%. Among 14 patients with femoral neck fracture who had osteosynthesis, photon defect in 3 patients diagnosed with AVN was 19.6% ± 5.2%, but photon defect in 11 patients who was not diagnosed with AVN was 10.7% ± 5.2%, showing statistically significant difference between 2 groups ( P = .001). Conclusion: Single-photon emission computed tomography/CT in patients with femoral neck fracture is considered to have diagnostic value in predicting occurrence of AVN, and percentage of photon defect is considered to be an useful index in determining the operative method.

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