scholarly journals Floating toe

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017
Author(s):  
Nathaly Caicedo ◽  
Ruben Radkievich ◽  
Diego Zanolli de Solminihac ◽  
Rafael Calvo ◽  
Pablo Wagner ◽  
...  
Keyword(s):  
Negative Influence ◽  
Interphalangeal Joint ◽  
Functional Score ◽  
Satisfaction Index ◽  
Hammer Toe ◽  
Functional Scores ◽  
High Prevalence ◽  
Patients With Diabetes ◽  
Hammer Toes ◽  
Toe Deformity

Category: Midfoot/Forefoot Introduction/Purpose: The Weil osteotomy (WO) is frequently used for treating metatarsalgia and metatarsophalangeal (MTP) instability. Nevertheless, it presents complications, being the floating toe the most frequent one. A modification has been proposed to decrease the beforementioned complication, removing a slice from the osteotomy (modified Weil osteotomy, MWO). Additionally, it has been proposed that stabilizing the toe interphalangeal joints when treating hammer toes may contribute to decrease the floating toe complication, given that all flexors contribute to MTP flexion. The objective of this research is to describe complications and functional score in patients operated with MWO with and without interphalangeal stabilization. Methods: 110 patients (250 toes) treated for metatarsalgia and hammer toe deformity were retrospectively collected and prospectively followed for 66 months (SD 15). 2 groups were studied, 45 adults with isolated MWO and 65 adults with MWO with toe stabilization. Average age 55. Patients with Diabetes, previous surgeries and infections were excluded. LEFS, AOFAS and satisfaction index were recorded. A physical examination looking for floating toe, MTP instability and metatarsalgia was performed. Statistical analysis included logistic regression spearmen correlation test, Mann-Whitney test and student T test. Results: LEFS and AOFAS scores were 70 and 73 respectively, with no differences between patients operated with isolated MWO or with toe stabilization. Satisfaction index average result was “minor reservations”. Floating toe incidence was 24%, with no difference between groups. There was no difference in functional scores and satisfaction index if floating toe was present or absent. There was no correlation between functional scores and satisfaction index. Metatarsalgia was present in 31% of patients, and there is a direct correlation of floating toe occurrence and pain (4 times more chance to have pain). Conclusion: There was no clinical significant consequence of floating toe on LEFS, AOFAS or satisfaction. There was no difference in complication rate, functional scores and patient satisfaction if the interphalangeal joint was fixed or not. Although floating toe didn’t influence on functional scores, it was associated with pain. It can be suggested that the scores utilized were not able to detect the negative influence of floating toe on every patient. The high prevalence of floating toe using the MWO should make us look for additional factors which we may be overlooking when treating metatarsalgia, such as plantar plate damage.

scholarly journals Type 1 diabetes in people hospitalized for COVID-19: new insights from the CORONADO study

2020 ◽  
Author(s):  
Matthieu Wargny ◽  
Pierre Gourdy ◽  
Lisa Ludwig ◽  
Dominique Seret-Bégué ◽  
Olivier Bourron ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Type 1 Diabetes ◽  
Severe Disease ◽  
High Risk Population ◽  
Risk Of Death ◽  
High Prevalence ◽  
Patients With Diabetes ◽  
Outcomes Study

Since the start of the COVID-19 pandemic, patients with diabetes were rapidly recognized as a high-risk population for severe disease. Indeed, a high prevalence of diabetes among patients with COVID-19 who required hospitalization has been consistently reported, reaching 33.8% in 5,700 people hospitalized for COVID-19 in New York City area (1). In addition, diabetes was associated with more than a double risk of intensive care unit (ICU) admission and more than a triple risk of death (2). However, precise data regarding the type of diabetes are scarce. We report here the clinical characteristics and early prognosis of patients with type 1 diabetes (T1D) hospitalized for COVID-19 in the nationwide multicenter observational CORONADO (CORONAvirus-SARS-CoV-2 and Diabetes Outcomes) study (3).

357 Comparative Effectiveness between Primary and Revision Foraminotomy for the Treatment of Lumbar Foraminal Stenosis

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 282-282
Author(s):  
Emily Hu ◽  
Jianning Shao ◽  
Heath P Gould ◽  
Roy Xiao ◽  
Colin Haines ◽  
...  
Keyword(s):  
Comparative Effectiveness ◽  
Retrospective Cohort ◽  
Minimum Clinically Important Difference ◽  
Functional Score ◽  
Foraminal Stenosis ◽  
Lumbar Foraminal Stenosis ◽  
Clinically Important Difference ◽  
Significant Difference ◽  
Functional Scores

Abstract INTRODUCTION Foraminotomy has demonstrated clinical benefit for the management of lumbar foraminal stenosis (LFS). Although many patients undergo multiple foraminotomies, there is little data comparing primary foraminotomy (PF) and revision foraminotomy (RF) in terms of cost and quality of life (QOL) outcomes. METHODS A retrospective cohort study was conducted among patients undergoing foraminotomy for LFS. QOL instruments (EQ-5D, PDQ, and PHQ-9) were prospectively collected between 2008 and 2016. Outcome measures included improvement in postoperative QOL, perioperative cost, and QOL minimum clinically important difference (MCID). RESULTS >579 procedures were eligible 476 (82%) PF and 103 (18%) RF. A significantly higher proportion of males underwent RF than PF (71% vs. 59%, P = 0.03) and PF was done on a significantly higher number of vertebral levels (2.2 vs. 2.0, P = 0.04). There were no other significant differences in demographics. Preoperatively, mean PDQ-Functional scores (50 vs. 54, P = 0.04), demonstrated significantly poorer QOL in the RF cohort. Postoperatively, EQ-5D index showed significant improvement in both the PF (0.547?0.648, P < 0.0001) and the RF (0.507?0.648, P < 0.0001) cohorts. Similarly, total PHQ-9 improved significantly in the PF cohort (7.84?5.91, P < 0.001) and in the RF cohort (8.55?5.53, P = 0.02), as did total PDQ (PF: 77?63, P < 0.0001; RF: 85?70, P = 0.04). QOL scores were also compared between groups preoperatively and postoperatively. The only significant difference between PF and RF was observed in preoperative PDQ-Functional score (50 vs. 54, P = 0.04). The proportion of patients achieving an MCID was not significantly associated with cohort. Finally, perioperative cost did not differ significantly between cohorts (PF: $13,383 vs. RF: $13,595, P = 0.82). CONCLUSION RF patients had poorer preoperative PDQ-Functional scores, but both PF and RF produce significant improvement in all measures. There was no difference in QOL outcomes or cost between PF and RF. Therefore, while one procedure does not clearly have superior cost effectiveness than the other, both achieved significant effectiveness.

scholarly journals Plastic lengthening amputation with vascularized bone grafts in children with bone sarcoma: a preliminary report

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Zhiqiang Zhao ◽  
Qinglin Jin ◽  
Xianbiao Xie ◽  
Yongqian Wang ◽  
Tiao Lin ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Young Patients ◽  
Bone Sarcoma ◽  
Postoperative Management ◽  
Functional Score ◽  
Leg Length ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Functional Scores ◽  
Distal Joint

Abstract Background At present, amputation was widely adopted for young patients when limb salvage was deemed risky with several surgical strategy such as rotationplasty. However, leg length discrepancies and unfavorable cosmetic results were indispensable complication of this strategy. The purpose of this study was to propose a novel reconstruction strategy and evaluate the early clinical and functional outcomes of the strategy. Methods Plastic lengthening amputation (PLA) has been developed by lengthening the stump to preserve one additional distal joint for fixing the artificial limb well. The surgical technique and postoperative management were documented, and the functional outcomes were compared with those of traditional amputation (TA). Six pairs of patients matched for age, sex, location, pathological type, and final prosthesis underwent individually designed plastic lengthening amputation with vascularized autografts or traditional amputation between January 2005 and December 2007. All patients were followed, and the locomotor index and the musculoskeletal tumor society score (MSTS) were used to describe and quantitatively grade limb functional outcomes after amputation. The complications and functional outcomes of the patients taken two kinds of procedures were compared. Results Twelve patients with osteosarcoma or Ewing’s sarcoma of either the femur or tibia were included in the study. Six patients underwent plastic lengthening amputations, three of whom also underwent vascular anastomosis. Patients were followed for an average of 48.17 months; bone healing required an average of 3.3 months. No local recurrence was found. The average postoperative locomotor index functional score of the affected limb was 32.67 ± 5.89 in the plastic lengthening amputation group while was 19.50 ± 7.87 in the traditional amputation group. The MSTS functional scores were 22.67 ± 1.33 and 24.17 ± 1.45 at 6 and 12 months for patients in PLA group while 17.00 ± 1.549 and 17.83 ± 1.64 at 6 and 12 months for patients in TA group. Conclusions Plastic lengthening amputations with vascularized autografts could preserve the knee joint to improve the function of the amputated limb in selected bone sarcoma patients.

scholarly journals Minimally invasive management of dorsiflexion contracture at the metatarsophalangeal joint and plantarflexion contracture at the proximal interphalangeal joint of the fifth toe

2011 ◽  
Vol 1 (2) ◽  
pp. 27
Author(s):  
Mariano De Prado ◽  
Pedro-Luis Ripoll ◽  
Pau Golanó ◽  
Javier Vaquero ◽  
Nicola Maffulli
Keyword(s):  
Minimally Invasive ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Invasive Technique ◽  
Wedge Osteotomy ◽  
Invasive Approach ◽  
Fifth Toe ◽  
Toe Deformity

Several surgical options have been described to manage persistent dorsiflexion contracture at the metatarsophalangeal joint and plantarflexion contracture at the proximal interphalangeal joint of the fifth toe. We describe a minimally invasive technique for the management of this deformity. We perform a plantar closing wedge osteotomy of the 5th toe at the base of its proximal phalanx associated with a lateral condylectomy of the head of the proximal phalanx and at the base of the middle phalanx. Lastly, a complete tenotomy of the deep and superficial flexor tendons and of the tendon of the extensor digitorum longus is undertaken. Correction of cock-up fifth toe deformity is achieved using a minimally invasive approach.

scholarly journals The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Łukasz Szelerski ◽  
Andżelika Pajchert-Kozłowska ◽  
Sławomir Żarek ◽  
Radosław Górski ◽  
Paweł Małdyk ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Treatment Time ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Length Of Hospital Stay ◽  
Bone Union ◽  
Functional Score ◽  
Ilizarov Method ◽  
Functional Scores ◽  
Aseptic Nonunions

AbstractNonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques. A total of 75 patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients’s mean age at the beginning of treatment was 46 years. The mean follow-up period was 10 years and 11 months. The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression. The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay. Bone union was achieved in all of the 75 evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me = 6.00 vs. Me = 4.00). We observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group. The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union, length of hospital stay, duration of Ilizarov treatment, or ASAMI bone scores. For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression. The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.

scholarly journals Ideal implant choice for proximal interphalangeal joint arthrodesis in hammer toe/claw toe deformity correction: A systematic review

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902091116
Author(s):  
Rachel XY Wei ◽  
Samuel KK Ling ◽  
TH Lui ◽  
Patrick SH Yung
Keyword(s):  
Systematic Review ◽  
Surgical Complication ◽  
Deformity Correction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Complication Rates ◽  
The Novel ◽  
Claw Toe ◽  
Hammer Toe ◽  
K Wires

Intramedullary devices have been developed to reduce the problems associated with Kirschner (K)-wire fixation in proximal interphalangeal joint (PIPJ) arthrodesis. The purpose of this systematic review is to compare the surgical outcomes of K-wires versus novel internal fixation devices in PIPJ arthrodesis in claw/hammer toe surgery. The databases searched were PubMed, Scopus, Cochrane, and Embase with keywords “claw toe OR hammer toe” AND “proximal interphalangeal OR PIP” AND “fusion OR arthrodesis.” Clinical trials published in English with evidence levels I, II, and III were included. Five studies, including one randomized controlled trial and four case-controlled studies, were identified to meet the inclusion criteria. Overall, the studies showed promising results in union rates using the novel internal devices compared to K-wires. However, the novel internal devices seem not to present advantages in clinical parameters such as pain levels, patient satisfaction, foot-related function, or surgical complication rates.

scholarly journals Importance of Mechanical Periodontal Therapy in Patients with Diabetes Type 2 and Periodontitis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Priscilla Naiff ◽  
Valéria Carneiro ◽  
Maria do Carmo Guimarães
Keyword(s):  
Oral Health ◽  
Health Professionals ◽  
Diabetes Type 2 ◽  
Periodontal Therapy ◽  
Systemic Complications ◽  
Dental Management ◽  
Oral Health Problem ◽  
High Prevalence ◽  
Patients With Diabetes

Periodontitis is an infectious and inflammatory disease of high prevalence worldwide and constitutes a significant oral health problem. It can lead to tooth loss. In addition, the local inflammatory process can cause the release of inflammatory mediators in the bloodstream and, consequently, contribute to the emergence of systemic effects as cardiovascular and diabetic complications. The purpose of this mini review is to alert health professionals about the risk that periodontitis represents for the onset or exacerbation of complications in individuals with type 2 diabetes mellitus and to emphasize that the mechanical treatment of periodontal disease and reestablishment of oral health are essential for the metabolic control of these patients. The periodontal therapy may help to reduce the risk of systemic complications in diabetes patients. Proper dental management should be suggested by health professionals, mainly from physicians to their patients, in order to improve the health conditions in these individuals.

Mapping recovery in simple and complex tibial plateau fracture fixation

2019 ◽  
Vol 101-B (8) ◽  
pp. 1009-1014 ◽  
Author(s):  
D. N. Ramoutar ◽  
K. Lefaivre ◽  
H. Broekhuyse ◽  
P. Guy ◽  
P. O’Brien
Keyword(s):  
Functional Outcome ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Short Form ◽  
Tibial Plateau Fractures ◽  
Functional Score ◽  
Complex Group ◽  
Sf 36 ◽  
Functional Scores ◽  
Plateau Fracture

Aims The aim of this study was to determine the trajectory of recovery following fixation of tibial plateau fractures up to five-year follow-up, including simple (Schatzker I-IV) versus complex (Schatzker V-VI) fractures. Patients and Methods Patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fractures were enrolled into a prospective database. Functional outcome, using the 36-Item Short Form Health Survey Physical Component Summary (SF-36 PCS), was collected at baseline, six months, one year, and five years. The trajectory of recovery for complex fractures (Schatzker V and VI) was compared with simple fractures (Schatzker I to IV). Minimal clinically important difference (MCID) was calculated between timepoints. In all, 182 patients were enrolled: 136 (74.7%) in simple and 46 (25.3%) in complex. There were 103 female patients and 79 male patients with a mean age of 45.8 years (15 to 86). Results Mean SF-36 PCS improved significantly in both groups from six to 12 months (p < 0.001) and one to five years (simple, p = 0.008; complex, p = 0.007). In both groups, the baseline scores were not reached at five years. The SF-36 PCS was significantly higher in the simple group compared with the complex group at both six months (p = 0.007) and 12 months (p = 0.01), but not at five years (p = 0.17). Between each timepoint, approximately 50% or more of the patients in each group achieved an MCID in their score change, indicating a significant clinical change in condition. The complex group had a much larger drop off in the first six months, with comparable proportions achieving MCID at the subsequent time intervals. Conclusion Tibial plateau fracture recovery was characterized overall by an initial decline in functional outcome from baseline, followed by a steep improvement from six to 12 months, and ongoing recovery up to five years. In simple patterns, patients tended to achieve a higher functional score by six months compared with the complex patterns. However, comparable functional scores between the groups achieved only at the five-year point suggest later recovery in the complex group. Function does not improve to baseline by five years in either group. This information is useful in counselling patients about the course of prospective recovery. Cite this article: Bone Joint J 2019;101-B:1009–1014.

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