scholarly journals Early Outcomes on the Use of an Anterior Plate for complicated Ankle Fusions

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
J. Chris Coetzee ◽  
Rebecca Stone
Keyword(s):  
Plate Fixation ◽  
Ankle Arthrodesis ◽  
Senior Author ◽  
Wound Complications ◽  
X Rays ◽  
Anterior Plate ◽  
Non Union ◽  
Ankle Fusion ◽  
Major Complications

Category: Ankle Introduction/Purpose: An ankle fusion is indicated for severe osteoarthritis of the ankle. An anterior ankle fusion plate for tibiotalar fusions provides a rigid and reproducible solution to treat ankle arthritis. With a plate fixation it might be possible to treat more complex deformities and provide additional stability in compromised patients. This study documents the early outcomes on the use of an anterior plate for patients undergoing an ankle arthrodesis. Methods: All ankle fusions using the anterior plate at our center were included and followed. Fifty-one patients (53 ankles) presented to the senior author between September 2014 and February 2017. Patients experienced ongoing ankle pain due to degenerative changes, a previous ankle fusion, post-traumatic arthritis (PTA) or failure of a total ankle arthroplasty (TAA). All patients’ medical and ankle surgical history was documented. This study was conducted in compliance and approved with a local IRB. Outcomes were evaluated pre-operatively and post-operatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS) and Visual Analog Scale (VAS) Pain scale. A patient satisfaction survey was distributed to all patients and results were tabulated. Average follow up for outcome scores 16.8 months (range 6 – 38 months). Results: Fifty-one patients(29 females) with the mean age of 56.56 years(26.3–74.8) had a mean follow-up of 16.6months(6– 38months). Diagnoses included 17 primary, 10 revision, 6 TAA failures and 20 PTA. 86.3%(44 patients) were non-diabetic. Non-smokers included 43.1%(22). VR-12 Physical improved from 29.46 to 37.72, and Mental 47.34 to 52.55 pre-operatively to post-operatively, respectively. AOS Pain improved: 462.41 to 252.8; AOS Disability: 567.52 to latest 387.77. Mean VAS improved from pre-operatively of 54.28 to latest of 30.61. Arthrodesis rate was 98%(52/53 ankles). 45 ankles were fused at 3 months by x-rays. Symptomatic patients (with pain) had a CT scan done at a minimum of 3 months (1/8 CT scans showed non-union & 7 were fused). Major complications were 3.8%(2 patients). There were no wound complications. Conclusion: An anterior plate construct is more invasive compared to arthroscopic or other arthrodesis options. However, the stability of the construct allows for a reliable option in complex situations, and the arthrodesis rate appears to be exceptional. In this complex patient population, the arthrodesis rate was 98%, while major complications only 4%. Summary Sentence: Anterior plate construct is more invasive compared to arthroscopic/other arthrodesis options. However, stability of the construct allows for a reliable option and fusion rates seem to be exceptional.

scholarly journals Fusion Rates of Ankle Arthrodesis with Anterior Plate Fixation Based on Computerized Tomography and Clinical Outcomes

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0027
Author(s):  
Philip Kaiser ◽  
W. Hodges Davis ◽  
J. Kent Ellington ◽  
Bruce E. Cohen ◽  
Todd A. Irwin ◽  
...  
Keyword(s):  
Ct Scan ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Plate Fixation ◽  
Ankle Arthrodesis ◽  
Ct Scans ◽  
Anterior Plate ◽  
Tibiotalar Joint ◽  
Non Union ◽  
Ankle Fusion

Category: Ankle; Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is a common treatment for tibiotalar joint arthritis and anterior plate fixation is often utilized. Prior series reporting on anterior plate fixation for ankle arthrodesis have been relatively small and none have exclusively used post-operative computerized tomography (CT) scans for confirmation of fusion. The purpose of this study was to determine radiographic and clinical outcomes of patients who underwent ankle arthrodesis with anterior plate fixation. The primary outcome of the study was whether or not successful arthrodesis was obtained based on a quantitation of the fusion mass on CT scan. Furthermore, correlation between ankle fusion and clinical outcomes along with complications were evaluated. Methods:: Adult patients who underwent ankle arthrodesis with anterior plate fixation (including straight anterior and anterolateral plates) were eligible for this study. Charts were retrospectively reviewed and data was collected in a prospective fashion. In total, 102 patients were included in the study and obtained a CT scan at least 90 days after surgery. The primary outcome was tibiotalar fusion, defined as osseous bridging of 50% or more of the tibiotalar joint based on CT scan reviewed by a single musculoskeletal radiologist. Secondary outcomes included patient reported outcome measures (PROMs): the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot function index (FFI), Visual analog scale (VAS) pain score, and Coughlin satisfaction scale. Additional surgeries and complications including nonunion, painful hardware, tibial stress fractures, wound dehiscence, deep infection, superficial infection, and nerve injury/deficit were recorded. Results: Post-operative CT scans demonstrated tibiotalar fusion in 85 of 102 (83.3%) patients. Of the 17 (16.7%) patients who were classified as non-unions, only 8 (47.1%) of them were symptomatic. Five patients (3.9%) in the union group and 2 patients (7.1%) in the non-union group developed tibial stress fractures. In the union group, 13.3% of patients underwent at least one secondary procedure compared to 53.6% in the non-union group (p<0.001). FFI (p=0.04) and Coughlin (p=0.03) scores were statistically lower in patients who underwent secondary procedures. Eighty-six patients (84.3%) did not demonstrate fusion between the lateral talus and fibula by CT but PROM scores were not statistically different compared to patients who demonstrated talofibular fusion. Conclusion: Tibiotalar arthrodesis utilizing anterior plate fixation is a reliable procedure to achieve ankle fusion based on 50% osseous bridging on post-operative CT scan. However, our results utilizing the accuracy of CT scanning demonstrated a lower rate of ankle fusion than historically reports which are primarily based on plain film imaging. Rates of tibial stress fracture and post-operative wound complications are relatively low with anterior plating, supporting this ankle arthrodesis procedure. Post- operative evaluation of ankle fusions using CT scan should be highly consider regardless of technique.

Adverse Events in the Treatment of Periprosthetic Fractures Around the Knee – a Clinical and Radiological Outcome Analysis

2018 ◽  
Vol 156 (03) ◽  
pp. 287-297 ◽  
Author(s):  
Anna Schreiner ◽  
Christoph Gonser ◽  
Christoph Ihle ◽  
Max Zauleck ◽  
Tim Klopfer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Revision Surgery ◽  
Plate Fixation ◽  
Oxford Knee Score ◽  
Revision Arthroplasty ◽  
Periprosthetic Fractures ◽  
X Rays ◽  
Non Union ◽  
Revision Tka

Abstract Background The incidence of periprosthetic fractures associated with total knee arthroplasty (PpFxK) has been reported to be 0.3 – 5.5%. 40% of all cases are related to revision TKA. The most common localisation is the distal femur. Classification is performed according to Rorabeck (RB). RB I – II fractures are usually treated with locked plating and retrograde intramedullary nailing, whereas RB III fractures are an indication for revision arthroplasty using a hinged endoprosthesis. PpFxK of the patella can be classified according to Goldberg and PpFxK of the proximal tibia can be grouped as in Felix. Interprosthetic fractures can be regarded as a special type of PpFx. Due to the increasing numbers of TKA being performed, increasing numbers of adverse events in arthroplasty can be expected. Adverse events in the treatment of PpFxK occur in up to 41% of patients according to the literature and revision is needed in approximately 29% of all cases. Risk factors are age, osteoporosis, infection, malalignment, osteolysis/loosening of the implant and status post revision. Patients A clinical and radiographic follow-up was performed with 50 patients (14 men, 36 women) treated for PpFxK of the femur, tibia and patella between 2011 and 2015 at the department of arthroplasty at a level 1 trauma center in Europe. Results The follow-up of all patients was 68%, with an average of 19.1 ± 14.6 (1 – 49) months between PpFxK and clinical follow-up. 16% of the patients were allocated for further treatment or revision surgery from other hospitals. The patientsʼ median age was 78.0 ± 8.8 (55 – 94) years. Most patients were affected by several orthopaedic and internal medical comorbidities. PpFxK classified as RB II were the most common fractures (60%, n = 30). PpFxK usually occurred 5.0 ± 4.8 (0 – 20) years after index TKA (primary or revision TKA), mostly in patients with CR-retaining endoprosthesis, whereas PpFxK according to Felix occurred significantly earlier and mostly in hinged TKAs. Patients achieved on average a mean Oxford Knee Score of 31.1 ± 9.9 (14 – 46) points. The functional Knee Society Score (KSS) was 52.6 ± 24.4 (20 – 100) and the mean KSS was 58.7 ± 26.8 (0 – 99) points (n = 25). Radiographic evaluation of the RB I – II patients showed frontal and sagittal malalignment in 20.6% of all cases after reduction and plate fixation. The overall rate of surgical adverse events was 50%; 44% of all RB patients needed revision surgery. Adverse events comprised non-union, failure of osteosynthesis, infection, wound healing disorders and re-fractures in the RB II and the Felix subgroup. Conclusion PpFxK are severe injuries and are associated with a high rate of adverse events related to treatment. Patients often have a complex background and a history of revision surgery or periprosthetic joint infection. The treatment of PpFxK should therefore take place at a centre with expertise in traumatology as well as in revision arthroplasty. Preoperative infection diagnostic testing as well as adequate imaging (X-rays and CT) are essential. We furthermore advise early evaluation of revision arthroplasty, especially in elderly patients suffering from PpFxK with insufficient bone quality around the TKA and closeness between fracture and TKA. In the case of plate fixation, it is important to give attention to correct reduction – to prevent non-union, loosening of the implant and failure of the osteosynthesis – as well as to consider double plating.

scholarly journals Anterior cervical discectomy and fusion performed using structural allograft or polyetheretherketone: pseudarthrosis and revision surgery rates with minimum 2-year follow-up

2020 ◽  
Vol 32 (4) ◽  
pp. 562-569
Author(s):  
Minghao Wang ◽  
Dean Chou ◽  
Chih-Chang Chang ◽  
Ankit Hirpara ◽  
Yilin Liu ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Plate Fixation ◽  
Anterior Cervical Discectomy ◽  
Anterior Plate ◽  
Cervical Discectomy ◽  
Posterior Surgery ◽  
Structural Allograft ◽  
Significant Difference ◽  
Surgery Rates

OBJECTIVEBoth structural allograft and PEEK have been used for anterior cervical discectomy and fusion (ACDF). There are reports that PEEK has a higher pseudarthrosis rate than structural allograft. The authors compared pseudarthrosis, revision, subsidence, and loss of lordosis rates in patients with PEEK and structural allograft.METHODSThe authors performed a retrospective review of patients who were treated with ACDF at their hospital between 2005 and 2017. Inclusion criteria were adult patients with either PEEK or structural allograft, anterior plate fixation, and a minimum 2-year follow-up. Exclusion criteria were hybrid PEEK and allograft cases, additional posterior surgery, adjacent corpectomies, infection, tumor, stand-alone or integrated screw and cage devices, bone morphogenetic protein use, or lack of a minimum 2-year follow-up. Demographic variables, number of treated levels, interbody type (PEEK cage vs structural allograft), graft packing material, pseudarthrosis rates, revision surgery rates, subsidence, and cervical lordosis changes were collected. These data were analyzed by Pearson’s chi-square test (or Fisher’s exact test, according to the sample size and expected value) and Student t-test.RESULTSA total of 168 patients (264 levels total, mean follow-up time 39.5 ± 24.0 months) were analyzed. Sixty-one patients had PEEK, and 107 patients had structural allograft. Pseudarthrosis rates for 1-level fusions were 5.4% (PEEK) and 3.4% (allograft) (p > 0.05); 2-level fusions were 7.1% (PEEK) and 8.1% (allograft) (p > 0.05); and ≥ 3-level fusions were 10% (PEEK) and 11.1% (allograft) (p > 0.05). There was no statistical difference in the subsidence magnitude between PEEK and allograft in 1-, 2-, and ≥ 3-level ACDF (p > 0.05). Postoperative lordosis loss was not different between cohorts for 1- and 2-level surgeries.CONCLUSIONSIn 1- and 2-level ACDF with plating involving the same number of fusion levels, there was no statistically significant difference in the pseudarthrosis rate, revision surgery rate, subsidence, and lordosis loss between PEEK cages and structural allograft.

Ankle Arthrodesis With Anterior Plate Fixation in Patients at High Risk for Nonunion

2019 ◽  
Vol 13 (3) ◽  
pp. 211-218
Author(s):  
Brian D. Steginsky ◽  
Mallory L. Suhling ◽  
Anand M. Vora
Keyword(s):  
High Risk ◽  
Functional Outcome ◽  
Plate Fixation ◽  
Comparative Trial ◽  
Ankle Arthrodesis ◽  
Anterior Plate ◽  
Computed Tomography Images ◽  
Foot Function ◽  
Tibiotalar Arthrodesis ◽  
Segmental Bone

Between January 1, 2011, and January 1, 2017, an orthopaedic foot and ankle surgeon performed tibiotalar arthrodesis on 221 patients. Thirty-two were included in this study. Inclusion criteria included patients with at least one risk factor for nonunion and/or malunion, isolated anterior ankle arthrodesis with plate fixation, patients older than 18, and a minimum of 1-year follow-up. Risk factors were avascular necrosis of the talus, severe segmental bone defect, smoking, inflammatory arthropathy, coronal deformity greater than 15°, diabetes mellitus, septic nonunion, failed ankle arthrodesis, and body mass index greater than 35. Functional outcome questionnaires (Ankle Osteoarthritis Score [AOS] and Foot Function Index [FFI]) were collected at the latest visit or by phone. Twenty-six (26/32, 81.2%) patients included in the study had computed tomography images available for review at an average of 3.2 months after surgery. The rate of successful arthrodesis was 93.8% (30/32) at an average of 78 days. Overall, 14 patients (14/32, 43.8%) developed a postoperative complication, including 1 patient that had a delayed nonunion and 2 patients that proceeded to nonunion. Twenty-three patients (23/32, 71.9%) completed the functional outcome questionnaires at an average of 26.8 months. Mean AOS and FFI scores improved significantly postoperatively ( P < .001). Sagittal tibiotalar and coronal tibiotalar alignment improved significantly in patients with severe preoperative deformity ( P < .001). Tibiotalar arthrodesis with anterior plate fixation in a high-risk cohort results in high union rates and significantly improved functional outcomes. Levels of Evidence: Therapeutic, Level IV: Prospective, comparative trial.

scholarly journals Results to 4-year follow-up of the treatment of the cervical stenosis by corpectomy, titanium mesh cage and anterior plate fixation

2017 ◽  
Vol 85 (5) ◽  
pp. 381-386
Author(s):  
Alejandro Antonio Reyes Sánchez ◽  
Luis Alberto Gameros Castañeda ◽  
Claudia Obil Chavarría ◽  
Armando Alpizar Aguirre ◽  
Barón Zárate Kalfópulos ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Cervical Stenosis ◽  
Titanium Mesh ◽  
Anterior Plate ◽  
Titanium Mesh Cage ◽  
Mesh Cage

scholarly journals Treatment of Zone II and III Fifth Metatarsal Fractures Using a Novel Fixation Technique

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Stephanie K. Eble ◽  
Oliver B. Hansen ◽  
Martin J. O’Malley ◽  
Mark C. Drakos
Keyword(s):  
Postoperative Complications ◽  
Return To Sport ◽  
Vascular Supply ◽  
X Rays ◽  
Non Union ◽  
Anatomic Reduction ◽  
Metatarsal Fractures ◽  
Zone Ii ◽  
Operative Notes

Category: Sports; Lesser Toes Introduction/Purpose: Zone II and III 5th metatarsal fractures are common injuries which can be addressed surgically with percutaneous fixation following anatomic reduction. Limited vascular supply and the specific anatomy of the 5th metatarsal causes concern for non-union of these fractures. This study evaluated a novel screw designed to optimize 5th metatarsal fixation. The titanium alloy headless screw (Jones Union System, Extremity Medical, Parsippany, NJ) provides compression across the fracture site using variable angle pitch and is designed to minimize the occurrence of painful hardware. In addition, we use an intramedullary reamer to create local autologous bone grafting in conjunction with an osteoplasty of the cuboid to obtain ideal positioning. This study represents the first to evaluate clinical outcomes following fixation with this system. Methods: Patients treated for a 5th metatarsal fracture between 2018 and 2019 by two surgeons fellowship-trained in foot and ankle orthopedics were identified. Operative notes were reviewed to ensure that patients were treated with the headless compression screw. 21 patients (22 fractures) were identified. Postoperative x-rays were reviewed to evaluate osseous bridging and time to union was determined. Retrospective chart review was performed to determine time to return to sport. Postoperative complications, including non-unions, need for revision, and need for hardware removal, were also evaluated. Results: Of the 22 total fractures, 16 were Zone II fractures and 6 were Zone III fractures. Average time to clinical follow-up was 13.60 months (range, 3.91-25.07). Average age at time of surgery was 28.82 years (range, 16 to 66). 16 males and 5 females were represented with average BMI of 27.41 kg/m2. Average time to union was 6.78 weeks (range, 5.13-12.12), and average time to return to sport was 11.38 weeks (range, 5.87-15.12). No patients experienced a non-union or painful hardware, and no other postoperative complications were observed. Conclusion: Fixation of Jones fractures using the Jones Union System produced excellent postoperative outcomes. This system, designed to address the challenges of 5th metatarsal anatomy, demonstrated effectiveness with expeditious times to union and return to sport. Union rates were high, and our cohort did not experience any postoperative complications. Although follow-up in some cases is short, no patient has experienced painful hardware. Our results suggest that this system is an effective approach for fixation of Zone II and III 5th metatarsal fractures.

scholarly journals Clinical and Radiographic Outcomes of Tibiotalocalcaneal or Pantalar Arthrodesis Using a Novel Lateral Locking Plate

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0041
Author(s):  
Tyler Rutherford ◽  
John Campbell ◽  
Rebecca Cerrato ◽  
Clifford Jeng
Keyword(s):  
Plate Fixation ◽  
Large Diameter ◽  
Lateral Side ◽  
Study Group ◽  
X Rays ◽  
Lateral Plate ◽  
Side Plate ◽  
Tertiary Referral Center ◽  
Number Of Patients

Category: Ankle Introduction/Purpose: For patients suffering from severe ankle and hindfoot arthritis or deformity, tibiotalocalcaneal (TTC) or pantalar arthrodesis may be the best option to achieve a plantigrade and painless foot. These fusions are typically fixed with a retrograde intramedullary nail, a lateral side plate, or screws alone. Theoretically, the advantages of a lateral side plate applied via a trans-fibular approach include the use and the multiple points of fixation available in the tibia, talus, and calcaneus. The results of a novel side plate construct with a unique screw hole that extends underneath the calcaneus are presented in this study. A large diameter screw can be inserted retrograde through this inferior hole to engage the medial tibial cortex and provide axial compression across the ankle and subtalar joints. Methods: This study retrospectively evaluated 39 patients that underwent a tibiotalocalcaneal (TTC) or pantalar arthrodesis using this novel lateral plate fixation technique by one of three fellowship trained surgeons at a tertiary referral center. Patients with less than a one year follow up were excluded. Thirty-nine patients were identified between 2012 and 2016. Two patients were deceased from other causes, 2 had a below the knee amputation due to chronic pain, and 9 were lost to follow up. Pre- and postoperative General Health and Wellness (SF-12) and Revised Foot Function Index scores were obtained. Study subjects were seen for a clinical evaluation and final post-operative x-rays. The Shapiro-Wilk test was used to test for normality. The paired student’s t-test was used to compare pre- and post-surgical outcome measures. Results: Twenty-six patients were included in the study group. Mean follow up time was 34.42 ± 12.94 months. The SF-12 score was 32.2 ± 10.22 (physical) and 54.8 ± 10.7 (mental) before surgery, and 41.35 ± 9.21 (p < 0.01) and 56.5 ± 7.47 (p = 0.73) at final follow-up, respectively. The FFI score was 106 ± 32.69 before surgery and 53.94 ± 24.14 after surgery (p = 0.06). Eighteen patients were satisfied or very satisfied with the outcome of the surgery (70%). CT confirmation of joint fusion was obtained in all 26 patients. Twenty out of the 26 patients demonstrated fusion of all joints (77%). There were 2 ankle, 1 subtalar, and 1 talonavicular nonunions. In total, 44 of 48 total joints were fused (91%). Conclusion: Tibiotalocalcanceal and pantalar arthrodesis using a novel lateral plate for the treatment of complex deformity and severe osteoarthritis demonstrated acceptable fusion rates considering the number of patients with high risk factors for nonunion in this study group. Complications included fractures at the proximal end of the plate construct and persistent neurapraxia which was well tolerated. Patients reported significant improvements in SF-12 clinical scores at final 34 month follow-up.

scholarly journals Complication Rates in Ankle and Hindfoot Charcot Arthropathy Treated with Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
David M. Macknet ◽  
Andrew Wohler ◽  
Bruce E. Cohen ◽  
J. Kent Ellington ◽  
Carroll P. Jones ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Limb Salvage ◽  
Ankle Arthrodesis ◽  
Limb Salvage Rate ◽  
Charcot Arthropathy ◽  
Non Union ◽  
Radiographic Union ◽  
Salvage Rate

Category: Diabetes; Ankle; Hindfoot; Other Introduction/Purpose: Charcot arthropathy of the ankle and hindfoot is a progressive and destructive process that can lead to instability and ulceration resulting in significant morbidity. When indicated, the surgical goals are to restore a stable plantigrade foot, reduce the risk of ulceration, and improve function to independent ambulation. Techniques for reconstruction of the neuropathic ankle/hindfoot include external and/or internal fixation. Current literature involving small series of surgical patients has shown a high rate of limb salvage and low complication rate. Our experience has been less promising, although we believe it remains a viable option. It is our goal to report the outcomes of Charcot patients undergoing corrective ankle and hindfoot reconstruction. Methods: We retrospectively reviewed 377 patients undergoing hindfoot and ankle arthrodesis at our institution from 2006- 2017. 77 patients were identified that underwent arthrodesis for Charcot arthropathy, 51 of which met inclusion and exclusion criteria with a minimum one year follow up. 42 had internal fixation as their primary procedure (plate or nail) and 9 patients underwent external fixation with a multi-planar external fixator. Median follow up time was 4 years (IQR 2.97 years). Preoperatively, basic demographic variables, etiology of neuropathy, ulcer status, radiographic measurements, Brodsky classification, and presence of a viable talus were collected and analyzed. Postoperatively, we collected complications including infection, hardware failure, ulceration, recurrent deformity, and nonunion. Reoperation numbers and indications for reoperation were also collected. The primary outcome measure was limb salvage at final follow up. Secondary outcome measures were ambulatory and footwear/bracing status. Results: 11 patients (20%) underwent amputation at final follow up and 26 (47.3%) achieved radiographic union, both of which did not vary by fixation type (p=0.67 and p=0.88). The primary reasons for amputation were persistent infection and non-union. 74.5% of patients developed a post-operative complication and 58.2% had at least one reoperation. 25.5% of patients developed a post- operative infection. Patients with a pre-operative ulceration were more likely to undergo external fixation (p=0.02), but amputation rates did not differ between groups (p>0.99). There was a trend toward increased risk of post-operative infection in the ulceration group (p=0.07). A pre-operative Meary’s angle >25° was more likely to undergo amputation (p=0.04) and less likely to achieve radiographic union (p=0.05). 75.9% of patients were ambulatory at final follow up. Conclusion: Our rates of amputation (20%), post-operative infection (25%), complications (74.5%) and non-union (52%) are higher than previously described. Previous literature has described a near 100% limb salvage rate, but in our report on a large series of Charcot patients undergoing hindfoot/ankle arthrodesis we describe an 80% limb salvage rate. Pre-operative Meary’s angle >25° was predictive of treatment failure.

scholarly journals Rotationplasty for Severe Congenital Femoral Deficiency

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 462
Author(s):  
Corey B. Fuller ◽  
Craig H. Lichtblau ◽  
Dror Paley
Keyword(s):  
Delayed Union ◽  
Senior Author ◽  
Wound Complications ◽  
Tibial Osteotomy ◽  
Radiographic Outcomes ◽  
Tibial Condyle ◽  
Age At Surgery ◽  
Reconstructive Option ◽  
Severe Degree

Rotationplasty is a reconstructive option for severe congenital femoral deficiency (CFD). The senior author (D.P.) developed five new rotationplasty techniques for use in CFD based on the Paley classification, including the Paley–Brown (fusion femur to pelvis), Paley (fusion femur to femoral head), Paley–Winkelman (insertion tibial condyle to acetabulum), PaleySUPERhip–Van Nes (hip osteotomy with knee fusion) and PaleySling–Van Nes (hip reconstruction with knee fusion revision) rotationplasty techniques. The purpose of this study is to retrospectively evaluate the complications, radiographic outcomes and need for secondary surgery in 19 rotationplasty cases performed by the senior author (D.P.) for severe CFD from 2009 to 2019. Rotationplasty comprised only 2% of the authors treated CFD cases during this period. Average age at surgery was 8.6 years old. Average follow-up was 3.3 years. Sixteen concomitant procedures were performed including temporary arthrodesis, tibial osteotomy and SUPERhip procedure. The most common complication was wound necrosis/dehiscence, which occurred in 52% of the cases related to the circumferential incision and required a total of 31 additional debridements. Additional complications were successfully treated and included sciatic nerve palsy decompressed by abducting the femur, a tibial delayed union that underwent bone grafting, two distal femur failed epiphysiodesis treated by revision with one osteotomy and a thigh compartment syndrome requiring debridement. Indication specific rotationplasty successfully addresses the severe degree of femoral deficiency, deformity, and discrepancy in patients with CFD, despite high rates of wound complications.

scholarly journals Neer Type II Distal End Clavicular Fracture: Outcome with Clavicular Hook Plate Fixation

2020 ◽  
Vol 2 (2) ◽  
pp. 1-4
Author(s):  
Sagar Panthi ◽  
Rishiswor Shrestha ◽  
Sabal Krishna Gaihre ◽  
 Angelica Karki ◽  
Suyachha Chettri
Keyword(s):  
Plate Fixation ◽  
Adult Population ◽  
Hook Plate ◽  
Type Ii ◽  
Clavicular Fracture ◽  
Rare Type ◽  
Non Union ◽  
Excellent Outcome ◽  
Clavicular Hook Plate

Background: Distal end clavicular fractures are rare type of injuries seen in adult population. These fractures are unstable because of various deforming forces. Clavicular hook plate aligns the clavicle along with ligaments. The aim of this study is to observe the outcome of displaced distal end clavicular fracture managed with hook plate fixation.Methods: Twenty five patients with displaced distal end clavicular fractures (Neer type II) were evaluated retrospectively from November 2018 to September 2020. Functional outcome were assessed via Constant and Murley score at one year final follow-up.Results: 60% of patient had excellent outcome, 32% of patient had good outcome and 8% of patient had fair outcome at final follow-up. Mean Constant and Murley score was 86. Four patients developed subacromial osteolysis which resolved at final follow-up. One patient had extra-articular ossification whereas none of the patient developed non-union and AC joint arthrosis.Conclusion: Clavicular hook plate provides stable fixation of distal end clavicular fracture with few complications and is cost-effective.Keywords: Clavicular Hook Plate; Complications; Distal End Clavicular Fractures; Subacromial Osteolysis

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