scholarly journals NEMISIS Minimally Invasive Surgical Correction for Midfoot Charcot Arthropathy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035 ◽  
Author(s):  
Roslyn Miller
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Revision Surgery ◽  
Soft Tissues ◽  
Significant Risk ◽  
Wedge Osteotomy ◽  
Charcot Neuroarthropathy ◽  
Minimally Invasive Surgical ◽  
Wound Breakdown ◽  
Hind Foot

Category: Diabetes Introduction/Purpose: The most common cause of Charcot Neuroarthropathy is diabetes. The incidence of diabetes continues to rise globally, with a significant socio-economic burden to both patient and society. Despite good total contact casting techniques, deformity and subsequent ulceration still occurs in this patient group. This make shoe-fitting challenging and the risk of subsequent ulceration increases. This in-turn increases the patients risk of amputation and mortality at five years. Conservative treatment is often protracted, with multiple clinic visits. The has a significant impact on the patients ability to work and quality of life. Open surgery carries a significant risk of poor wound healing and infection again with risk of ulceration. NEMISIS for mid-foot Charcot provides surgeons with a surgical technique for osteotomy, that protects the soft tissues. Methods: The surgical technique utilises Minimally Invasive Shanon and Wedge burrs to perform a biplanar closing wedge osteotomy to achieve a triplanar correction. This takes the tension off the soft tissues which ensures that there is still good tissue cover, without compromising the blood supply to the skin, therefore in theory reducing the risk of infection. Stabilisation is achieved with screws, beams and bolts, +/-medial column plating. Patients are immobilised in a Bholer walker for a period of 3 months post-op. The short to medium term results (3months to 3 years) are presented. Patients are followed up to asses for re-ulceration at the same site, different site, failure of metalwork, return to surgery. Results: 16 patients were followed-up. 14 were diabetics. 4 patients developed deep-seated infection, which required removal of the metal-work. 2 of these patients did not have recurrence of their deformity and progressed to orthotic foot-wear. 1 patient had recurrence of deformity with wound breakdown and is awaiting further surgery. 1 patient had removal of metalwork from midfoot and subsequently developed hind-foot deformity which was stabilised with a hind-foot fusion nail. 1 patient broke the medial beam and bolts and required revision surgery. 2 patients had recurrence of plantar exostosis which was managed with minimally invasive exostectomy. 1 patient had early stabilisation of mid-foot and had subsequent Charcot of the talus, managed conservatively. The remaining patients have not required revision surgery. There have been not amputations. Conclusion: NEMISIS Minimally Invasive Surgery for Mid-Foot Charcot is a promising surgical technique which may help to reduce infection rates and subsequent amputations. The technique is relatively straightforward to teach, but is currently limited by the size of the burrs. The technique however can be coupled with innovation in biologics to aid the surgeon further in trying to achieve a stable plantigrade foot that does not have recurrence of ulceration and deformity.

scholarly journals NEMISIS for diabetic forefoot pathology

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035
Author(s):  
Roslyn Miller
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Achilles Tendon ◽  
Invasive Surgery ◽  
Soft Tissues ◽  
Significant Risk ◽  
Cost Benefit ◽  
Metatarsal Head ◽  
Normal Function ◽  
Charcot Neuroarthropathy

Category: Diabetes Introduction/Purpose: The most common cause of Charcot Neuroarthropathy is diabetes. The incidence of diabetes continues to rise globally, with a significant socio-economic burden to both patient and society. Despite good total contact casting techniques, deformity and subsequent ulceration still occurs in this patient group. This make shoe-fitting challenging and the risk of subsequent ulceration increases. This in-turn increases the patients risk of amputation and mortality at five years. Conservative treatment is often protracted, with multiple clinic visits. The has a significant impact on the patients ability to work and quality of life. Open surgery carries a significant risk of poor wound healing and infection again with risk of ulceration. NEMISIS for mid-foot Charcot provides surgeons with a surgical technique for osteotomy, that protects the soft tissues. Methods: 15 patients had NEMISIS Minimally Invasive Surgery to their forefoot for management of diabetic foot ulceration. 8 patients (11 metatarsal heads)had debridement of a metatarsal head with Minimally Invasive Shannon and Wedge Burrs. 1 patient had 3 separate debridements, but of different metatarsal heads. 2 patients had surgery to the 1st metatarsal. 1 patient had minimally invasive debridement of sesamoids. All patients had their Achilles tendon assessed for increased tension. Percutaneous tenotomy was performed if the Achilles was found to be tight. Only the patients with surgery to the 1st Metatarsal required screw fixation. All cases were performed as day cases. Results: Patients were able to be discharged the same day, with weekly follow-up for dressings. Patients were allowed to fully weight bear as tolerated. Ulcers healed within six week on average. There were no recurrences of ulcer on the same metatarsal head within the time period. Patients had often had ulcers present, in excess of six months prior to being referred for surgery. All patients were delighted with the result. Conclusion: NEMISIS Minimally Invasive Surgery for diabetic forefoot pathologies provides rapid healing for patients with chronic ulceration. Their biomechanics should be assessed pre-operatively to check if there is significant forefoot overloading. If so, the Achilles tendon should also be addressed. Early intervention with NEMISIS Minimally Invasive Surgery, could reduce the number of visits the patient has to make to the clinic and also facilitate the firing of easier constructed shoes. This potentially will allow the patient to return to normal function as quickly as possible and thus potentially has significant cost benefit implications also.

scholarly journals Comparison of a minimally invasive surgical technique with open surgery for transverse patella fractures

2019 ◽  
Author(s):  
Jie Shao ◽  
Jiabao Wang ◽  
Yu Chen ◽  
Ningfang Mao ◽  
Qiulin Zhang ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Minimally Invasive Surgical ◽  
Patella Fractures

scholarly journals Results of a novel surgical technique for iridodialysis repair using segments

2021 ◽  
Author(s):  
Ugur Unsal ◽  
Huri Sabur ◽  
Mehmet Soyler
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Clinical Results ◽  
Study Data ◽  
Invasive Technique ◽  
Minimally Invasive Surgical ◽  
Corrected Distance Visual Acuity ◽  
History Of ◽  
Surgical Manipulation

Abstract Purpose: To describe a novel surgical technique for iridodialysis repair using iris retractor segments and report its clinical results.Methods: 53 eyes of 53 patients who underwent surgery for iridodialysis repair were enrolled in this retrospective study. Data recorded from patient files consisted of age, sex, history of trauma, surgical indications and type of surgery, preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and follow-up time. The novel, minimally invasive surgical technique was explicitly described in detail.Results: Mean follow-up time was 34.4 (range 12-84) months. The subjects were 29 (54.7%) men and 26 (45.3%) women, and the mean age was 56.6±14.0 years. Iridodialysis repair performed using one segment in 37 (69.8%) eyes, two segments in 15 (28.3%) eyes, and three segments in 1 (1.9%) eye. Pupilloplasty was performed in 17 eyes due to wide pupil diameter. The iridodialysis repair was combined with lens removal in 48 eyes, and anterior vitrectomy was performed in 10 eyes. CDVA significantly improved after surgery (p<0.001). Post-traumatic IOP rise was the most common complication, and six patients needed medical therapy for glaucoma control.Conclusion: Iridodialysis repair using iris retractor segment is a minimally invasive technique and found to be safe and effective, providing less surgical manipulation and surgical time than other techniques.

scholarly journals Percutaneous and Minimally Invasive Surgical Technique for Achilles Tendon Repair

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0025
Author(s):  
Tyler Hoskins ◽  
David Goyette ◽  
Jay Patel ◽  
Christopher Mazzei ◽  
Arianna L. Gianakos ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Achilles Tendon ◽  
Functional Outcome ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
P Value ◽  
Invasive Approach ◽  
Minimally Invasive Surgical ◽  
Iatrogenic Nerve Injury

Category: Ankle; Sports; Trauma Introduction/Purpose: Achilles tendon rupture is a traumatic injury that can cause considerable morbidity and reduced function. The optimal treatment method for this injury remains controversial. Non-operative intervention puts patients at higher risk of re-rupture whereas surgical intervention has risks of infection and iatrogenic nerve injury. Recently, surgeons have established a less invasive surgical approach to repairing the achilles tendon. The ‘Percutaneous or Mini-Invasive’ technique was adopted in order to reduce infection rates and wound breakdown. However, due to the scarce amount of literature reported, the efficacy of this procedure still remains under scrutiny. The goal of this study was to examine the functional outcomes of patients treated at our facility for a ruptured achilles tendon using the percutaneous and minimally invasive surgical technique. Methods: From 2014 to 2020 eighty-one patients underwent a percutaneous or mini invasive surgery at our facility for the treatment of a ruptured achilles tendon. Functional outcome scores were assessed using the American Orthopaedic Foot & Ankle scoring system (AOFAS) and the Achilles Tendon Rupture Score (ATRS). Outcomes, complications, and any reoperations were recorded through retrospective chart review, direct patient examination, and phone calls to patients and their families. A statistical analysis was performed using Fischer’s Exact Test. Results were deemed statistically significant if the calculated p-value was less than 0.05. Results: The mean follow up for our patient cohort was 36.40 months (range, 6 to 71). The average age was 41.46 years (range, 17- 65). Mean pre-op AOFAS and ATRS were 45.60 and 47.18 respectively, compared to 90.29 and 87.97 after surgery (p-value <0.05). There were two significant complications reported post-operatively. One patient re-ruptured their Achilles tendon four months post-operatively. This patient was successfully treated with a mini invasive approach and reconstruction of the tendon. A second patient developed a superficial infection ten months post-operatively. This patient successfully underwent irrigation and debridement of the wound. Conclusion: The pre-op and post-op AOFAS and ATRS scores were deemed statistically significant. A percutaneous and mini invasive approach to repair a ruptured achilles tendon, although new, offers promising functional outcome results and remains a viable treatment option to decrease the incidence rate of post-operative infection and iatrogenic nerve injury. However, a prospective randomized controlled trial comparing the efficacy of this procedure to other surgical methods would be necessary to further evaluate and validate our findings.

scholarly journals One-step Management of Severely Deformed, Long-Neglected Club Feet

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Michael Strauss ◽  
Isabella van Dalen
Keyword(s):  
Minimally Invasive ◽  
External Fixation ◽  
Soft Tissues ◽  
Operative Management ◽  
Wedge Osteotomy ◽  
Foot Deformities ◽  
Early Management ◽  
Tendon Transfers ◽  
One Stage ◽  
Deforming Forces

Category: Other Introduction/Purpose: Early management of the club foot using the Ponsetti technique has almost eliminated severe residual deformities from this problem. Unfortunately, in remote regions of the world patients may not have been afforded the benefits of this technique. The consequences are severely deformed, long-neglected foot deformities. Interventions to mitigate this problem have included talectomies, osteotomies, tendon transfers, gradual corrections using Ilizarov principles and as a last resort, transtibial amputations. All have undesirable features such as inadequate corrections with residual deformities, need for additional surgeries, intensive post-operative management and/or need for custom orthotics or prostheses. We propose a one-stage, single setting approach to this problem that fully realigns the foot and requires minimum of post-operative management. Methods: During a 2017 humanitarian mission to Vietnam, six patients with severely deformed, long-neglected club feet were managed at a remote orthopaedic rehabilitation facility using our one-stage, single surgery approach. The six-step procedure included: 1) Percutaneous tri-hemisections (Hoke) of the Achilles tendon, 2) Excision of lateral ulcers/bursas, 3) Minimally invasive releases of all constricting soft tissues structures, 4) Closing wedge osteotomy at apex of deformity, 5) Manual reduction to achieve plantigrade foot, and 6) Maintenance of correction with temporary spanning external fixation in five patients and percutaneous Steinmann pins in a four-year old patient. No tendon transfers were done. No tourniquets or perioperative antibiotics were used with these minimally invasive and percutaneous interventions. At six weeks, the external fixation was removed, walking casts were applied with minimal manipulations to optimally position the feet. At 12 weeks the casts were removed, patients allowed to use footwear of their choosing. Results: Follow-ups initially obtained weekly, then monthly through e-mails by a co-author fluent in Vietnamese were supplemented with photographs. Near-plantigrade feet axially aligned with the leg were obtained with all the initial corrections. By 48 hours pain was reported as minimal even though marked tension occurred across intact joint capsules in order to achieve the corrections. One skin, pin tract infection was reported that resolved once the pin was removed. Follow-up information at six months report that the corrections have been maintained with high satisfaction in all patients. Conclusion: Our innovative approach to deformed, neglected club feet is supported by appreciating the biomechanics of the problems. Dynamic deforming forces (tendons and muscles) must be released. Tendon transfers are inadequate to correct contractures. Bony deformities must be osteotomized. Viscoelasticity of ligaments and joint capsules deform with time and need not be released; corrections initially obtained using the fixators become permanent with time. Our experiences support the use of our approach for the patient population with which we dealt and suggest that earlier soft tissue releases of dynamic deforming forces be done in conjunction with the Ponsetti technique.

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