scholarly journals Is it justifiable to perform tibio-talar arthrodesis rather than fixation as the treatment for severe pilon fractures?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039
Author(s):  
Jayasree Ramaskandhan ◽  
Malik Siddiqu ◽  
Sultan Qasim
Keyword(s):  
Functional Disability ◽  
Statistical Tests ◽  
Definitive Treatment ◽  
Pilon Fracture ◽  
Primary Osteoarthritis ◽  
Functional Scores ◽  
Group A ◽  
Group B ◽  
Pilon Fractures

Category: Trauma Introduction/Purpose: The purpose of this study was to compare functional outcome at minimum 2 years follow up post fixation of pilon fractures to that of patients undergoing elective procedure (in the form of TAR or ankle arthrodesis) for primary osteoarthritis of the ankle to assess whether pilon fracture patients would benefit from tibio-talar arthrodesis as a primary procedure rather than fixation to avoid significant functional disability between primary fixation and subsequent arthrodesis. Methods: This is a retrospective study of prospectively collected data of patients operated between April 2012 and December 2015. All patients with primary osteoarthritis undergoing elective TAR/arthrodesis (Group A) had pre-op functional scores recorded (MOX-FQ, EQ-5D and Foot and ankle outcome score FAOS). Patients with bilateral ankle arthritis, previous reconstructive surgery, inflammatory arthritis, hip and knee arthritis, spinal pathology and underlying neurological conditions were excluded from Group A. Patients in Group B (post Pilon fracture fixation with a minimum 2 year follow up) completed a postal questionnaire with the above scores. Outcomes between groups were compared using inferential statistical tests using SPSS. Results: Mean age of patients in Group A and Group B were (62.6 ± 10.9 years) and (46.4 ± 15 years) respectively; p<0.001. In group B, 9 patients (16.6%) had associated injuries and 45 patients (83.3%) had isolated injuries. 49 patients underwent an open reduction and internal fixation vs. 5 patients with hybrid fixator as a definitive management in Group B with 2 patients having significant infection (1 in each group). The results of functional scores comparing Group A to Group B (including sub-group analysis) are awaited and will be submitted subject to acceptance of this abstract. Conclusion: The outcomes of pilon fracture are well known to be poor with high rate of secondary osteoarthritis and significant functional disability associated with it in young individuals in active employment. The gold standard treatment for patients with significant osteoarthritis of the ankle is tibio-talar arthrodesis. However, a group of these patients continue to have high functional disability between initial injury and to the point of tibio-talar arthrodesis. The results of this study will highlight the justification to perform tibio-talar arthrodesis as a definitive treatment at the time of injury, rather than fixation.

scholarly journals Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199042
Author(s):  
Hyungsuk Kim ◽  
Chu Hwan Byun ◽  
Sung Bin Han ◽  
Hyun Seok Song
Keyword(s):  
Los Angeles ◽  
Constant Score ◽  
Early Postoperative Period ◽  
Level Of Evidence ◽  
Supraspinatus Tear ◽  
Functional Scores ◽  
Group A ◽  
Vas Scores ◽  
Group B

Background: Although everted bursal flaps of delaminated tears have been reported, few studies have reported radiologic images, arthroscopic findings, and clinical results after repair. Purpose: To compare the repair outcomes of everted delaminated tears with those of classic delaminated supraspinatus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Among 153 patients who underwent arthroscopic rotator cuff repair for a delaminated supraspinatus tear, everted bursal flap tears were observed in 24 patients upon arthroscopy (group A). Another 24 patients with classic delaminated supraspinatus tears, matched for age and sex, were selected for group B. Magnetic resonance imaging (MRI) and ultrasonography were performed preoperatively and postoperatively. Patients were evaluated using a visual analog scale (VAS) for pain as well as functional scores (American Shoulder and Elbow Surgeons [ASES] score, Constant score, and University of California Los Angeles shoulder score). Scores were compared preoperatively and at final follow-up (mean follow-up, 32 months). Results: Patients in both groups A and B reported improved VAS and functional scores at the final follow-up. In group A, preoperative VAS scores were higher and functional scores were poorer than in group B. Subacromial effusions with tendon swelling on preoperative MRI were more common in group A. During follow-up ultrasonography, group A patients exhibited persistent subacromial effusion. However, VAS scores at final follow-up were significantly better in group A (0.4 ± 0.7) than in group B (1.6 ± 1.4) ( P < .001), and ASES scores at final follow-up were better in group A (84.3 ± 4.3) than in group B (77.0 ± 10.2) ( P = .005). Conclusion: Everted bursal flap delaminated tears were associated with higher VAS scores and poorer functional scores preoperatively. Although subacromial effusions were experienced by group A during the early postoperative period, clinical outcomes at final follow-up were significantly better for everted delaminated tears compared with classic delaminated tears.

scholarly journals Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Pompeo Catania ◽  
Daniele Passaretti ◽  
Giorgio Montemurro ◽  
Simone Ripanti ◽  
Stefano Carbone ◽  
...  
Keyword(s):  
Blood Loss ◽  
Age Distribution ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Intraoperative Blood Loss ◽  
Pertrochanteric Fractures ◽  
Functional Scores ◽  
Group A ◽  
Group B

Abstract Introduction Pertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails. Materials We enrolled 323 subjects with PFs, classified according to AO/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma® nail (155 cases) and group B, Gamma 3-Stryker® nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12 months. Results The study group was composed of 106 male and 217 female with an average age of 85.4 (range, 65–90, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45 ml vs 51 ml, respectively (p < 0.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (p = 0.0347). The greatest difference was detectable comparing subgroups 31.A2 (p = 0.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (p < 0.001). Conclusion Elos® nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3® nail, a well-known and appreciated system for over 25 years.

scholarly journals Foot Loading Analysis of Intraarticular Tibia Pilon Fracture

2021 ◽  
Author(s):  
Anil Agar ◽  
Adem ŞAHİN ◽  
Seyit Ali Guclu ◽  
Deniz Gülabi ◽  
Cemil Erturk
Keyword(s):  
Functional Results ◽  
Pilon Fracture ◽  
Plantar Pressure Distribution ◽  
Functional Scores ◽  
The Mean ◽  
Foot Loading ◽  
Gait Function ◽  
Pilon Fractures ◽  
Loading Analysis

BACKGROUND: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of treatment and adverse effects on gait function. The aim of the study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis and plantar pressure distribution in patients with tibia pilon fractures. METHODS: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January 2015 and January 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria, ankle functional scores with the Teeny-Wiss score, and ankle arthrosis with the Takakura classification. In the last follow-up of the patients, foot loading analysis was performed and the results of the patients were evaluated for their relation with postoperative reduction quality, ankle functions and ankle arthrosis. RESULTS: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range 19-78). The mean follow-up was 34.3 months (range 24 - 58). The mean Ovadia-Beals score was 12.35 {plus minus} 4.6 in the postoperative plain radiographs of the patients; the mean Teeny-Wiss score in the last follow-up was 76.82 {plus minus} 17.69, and the Takakura score was 1.47 {plus minus} 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior and 52.42% on the posterior of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial of the ankle and 57.85% loaded on the lateral of the foot. CONCLUSION: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.

scholarly journals Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach.

2020 ◽  
Author(s):  
Chen Zhao ◽  
Lei Luo ◽  
Liehua Liu ◽  
Pei Li ◽  
Lichuan Liang ◽  
...  
Keyword(s):  
Loss Rate ◽  
Deformity Correction ◽  
Operation Time ◽  
Clinical Results ◽  
Surgery Group ◽  
Significant Difference ◽  
Functional Scores ◽  
Group A ◽  
Group B

Abstract Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis.Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores and complications were compared between the two groups.Results: There was no significant difference in the operation time or blood loss between groups A and B (P>0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2±15.2° and 27.9±7.7°, respectively, which significantly decreased to 4.9±11.8° and 10.4±5.6° after the operation, respectively (P<0.05). At the final follow-up, the angles were 7.1±10.5° and 14.6±8.0°, respectively. The correction angle and correction rate in group A (31.3±16.6°, 88.6±43.6%) were greater than those in group B (17.5±4.4°, 64.9±14.0%) (P<0.05). There was no significant difference in the loss angle between groups A and B (P>0.05), but the loss rate in group B (24.0±27.8%) was higher than that in group A (9.6±10.2%) (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

scholarly journals Relationship Between Age at Initial Shoulder Instability and Overall Outcomes After Arthroscopic Bankart Repair: Mean 6-Year Follow-up

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096488
Author(s):  
Sijia Feng ◽  
Yuxue Xie ◽  
Mo Chen ◽  
Yuzhou Chen ◽  
Zheci Ding ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Shoulder Instability ◽  
Structural Changes ◽  
Bankart Repair ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores ◽  
Structural Differences ◽  
Group A ◽  
Group B

Background: Age at surgery plays a crucial role in the frequency of recurrent shoulder instability. However, there are few studies that evaluate the relationship between age at initial shoulder instability and overall outcomes after stabilization surgery. Purpose: To compare clinical outcomes and structural changes after arthroscopic Bankart repair in patients who experienced initial shoulder instability during adolescence versus those with later onset instability. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients who underwent arthroscopic Bankart repair at a single institution between 2007 and 2017. Comparisons were made between patients who experienced initial shoulder instability during adolescence (age 13-19 years; group A) and those with later onset instability (age 20-35 years; group B). Clinical outcomes (recurrence rate, postoperative pain, functional scores, active range of motion, and return to sports) and structural changes demonstrated by magnetic resonance imaging (MRI) were evaluated at minimum 2-year follow-up. In addition, functional outcomes within each group were compared between the patients with and without postoperative recurrence. Results: A total of 58 patients were included (24 patients in group A and 34 patients in group B). The mean follow-up was 72.1 months. Group A demonstrated a significantly higher recurrence rate than group B (41.7% vs 11.8%, respectively; P = .009; risk ratio, 5.36 [95% CI, 1.43-20.09]) as well as significantly lower Rowe (76.9 ± 20.1 vs 88.7 ± 13.2, respectively; P = .01) and Constant-Murley scores (92.2 ± 7.6 vs 96.3 ± 4.2, respectively; P = .01). Postoperative MRI revealed no significant structural differences between the groups regarding the glenoid labrum, glenohumeral cartilage, or osseous reaction around the implanted anchors. In group A, patients with recurrence had less satisfaction regarding postoperative sports level than those without recurrence, whereas in group B, patients with recurrence had more postoperative pain and functional impairment compared with those without recurrence. Conclusion: Initial shoulder instability during adolescence was associated with a higher recurrence rate and lower functional scores after arthroscopic Bankart repair compared with later onset instability, although no significant structural differences were found between the groups on MRI at a mean 6-year follow-up.

scholarly journals Diabetic Foot: Surgical Approach in Emergency

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
C. Setacci ◽  
P. Sirignano ◽  
G. Mazzitelli ◽  
F. Setacci ◽  
G. Messina ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Major Amputation ◽  
Surgical Debridement ◽  
Definitive Treatment ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Mean Time

Introduction. Critical limb lschemia (CLI) and particularly diabetic foot (DF) are still considered “Cinderella” in our departments. Anyway, the presence of arterial obstructive disease increases the risk of amputation by itself; when it is associated with foot infection, the risk of amputation is greatly increased.Methods. From January 2007 to December 2011, 375 patients with DF infection and CLI have been admitted to our Unit; from 2007 to 2009, 192 patients (Group A) underwent surgical debridement of the lesion followed by a delayed revascularization; from 2010 to 2011, 183 patients (Group B) were treated following a new 4-step protocol: (1) early diagnosis with a 24 h on call DF team; (2) urgent treatment of severe foot infection with an aggressive surgical debridement; (3) early revascularization within 24 hours; (4) definitive treatment: wound healing, reconstructive surgery, and orthesis. We reported rates of mortality, major amputation, and foot healing at 6 months of followup.Results. The majority of patients in both groups were male; no statistical differences in medical history and clinical condition were reported at the baseline. The main difference between the two groups was the mean time from debridement to revascularization (3 days in Group A and 24 hours in Group B). After 6 months of follow-up, mortality was 11% in Group A versus 4.4% in Group B. Major amputation rate was 39.6% and 24.6% in Groups A and B, respectively. Wound healing was achieved in 17.8% in Group A and 20.8% in Group B.Conclusions. This protocol requires a lot of professional skills that should to reach the goal to avoid major amputations in patients with DF. Only an interdisciplinary integrated DF team and an early intervention may significantly impact the outcome of our patients: “Time is Tissue”!

scholarly journals Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach.

2020 ◽  
Author(s):  
Chen Zhao ◽  
Lei Luo ◽  
Liehua Liu ◽  
Pei Li ◽  
Lichuan Liang ◽  
...  
Keyword(s):  
Loss Rate ◽  
Deformity Correction ◽  
Operation Time ◽  
Clinical Results ◽  
Surgery Group ◽  
Significant Difference ◽  
Functional Scores ◽  
Group A ◽  
Group B

Abstract Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis . Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores and complications were compared between the two groups. Results: There was no significant difference in the operation time or blood loss between groups A and B (P>0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2±15.2° and 27.9±7.7°, respectively, which significantly decreased to 4.9±11.8° and 10.4±5.6° after the operation, respectively (P<0.05). At the final follow-up, the angles were 7.1±10.5° and 14.6±8.0°, respectively. The correction angle and correction rate in group A (31.3±16.6°, 88.6±43.6%) were greater than those in group B (17.5±4.4°, 64.9±14.0%) (P<0.05). There was no significant difference in the loss angle between groups A and B (P>0.05), but the loss rate in group B (24.0±27.8%) was higher than that in group A (9.6±10.2%) (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

scholarly journals Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach.

2020 ◽  
Author(s):  
Chen Zhao ◽  
Lei Luo ◽  
Liehua Liu ◽  
Pei Li ◽  
Lichuan Liang ◽  
...  
Keyword(s):  
Loss Rate ◽  
Deformity Correction ◽  
Operation Time ◽  
Clinical Results ◽  
Surgery Group ◽  
Significant Difference ◽  
Functional Scores ◽  
Group A ◽  
Group B

Abstract Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis . Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores and complications were compared between the two groups. Results: There was no significant difference in the operation time or blood loss between groups A and B (P>0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2±15.2° and 27.9±7.7°, respectively, which significantly decreased to 4.9±11.8° and 10.4±5.6° after the operation, respectively (P<0.05). At the final follow-up, the angles were 7.1±10.5° and 14.6±8.0°, respectively. The correction angle and correction rate in group A (31.3±16.6°, 88.6±43.6%) were greater than those in group B (17.5±4.4°, 64.9±14.0%) (P<0.05). There was no significant difference in the loss angle between groups A and B (P>0.05), but the loss rate in group B (24.0±27.8%) was higher than that in group A (9.6±10.2%) (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

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