scholarly journals Repair of the acute deltoid ligament complex rupture associated with ankle fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Ming-Zhu Zhang ◽  
Guang-rong Yu
Keyword(s):  
Ankle Instability ◽  
Outcome Measurement ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Ligament Rupture ◽  
Sf 36 ◽  
The Mean ◽  
Mean Time ◽  
Center Study

Category: Trauma Introduction/Purpose: It is controversial for operative repair of deltoid ligament in acute ankle fractures. To investigate the indication for surgical interference and the clinical outcome about repair whole deltoid ligament rupture associating with ankle fractures. Methods: We performed multiple-center study in 4 clinical centers in 4 cities of China. From January 2006 to December 2011, of 1533 ankle fractures operated, 131 deltoid ligament rupture were identified and repaired operatively. They were 74 males and 57 females with a mean age of 37.2 years (range, 15-83 years). Clinical examination, radiographs, AOFAS ankle-hindfoot scores and visual analogue scale were used for outcome measurement. Results: All incision healed primarily. 106 patients were followed up for 12 to 72 months with the mean follow-up of 27 months. The mean time of fracture union was 14.5 weeks (range, 9-16 weeks). The mean AOFAS ankle-hindfoot score at last follow-up was 91.4 points (range, 83-100 points). The mean score of VAS was 1.2 points (range, 0-6 points). The mean score of SF-36 was 91.2 points (range, 80-96 points). There was no ankle instability and post-trauma osteoarthritis. Conclusion: This multiple-center study demonstrated that deltoid ligament repair can benefit patients with unstable ankle after fracture fixation. A reasonable clinical evaluation and surgical repair could be done, choosing an appropriate repair technique according to the site of deltoid ligament rupture.

scholarly journals Repair of the Deltoid Ligament Complex Rupture Associated with Ankle Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Mingzhu Zhang
Keyword(s):  
Ankle Instability ◽  
Outcome Measurement ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Ligament Rupture ◽  
Sf 36 ◽  
The Mean ◽  
Mean Time ◽  
Center Study

Category: Ankle Introduction/Purpose: It is controversial for operative repair of deltoid ligament in acute ankle fractures. To investigate the indication for surgical interference and the clinical outcome about repair whole deltoid ligament rupture associating with ankle fractures. Methods: We performed multiple-center study in 4 clinical centers in 4 cities of China. From January 2006 to December 2011, of 1533 ankle fractures operated, 131 deltoid ligament rupture were identified and repaired operatively. They were 74 males and 57 females with a mean age of 37.2 years (range, 15-83 years). Clinical examination, radiographs, AOFAS ankle-hindfoot scores and visual analogue scale were used for outcome measurement. Results: All incision healed primarily. 106 patients were followed up for 12 to 72 months, with the mean follow-up of 27 months.The mean time of fracture union was 14.5 weeks (range, 9-16 weeks). The mean AOFAS ankle-hindfoot score at last follow-up was 91.4 points (range, 83-100 points). The mean score of VAS was 1.2 points (range, 0-6 points). The mean score of SF-36 was 91.2 points (range, 80-96 points). There was no ankle instability and post-trauma osteoarthritis. Conclusion: This multiple-center study demonstrated that deltoid ligament repair can benefit patients with unstable ankle after fracture fixation. A reasonable clinical evaluation and surgical repair could be done, choosing an appropriate repair technique according to the site of deltoid ligament rupture.

scholarly journals Invisible Injuries in Ankle Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Robin Blom ◽  
Markus Knupp ◽  
Beat Hintermann ◽  
Sjoerd Stufkens
Keyword(s):  
Ankle Instability ◽  
External Rotation ◽  
Plantar Flexion ◽  
Axial Loading ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Neutral Position ◽  
Need For Treatment ◽  
Ligament Rupture ◽  
Fresh Frozen

Category: Ankle, Trauma, Biomechanical Introduction/Purpose: Ankle fractures are often associated with ligamentous injuries of the distal tibiofibular syndesmosis, the deltoid ligament and are predictive of ankle instability, early joint degeneration and long-term ankle dysfunction. Detection of ligamentous injuries and the need for treatment remain subject of ongoing debate. In the classic article of Boden it was made clear that injuries of the syndesmotic ligaments were of no importance in the absence of a deltoid ligament rupture. Even in the presence of a deltoid ligament rupture, the interosseous membrane withstood lateralization of the fibula in fractures up to 4.5 mm above the ankle joint. Generally, syndesmotic ligamentous injuries are treated operatively by temporary fixation performed with positioning screws. But do syndesmotic injuries need to be treated operatively at all? Methods: The purpose of this biomechanical cadaveric study was to investigate the relative movements of the tibia and fibula, under normal physiological conditions and after sequential sectioning of the syndesmotic ligaments. Ten fresh-frozen below-knee human cadaveric specimens were tested under normal physiological loading conditions. Axial loads of 50 Newton (N) and 700 N were provided in an intact state and after sequential sectioning of the following ligaments: anterior-inferior tibiofibular (AITFL), posterior-inferior tibiofibular (PITFL), interosseous (IOL), and whole deltoid (DL). In each condition the specimens were tested in neutral position, 10 degrees of dorsiflexion, 30 degrees of plantar flexion, 10 degrees of inversion, 5 degrees of eversion, and externally rotated up to 10 Nm torque. Finally, after sectioning of the deltoid ligament, we triangulated Boden’s classic findings with modern instruments. We hypothesized that only after sectioning of the deltoid ligament; the lateralization of the talus will push the fibula away from the tibia. Results: During dorsiflexion and external rotation the ankle syndesmosis widened, and the fibula externally rotated after sequential sectioning of the syndesmotic ligaments. After the AITFL was sectioned the fibula starts rotating externally. However, the external rotation of the fibula significantly reduced when the external rotation torque was combined with axial loading up to 700 N as compared to the external rotation torque alone. The most relative moments between the tibia and fibula were observed after the deltoid ligament was sectioned. Conclusion: Significant increases in movements of the fibula relative to the tibia occur when an external rotation torque is provided. However, axial pressure seemed to limit external rotation because of the bony congruence of the tibiotalar surface. The AITFL is necessary to prevent the fibula to rotate externally when the foot is rotating externally. The deltoid ligament is the main stabilizer of the ankle mortise.

scholarly journals Cross-Cultural Adaptation and Psychometric Properties of the Lithuanian Version of the Majeed Pelvic Score

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 417
Author(s):  
Giedrius Petryla ◽  
Rokas Bobina ◽  
Sigitas Ryliškis ◽  
Valentinas Uvarovas ◽  
Jaunius Kurtinaitis ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Cultural Adaptation ◽  
Pelvic Fractures ◽  
Cross Cultural ◽  
Cross Cultural Adaptation ◽  
Sf 36 ◽  
The Mean ◽  
Mean Time ◽  
Function Assessment

Background and Objectives: There are no valid patient-based pelvic ring function assessment tools in Lithuania. The most widely used instrument is the Majeed Pelvic Score (MPS), which is proven to be an effective tool for assessing pelvic function after pelvic injuries. The aims of our study were: (1) the translation and cross-cultural adaptation of the MPS for the Lithuanian-speaking population, (2) to test the psychometric properties of the Lithuanian version of the MPS (MPS-LT) at follow-up two-time points after pelvic fractures. Materials and Methods: The MPS was translated and culturally adapted. Psychometric properties of the MPS-LT were determined in one patient group (n = 40) at two time-points during follow-up examination from 1.5 to 3 months (mean 2 months) and from 11 to 20 months (mean 12 months). Results: At the mean time of 2 months after trauma, Cronbach’s α of the MPS-LT was 0.65. Correlation of the MPS-LT with the Iowa Pelvic Score (IPS) was r = 0.84 (p < 0.001), and with the Lithuanian SF-36, PCS was r = 0.53 (p < 0.001). At the mean time follow-up of 12 months, Cronbach’s α was 0.86, correlation with the IPS was r = 0.92 (p < 0.001), and with the Lithuanian SF-36, PCS – r = 0.82 (p < 0.001). At the 2-month follow-up, neither floor nor ceiling effects were reached, but at 12 months, 27.5% of patients reached the ceiling effect, while none reached the floor effect. The effect size of the MPS-LT was 1.66. Conclusions: The MPS-LT has limited ability to measure functional outcomes at 2 months after pelvic fracture. In contrast, at the 12-month follow-up examination, the MPS-LT had a good ability to assess pelvic function, and it was sensitive to health changes. The MPS-LT can be used as a pelvic function assessment tool after pelvic fractures for the Lithuanian-speaking population.

scholarly journals Outcomes after Lengthening Calcaneal Osteotomy for Flexible Flatfoot Deformity– Evans versus Hintermann Osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Christian Plaass ◽  
Sarah Ettinger ◽  
Leif Claassen ◽  
Daiwei Yao ◽  
Christina Stukenborg-Colsman ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Clinical Results ◽  
Hindfoot Alignment ◽  
Parametric Data ◽  
Sf 36 ◽  
Flexible Flatfoot ◽  
Outcome Scores ◽  
The Mean ◽  
Mean Time

Category: Hindfoot Introduction/Purpose: Evans and Hintermann calcaneal osteotomies are commonly used to correct flexible pes planovalgus deformity. Both methods are well accepted with good clinical results. The aim of this study was to compare the outcomes after Evans or Hintermann osteotomy. Methods: We retrospectively examined 49 patients who were operated for the treatment of flexible flatfoot deformity between October 2007 and March 2014. Sixteen Evans and 36 Hintermann osteotomies were performed. The data was collected using clinical and radiological examination as well as clinical scores (FAOS, SF-36) during regular follow-up. A paired t-test was used for statistical analysis. A one-way anova with the Holm-Sidak’s multiple comparisons test was used to compare non-parametric data. Results: The mean age was 39.6 ± 18.69 years in the Hintermann (H) group and 32.8 ± 17.86 years in the Evans (E) group. The mean follow up was 67.67 ± 20.57 months in the E- and 39.71 ± 12.77 months in the H-group. In both groups FAOS and SF-36 improved significantly (p<0.05). The hindfoot alignment improved significantly in both groups (p<0.05). The mean time to return to work and sports was 14.25 ± 8.92 and 19.0 ± 18.62 weeks in the E-group, 19.36 ± 16.71 and 28.25 ± 20.07 weeks in the H- group. Seven patients of each group needed an implant removal; one patient underwent an arthrodesis of the subtalar joint in the E-group. There were no significant differences between the outcomes of both groups. Conclusion: Both surgical techniques lead to good correction of the flatfoot deformity and show a significant improvement of the clinical outcome scores. Neither of these two surgical techniques can be identified as being superior.

Medial Impingement Syndrome of the Anterior Tibiotalar Fascicle of the Deltoid Ligament on the Talus

2000 ◽  
Vol 21 (5) ◽  
pp. 385-391 ◽  
Author(s):  
Susan M. Mosier-La Clair ◽  
Michael T. Monroe ◽  
Arthur Manoli
Keyword(s):  
Impingement Syndrome ◽  
Surgical Debridement ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
The Mean

Eleven patients with medial impingement syndrome of the anterior tibio-talar fascicle (ATTF) of the deltoid ligament on the talus were identified. Six sustained inversion injuries, one talus and four ankle fractures. The mean preoperative Ankle-Hindfoot Scale (AHS) was 56 and the postoperative was 87. Surgical debridement of the ATTF was performed. A thickened ATTF and localized synovitis were seen. Talar osteophytes were removed in 8 patients. Mean follow up 4 years. Nine patients had good to excellent results and all patients returned to work.

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

scholarly journals Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fabrizio Rivera ◽  
Alessandro Bardelli ◽  
Andrea Giolitti
Keyword(s):  
Operating Room ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Medium Term ◽  
Operating Room Table ◽  
Sf 36 ◽  
Standard Operating ◽  
The Mean

Abstract Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Borrego Rodriguez ◽  
C Palacios Echevarren ◽  
S Prieto Gonzalez ◽  
JC Echarte Morales ◽  
R Bergel Garcia ◽  
...  
Keyword(s):  
Phase Ii ◽  
Hospital Readmissions ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
The Mean ◽  
Acute Cardiovascular Event ◽  
Mean Time

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

scholarly journals Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110108
Author(s):  
Andrea Bardos ◽  
Sanjeeve Sabhrawal ◽  
Graham Tytherleigh-Strong
Keyword(s):  
Ct Scan ◽  
Constant Score ◽  
Case Series ◽  
Sternal Fracture ◽  
Elite Level ◽  
The Mean ◽  
Mean Time ◽  
Time From Injury ◽  
Sternal Fractures

Background: Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported. Purpose: To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture. Study Design: Case series; Level of evidence, 4. Methods: Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan. Results: Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ P < .05]), Constant score (from 84 to 96.4 [ P < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ P < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications. Conclusion: Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.

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