scholarly journals Treatment of late-stage Freiberg disease using a double stemmed flexible silicone prosthesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Ming-Zhu Zhang ◽  
Guang-rong Yu
Keyword(s):  
Plantar Flexion ◽  
Clinical Results ◽  
Analog Scale ◽  
Silicone Prosthesis ◽  
Prosthesis Replacement ◽  
Freiberg Disease ◽  
Metatarsophalangeal Joints ◽  
Late Stages ◽  
Dorsal Flexion

Category: Lesser Toes Introduction/Purpose: The purpose of this study was to evaluate the clinical outcomes using a double stemmed flexible silicone prosthesis for the treatment of Freiberg disease in its late stages. Methods: The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease in their late stages. They underwent double stemmed flexible silicone prosthesis replacement for metatarsophalangeal joints. The average age was 63.8 (range 30~88) years. The average follow up period was 26 (range 18–42) months. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), AOFAS and Maryland metatarsophalangeal joints scale before surgery and at the latest follow-up. Results: The average ROM of dorsal flexion improved from 39.3±6.1° before surgery to 75.4±8.6° at latest follow-up (p<0.001). The average ROM of plantar flexion improved from 19.0±11.4° before surgery to 20.2±9.3° at latest follow-up (p=0.14). The average VAS significantly improved from 8.1±0.5 before surgery to 2.6±0.2 at latest follow-up (p<0.001). The average Maryland metatarsophalangeal joints score significantly improved from 65.3±9.3 points before surgery to 90.3±4.1 points at the latest follow-up (p<0.001). The average AOFAS was 89.4±8.5 after surgery compared 56.3±6.4 preoperatively (p<0.005). Conclusion: A flexible silicone prosthesis replacement was carried out to treat Freiberg disease in its late stages. The function was observed in all cases with improved clinical results. The silicone prosthesis was considered to be useful in certain cases.

scholarly journals Treatment of late-stage Freiberg disease using a double stemmed flexible silicone prosthesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Mingzhu Zhang ◽  
Guang-Rong Yu ◽  
Yunfeng Yang
Keyword(s):  
Plantar Flexion ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Bone Union ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Silicone Prosthesis ◽  
Closing Wedge ◽  
Freiberg Disease

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to evaluate the clinical outcomes using a double stemmed flexible silicone prosthesis for the treatment of Freiberg disease in its late stages. Methods: The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease that underwent extra-articular dorsal closing-wedge osteotomy using a polyblend suture. The average age was 31.7 (range 13–72) years. The average follow up period was 17 (range 14–24) months. Regarding image findings, time to bone union and metatarsal shortening was reviewed. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), and Japanese Society of the Surgery of Foot lesser toe scale (JSSF score) in the MTP joint before surgery and at the latest follow-up. Results: Calluses under the metatarsal head were not observed in any cases. The mean metatarsal shortening was 2.33± 2.07 mm at follow-up. The bone union required an average of 8.4±0.8 weeks. The average ROM of dorsal flexion improved from 37.2±5.3° before surgery to 73.6±9.9° at latest follow-up (p<0.0001). The average ROM of plantar flexion improved from 16.0±10.1° before surgery to 19.5±8.6° at latest follow-up (p=0.35). The average VAS significantly improved from 75.3±8.5 before surgery to 4.9±4.2 at latest follow-up (p<0.0001). The average JSSF score significantly improved from 67.3±9.4 points before surgery to 98.8±3.0 points at the latest follow-up (p<0.0001). Conclusion: Extra-articular dorsal closing-wedge osteotomy using a polyblend suture was carried out to treat Freiberg disease. The bone union was observed in all cases with improved clinical results. Fixation using a polyblend suture was considered to be useful.

Osteochondral Autologous Transplantation Versus Dorsal Closing Wedge Metatarsal Osteotomy for the Treatment of Freiberg Infraction in Athletes: A Randomized Controlled Study With 3-Year Follow-up

2019 ◽  
Vol 47 (10) ◽  
pp. 2367-2373 ◽  
Author(s):  
Dimitrios Georgiannos ◽  
Kostas Tsikopoulos ◽  
Dimitrios Kitridis ◽  
Panagiotis Givisis ◽  
Ilias Bisbinas
Keyword(s):  
Autologous Transplantation ◽  
Metatarsal Osteotomy ◽  
Foot And Ankle ◽  
Analog Scale ◽  
Athletic Population ◽  
Randomized Controlled ◽  
Freiberg Disease ◽  
The Mean ◽  
Osteochondral Autologous Transplantation

Background: Dorsiflexion closing wedge metatarsal osteotomy (DCWMO) has been considered the traditional treatment of Freiberg disease. Several case reports presented osteochondral autologous transplantation (OAT) as an alternative treatment. Purpose/Hypothesis: The purpose was to compare the results of DCWMO versus OAT for the treatment of Freiberg infraction in an athletic population. It was hypothesized that OAT was superior to DCWMO regarding functional outcomes, pain, and the time that the athletes returned to training and to previous sport level. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Between 2008 and 2013, 27 consecutive patients with Freiberg disease were randomly assigned to either the DCWMO group (14 patients) or the OAT group (13 patients). The primary outcomes collected were as follows: postoperative complications, range of motion of the metatarsophalangeal joint, length of the metatarsal, function of the foot (measured with the American Orthopaedic Foot and Ankle Society–lesser metatarsophalangeal-interphalangeal [AOFAS-LMI] score), and pain (assessed with the visual analog scale–foot and ankle score). Results: Mean follow-up was 46 months (range, 36-60 months). The mean ± SD AOFAS-LMI score in the DCWMO group was 63.4 ± 14.4 preoperatively, 81.8 ± 6.6 at 1 year postoperatively, and 84.4 ± 5.6 at 3 years postoperatively, while in the OAT group, it was 62.8 ± 14, 89.9 ± 7.1, and 92 ± 6.9, respectively ( P < .001). The differences in the AOFAS-LMI scores favoring the OAT group at 1 and 3 years reached statistical but not clinical significance. The mean visual analog scale–foot and ankle score was improved significantly from 48.1 ± 11.5 to 91.8 ± 9.5 in the DCWMO group and from 49.9 ± 10.9 to 95.4 ± 4.4 in the OAT group. There was a shortening of the metatarsals by a mean 1.9 ± 0.5 mm in the DCWMO group, as opposed to a metatarsal lengthening of 0.2 ± 0.1 mm in the OAT group. In the OAT group, patients were able to start training at 6 ± 1 weeks ( P < .001) and return to full sport action at 10 ± 2.5 weeks ( P < .05), while in the DCWMO group, the time was 8 ± 1.5 and 13 ± 2.5 weeks, respectively. Conclusion: The authors concluded that OAT is equal to DCWMO. Acceptable clinical results were reported, as well as very low morbidity and early return to sport activities. That makes the OAT procedure a safe, effective, and optimal treatment for an athletic population experiencing Freiberg infraction.

The Weil Osteotomy of the Lesser Metatarsals: a Clinical and Pedobarographic Follow-up Study

2000 ◽  
Vol 21 (5) ◽  
pp. 370-374 ◽  
Author(s):  
Geoffroy Vandeputte ◽  
Greta Dereymaeker ◽  
Annie Steenwerckx ◽  
Louis Peeraer
Keyword(s):  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Complete Disappearance ◽  
Joint Range Of Motion ◽  
Shortening Osteotomy ◽  
Joint Range ◽  
Metatarsophalangeal Joints ◽  
Mtp Joints

The clinical results with pedobarographic analysis were assessed in 32 patients (59 metatarsals) who underwent a distal metatarsal shortening (Weil) osteotomy for either intractable plantar keratoses or chronically dislocated lesser metatarsal phalangeal joints. All patients had increased pressure under the involved metatarsal heads. Thirty three of the 59 metatarsophalangeal (MTP) joints were chronically dislocated. At an average follow-up of 30 months, patients rated the result as excellent or good for 32 of the 37 feet (86%). The mean preoperative AOFAS score was 59 (maximum 100), which improved to 81 postoperatively. This difference is significant : p= 0,00001 (with t-test). Comparison of the pre and post-operative pedobarographic measurements showed a significant decreased load under the affected metatarsal heads (p = 0.05). A complete disappearance of the callus was noted under 44 operated metatarsals (75%) and partial disappearance under 12 metatarsals (20%). Two symptomatic transfer lesions occurred under an adjacent metatarsal head. Recurrent dislocations occurred in 5 joints (15%). While metatarsophalangeal joint range of motion was significantly diminished, toe strength was maintained. Average metatarsal shortening was 5.9 mm with no nonunions, delayed unions, or malunions. The Weil shortening osteotomy is a simple and reliable procedure which can effectively reduce the load under the lesser metatarsophalangeal joints and is helpful for the reduction of dorsally dislocated MTP joints.

scholarly journals Clinical Results of Arthroscopic Treatment for Lateral Epicondylitis of Elbow

1970 ◽  
Vol 14 (2) ◽  
pp. 187-192 ◽  
Author(s):  
Jin Young Park ◽  
Jeong Woo Kim ◽  
Churl Hong Chun ◽  
Hong Je Kang ◽  
Jong Yun Kim ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Lateral Epicondylitis ◽  
Clinical Results ◽  
Loose Body ◽  
Arthroscopic Debridement ◽  
Performance Score ◽  
Analog Scale ◽  
Mayo Elbow Performance Score ◽  
The Mean

PURPOSE: The purpose of this study was to evaluate the clinical result of arthroscopic debridement with treatment of associated intra-articular lesions in lateral epicondylitis patients who did not response to conservative treatment.METHOD: Between March 2005 and January 2010, 43 patients who were diagnosed with lateral epicondylitis and did not response to conservative treatment over 6 months were selected. The mean age of the patients was 51 years (39~68 years) and the mean follow up period was 36.7 months (18~72 months). Among the 43 patients, 15 were male and 28 were female. They were evaluated by visual analog scale (VAS) and Mayo Elbow Performance Score (MEPS).RESULTS: Intra-articular synovitis was found in 11 cases (26%) and intra-articular loose body was observed in 2 cases. The average VAS score was 7(+/-0.7) preoperatively and decreased to 1(+/-1.0) at last follow up. MEPS was 45(+/-10.2) preoperatively and increased to 93(+/-10.0). At last follow up, 41 of the 43 patients showed satisfaction (MEPS <75) and 2 showed dissatisfaction (MEPS > or =75).CONCLUSION: There was a better outcome at 18 months follow up after arthroscopic debridement with treatment of associated intra-articular lesion in lateral epicondylitis patients who had not responsed to conservative treatment.

Coccygectomy for chronic refractory coccygodynia: clinical case series and literature review

2011 ◽  
Vol 14 (5) ◽  
pp. 654-663 ◽  
Author(s):  
Edward E. Kerr ◽  
Daniel Benson ◽  
Rudolph J. Schrot
Keyword(s):  
Literature Review ◽  
Clinical Case ◽  
Chart Review ◽  
Outcome Measure ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Clinical Results ◽  
Analog Scale ◽  
Comprehensive Literature Review

Object Coccygodynia is disabling pain in the coccyx and is usually provoked by sitting or rising from sitting. The diagnosis can be missed by neurosurgeons likely to encounter the disorder, and surgical treatment for coccygodynia has historically been viewed with caution. The authors conducted a retrospective review of 62 successive coccygectomy surgeries for coccygodynia performed at their institution. Methods Sixty-two consecutive cases of coccygectomy for coccygodynia in 61 unique patients were identified from the surgical database; they had been treated between 1997 and 2009. The authors succeeded in contacting 26 patients for follow-up (42.6%). A retrospective chart review was performed, and a telephone questionnaire was administered to these patients. Data collected included cause, pre- and postoperative visual analog scale, a graded outcome measure, and patient satisfaction. The median follow-up time was 37 months (range 2–133 months). Results The clinical results among the 26 patients with follow-up were as follows: 13 excellent, 9 good, 2 fair, and 2 poor. The overall favorable (excellent and good) outcome after coccygectomy was 84.6%. There were 3 wound infections (11.5%). There were no rectal injuries. An overwhelming majority of patients were satisfied with the procedure. Conclusions The authors report the results of their clinical case series, which to date is the largest in North America. The results closely concur with previously published case series from Europe. Coccygectomy for chronic intractable coccygodynia is simple and effective, with a low complication rate. A comprehensive literature review and discussion of coccygectomy is provided.

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

scholarly journals Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

2020 ◽  
Vol 9 (9) ◽  
pp. 2808
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak ◽  
Leszek Sagan ◽  
Bartosz Limanówka ◽  
Katarzyna Kołaczyk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Class I ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Stent Deformation ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

scholarly journals Force Generation on the Hallux Is More Affected by the Ankle Joint Angle than the Lesser Toes: An In Vivo Human Study

Biology ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 48
Author(s):  
Junya Saeki ◽  
Soichiro Iwanuma ◽  
Suguru Torii
Keyword(s):  
Repeated Measures ◽  
Joint Angle ◽  
Plantar Flexion ◽  
Human Study ◽  
Force Generation ◽  
Functional Difference ◽  
Multiple Comparison Test ◽  
The Difference ◽  
Metatarsophalangeal Joints

The structure of the first toe is independent of that of the other toes, while the functional difference remains unclear. The purpose of this study was to investigate the difference in the force generation characteristics between the plantar-flexion of the first and second–fifth metatarsophalangeal joints (MTPJs) by comparing the maximal voluntary plantar-flexion torques (MVC torque) at different MTPJs and ankle positions. The MVC torques of the first and second–fifth MTPJs were measured at 0°, 15°, 30°, and 45° dorsiflexed positions of the MTPJs, and at 20° plantar-flexed, neutral, and 20° dorsiflexed positions of the ankle. Two-way repeated measures analyses of variance with Holm’s multiple comparison test (MTPJ position × ankle position) were performed. When the MTPJ was dorsiflexed at 0°, 15°, and 30°, the MVC torque of the first MTPJ when the ankle was dorsiflexed at 20° was higher than that when the ankle was plantar-flexed at 20°. However, the ankle position had no significant effect on the MVC torque of the second–fifth MTPJ. Thus, the MVC torque of the first MTPJ was more affected by the ankle position than the second–fifth MTPJs.

scholarly journals Adenosine-induced Asystole during AVM Embolization

2021 ◽  
Author(s):  
V. Hellstern ◽  
P. Bhogal ◽  
M. Aguilar Pérez ◽  
M. Alfter ◽  
A. Kemmling ◽  
...  
Keyword(s):  
Demographic Data ◽  
Clinical Results ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Residual Shunt ◽  
Grade 5 ◽  
Martin Grade ◽  
Grade 3 ◽  
Brain Avms

Abstract Background Adenosine induced cardiac standstill has been used intraoperatively for both aneurysm and arteriovenous malformation (AVM) surgery and embolization. We sought to report the results of adenosine induced cardiac standstill as an adjunct to endovascular embolization of brain AVMs. Material and Methods We retrospectively identified patients in our prospectively maintained database to identify all patients since January 2007 in whom adenosine was used to induce cardiac standstill during the embolization of a brain AVM. We recorded demographic data, clinical presentation, Spetzler Martin grade, rupture status, therapeutic intervention and number of embolization sessions, angiographic and clinical results, clinical and radiological outcomes and follow-up information. Results We identified 47 patients (22 female, 47%) with average age 42 ± 17 years (range 6–77 years) who had undergone AVM embolization procedures using adjunctive circulatory standstill with adenosine. In total there were 4 Spetzler Martin grade 1 (9%), 9 grade 2 (18%), 15 grade 3 (32%), 8 grade 4 (18%), and 11 grade 5 (23%) lesions. Of the AVMs six were ruptured or had previously ruptured. The average number of embolization procedures per patient was 5.7 ± 7.6 (range 1–37) with an average of 2.6 ± 2.2 (range 1–14) embolization procedures using adenosine. Overall morbidity was 17% (n = 8/47) and mortality 2.1% (n = 1/47), with permanent morbidity seen in 10.6% (n = 5/47) postembolization. Angiographic follow-up was available for 32 patients with no residual shunt seen in 26 (81%) and residual shunts seen in 6 patients (19%). The angiographic follow-up is still pending in 14 patients. At last follow-up 93.5% of patients were mRS ≤2 (n = 43/46). Conclusion Adenosine induced cardiac standstill represents a viable treatment strategy in high flow AVMs or AV shunts that carries a low risk of mortality and permanent neurological deficits.

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

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