Early Weight-Bearing Does Not Compromise Postoperative Healing in Jones Fracture ORIF

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Several controversies persist regarding fracture treatment of the fifth metatarsal base. Due to its low blood supply, Jones fracture has an inherent difficulty of consolidation, and may devolop complications such as delayed union, non- union and refracture. Usually the Jones fracture treatment is done with extended period of non-weightbearing with either nonoperative or operative treatment. The surgery is indicated particularly in athletes or in the setting of nonunion or fracture displacement. The purpose of the present retrospective case series is to assess postoperative outcomes among patients who weight bear earlier than standard practice. Methods: We performed a retrospective analysis of the medical and radiographic records from patients who had undergone operative IM fixation of an acute isolated Jones fracture from May 2013 and August 2018. Patients were permitted to weight- bear as tolerated. Demographic information, such as age, gender, body mass index, the use of tobacco, presence of medical comorbidities, and the time of radiographic union were evaluated. Standardized radiographs at 2 weeks, 6 weeks, 3 months and 6 months after surgeries were chosen for evaluation. Radiographic union was defined as bridging in 2 of 3 (medial, lateral, plantar) cortices. Results: Twenty one patients were included for analysis. Of these, 14 had at least one comorbidity present at time of operation. Average BMI was 37.6, and average age was 44.8. One patient (4.8%) was lost to follow up, and therefore did not have radiographic results available for review at any appointment. At 6 weeks, 16 of 21 patients showed signs of radiographic healing; 8 were completely healed, and 8 were incomplete. One patient (4.8%) had nonunion, which was documented at 6 week, 3 month, and 6 month readings. None of the 21 patients experienced any other postoperative complications, including infection, wound dehiscence, sepsis, DVT, implant failure, or need for revision surgery. Conclusion: Patients who were subjected to early weight-bearing after fifth metatarsal Jones fracture surgery had satisfactory fusion rates with no additional postoperative complications, even despite having high average BMI and multiple comorbidities. We believe that patients can be treated with early weightbearing as tolerated after operative fixation of an acute Jones fracture, and achieve satisfactory outcomes comparable those associated with traditional postoperative protocols.

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Arthroscopic-assisted arthrodesis in the foot and ankle. Subtalar, tibiotalar, tibiocalcaneal, and metatarsophalangeal: 25 years of experience

Journal of Arthroscopic Surgery and Sports Medicine ◽

10.25259/jassm_16_2021 ◽

2021 ◽

Vol 0 ◽

pp. 1-7

Author(s):

Luis Perez-Carro ◽

Carlos Rodrigo-Arriaza ◽

Lorena Trueba-Sanchez ◽

Gustavo Gutierrez-Castanedo ◽

Guillermo Menendez-Solana ◽

...

Keyword(s):

Case Series ◽

Invasive Procedure ◽

Foot And Ankle ◽

Retrospective Case ◽

Aofas Score ◽

Level Of Evidence ◽

Non Union ◽

End Stage ◽

Mean Time ◽

Radiographic Union

Objectives: Arthritis of the foot and ankle joints provoke pain and restricts function. The arthroscopic assisted arthrodesis (AAA) is a minimally invasive procedure for end stage arthritis to eliminate pain and achieve painless mobilization, with numerous benefits like faster time to union, less blood loss, less morbidity, less infection rate, and less soft tissue complications compared with open surgery. The objective of this paper is to retrospectively evaluate our case series (136 patients) of arthroscopic assisted foot and ankle fusion that includes the subtalar, tibiocalcaneal, tibiotalar and metatarsophalangeal joint in our last 25 years of practice. Level of Evidence: Level IV, retrospective case series. Materials and Methods: Patients who underwent arthroscopic assisted arthrodesis in the foot and ankle were identified by review of a registry. Minimum follow-up was 24 months. Patient demographics characteristics, time to radiographic union, and preoperative and postoperative American Orthopaedic Foot and Ankle Society score (AOFAS) were obtained. Results: Subtalar fusion: 43 patients. Radiographic union was seen in 40 patients at a mean time of 10 weeks (8-14) and non union was seen in three patients, of which 1 required open revision surgery. AOFAS score improved from 43 preoperatively (27-57) to 83 (67-93) postoperatively. Tibiotalar fusion: 55 patients. Radiographic union in a mean time of 12 weeks (7-15) in all 55 cases. AOFAS score improved from 50.5 preoperatively (25-60) to 82 (62-94) postoperatively. Tibiotalocalcaneal fusion: 3 patients. 2 patients with radiographic union at 14 and 16 weeks and 1 showed a fibrotic union of the subtalar joint without pain. AOFAS score improved from 43 preoperatively (34-58) to 78 (67-81) postoperatively. Metatarsophalangeal fusion: 35 patients. Radiographic union in 33 patients at a mean time of 8 weeks (6-11). Two patients presented asymptomatic non union. AOFAS score improved from 38 preoperatively (30-60) to 86 (75-93) postoperatively. Conclusion: Arthroscopic assisted arthrodesis in the foot and ankle is an excellent procedure for end stage degenerated joint.

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Tibia non-union management using limb reconstruction system fixator-a case series

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211624 ◽

2021 ◽

Vol 7 (3) ◽

pp. 649

Author(s):

Neetin P. Mahajan ◽

Vaibhav V. Sakhare ◽

Prasanna Kumar G. S.

Keyword(s):

Weight Bearing ◽

Case Series ◽

Early Weight Bearing ◽

Limb Reconstruction ◽

Non Union ◽

Orthopedic Surgeons ◽

Joint Range Of Motion ◽

Single Frame ◽

Tibia Fractures ◽

Joint Range

The management of non-unions is always the challenge to the orthopedic surgeons. It requires proper expertise in that field. Improper management leads to multiple surgeries and disability in patients. External fixation using limb reconstruction system (LRS) is one of the options in the management of these conditions. We present a series of 04 cases of non-union tibia managed with LRS fixator. All the patients had compound tibia fractures, 02 patients were managed initially with AO external fixator, one with plating and another with intramedullary nailing. Out of four cases, two cases were infected non unions and two cases were non infective non unions. All the four patients were managed secondarily with LRS fixator with less complications and good outcome. LRS fixator is one of the best options in the management of both infective and non-infective non unions of the tibia. It helps in both compression and distraction in a single frame with minimal complications. It gives good stability in the bone which helps in early weight bearing and adjacent joint range of motion.

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Radiographic Correlation of Hallux MP Fusion Position and Plate Angle

Foot & Ankle International ◽

10.3113/fai.2009.0873 ◽

2009 ◽

Vol 30 (9) ◽

pp. 873-876 ◽

Cited By ~ 10

Author(s):

J. Thaddeus Leaseburg ◽

James K. DeOrio ◽

Shane A. Shapiro

Keyword(s):

Weight Bearing ◽

Proximal Phalanx ◽

Case Series ◽

Statistical Correlation ◽

Titanium Plate ◽

Care Needs ◽

Retrospective Case ◽

Level Of Evidence ◽

Lower Correlation ◽

Proper Weight

Background: This study assessed the variability of plate bend in regard to final metatarsophalangeal (MP) fusion angles and toe-to-floor distance. We hypothesized that the final MP angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance would be dictated solely by the magnitude of the bend in the plate. Materials and Methods: This is a retrospective analysis of 35 sequential patients who underwent MP fusion with a low-contour titanium plate. Postoperative weightbearing radiographs were analyzed for plate angle, MP fusion angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance. Results: We found statistical correlation between plate angle and MP angle and between plate angle and the angle of the proximal phalanx to the floor. However, there was low correlation between plate angle and with toe-to-floor distance. In addition, we noted many outliers, which resulted in higher or lower correlation of the MP angle to the expected plate angle and, thus, a relationship between angles that was far from linear. Conclusion: Care needs to be taken when relying solely on the bend in the plate to determine the final position of the toe in MP fusions. Although the association between plate bend and MP angle and proximal phalanx to floor angle was strong, the association between the bend in the plate and weight bearing toe-to-floor distance was variable. This could result in the toe hitting the shoe or the need to vault over the toe. Therefore, the surgeon must match the plate to each patient's anatomy to ensure proper weight bearing toe-to-floor distance and not rely on plate angle exclusively. Level of Evidence: IV, Retrospective Case Series

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Revision of 116 orthognathic surgery patients operated on with the high-oblique sagittal osteotomy (HOSO): a retrospective case series (PROCESS-compliant article)

Clinical Oral Investigations ◽

10.1007/s00784-020-03653-2 ◽

2020 ◽

Author(s):

C. Herrera-Vizcaino ◽

L. Seifert ◽

M. Berdan ◽

S. Ghanaati ◽

M. Klos ◽

...

Keyword(s):

Complication Rate ◽

Orthognathic Surgery ◽

Mouth Opening ◽

Case Series ◽

Operation Time ◽

University Hospital ◽

Material Failure ◽

Retrospective Case ◽

Non Union ◽

Facial Plastic

Abstract Background The high-oblique sagittal osteotomy (HOSO) is an alternative to a bilateral sagittal split osteotomy (BSSO). Due to its novelty, there are no long-term studies which have focused on describing the incidence and type of complications encountered in the post-operative follow-up. The aim of this retrospective study is to analyze patients operated on with this surgical technique and the post-operative complications encountered. Patient and methods The electronic medical records of all patients treated with orthognathic surgery at the Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany, between the years 2009 and 2016 were retrospectively reviewed. Results A total of 116 patients fulfilled the inclusion criteria. The cases operated on with the standard osteosynthesis (X, Y, and straight) showed a complication rate of 36.37% (n = 4/11). The cases operated on with the HOSO-dedicated plates (HOSO-DP) showed, in total, a complication rate of 6.67% (n = 7/105). The most common post-operative complication resulting from both fixation methods was a reduction in mouth opening and TMJ pain for 4.3%. During the first years of performing the surgery (2009–211), a variety of standard plates had material failure causing non-union or pseudarthrosis. No cases of material failure were observed in the cases operated on with the HOSO-DP. The statistical results showed a highly significant dependence of a reduction in OP-time over the years, when the HOSO was performed without additional procedures (R2 > 0.83, P < 0.0015). Conclusion The rate of complications in the HOSO were shown to be comparable to the rate of complications from the BSSO reported in the literature. Moreover, the use of the ramus dedicated plate appears to provide enough stability to the bone segments, making the surgery safer. Clinical relevance The HOSO needs to be considered by surgeons as an alternative to BSSO. Once the use of the HOSO-DP was established, the rate of complications and the operation time reduced considerably.

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Ankle Arthrodesis with Cannulated Screw: Case Series

Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya ◽

10.30651/jqm.v4i1.2661 ◽

2020 ◽

Vol 4 (1) ◽

pp. 87

Author(s):

Andre Triadi Desnantyo ◽

Muhammad Zaim Chilmi ◽

Hizbillah Yazid

Keyword(s):

Weight Bearing ◽

Case Series ◽

Ankle Arthrodesis ◽

Cannulated Screw ◽

Average Score ◽

Foot And Ankle ◽

Early Weight Bearing ◽

Sf 36 ◽

Clinical Scoring ◽

Hind Foot

ABSTRACT Ankle osteoarthritis patients are young and lack of available long last treatment. Ankle arthrodesis remains the gold standard and is the procedure of choice for younger patients who are heavy laborers. These case series evaluate and report five patients undergone ankle arthrodesis at RSUD Dr. Soetomo Surabaya on 2012-2016. The data were collected from patient files, radiographs, and a recent physical examination. The outcome has been assessed with SF-36 score and clinical scoring system Ankle-Hind foot American Foot and Ankle Society. Three male patients and two female patients underwent ankle arthrodesis with cannulated screw, caused by neglected severe ankle dislocation. One patient had open dislocation. Based on SF-36 scoring, the five patients had average score 76,7 with highest and lowest score were 95,9 and 56,7. Based on clinical score ankle-hind foot American Ankle and Foot Society, the average score was 68(51 – 88). The scoring result includes general health, physic, emotional, and social. And clinical scoring ankle-hind foot American Foot and Ankle Society evaluation includes pain, function, and alignment. It shows that there was patient that gains an almost perfect result. Patient with the lowest score also had knee osteoarthritis contralateral from the operated ankle. Early weight bearing on ankle arthrodesis with cannulated screw was the major factor caused unsatisfactory result of this patient. Ankle arthrodesis with cannulated screw has satisfactory result eventhough remain complain on one patient. Nevertheless, ankle arthrodesis with cannulated screw still has an important role in the treatment of choice on ankle reconstruction.Keywords : Ankle arthrodesis, cannulated screw, ankle joint fusion

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Retrospective Analysis of Complication Rates Associated With Auricular Reconstruction After Skin Cancer Surgery

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419890841 ◽

2019 ◽

Vol 24 (2) ◽

pp. 137-143

Author(s):

Diana Crișan ◽

Horațiu Alexandru Colosi ◽

Avram Manea ◽

Sabine Kastler ◽

Anna Lipke ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Infection ◽

Tumor Resection ◽

Case Series ◽

Skin Tumor ◽

Complication Rates ◽

Ear Reconstruction ◽

Retrospective Case ◽

Auricular Reconstruction ◽

Early Postoperative Complications

Background There is limited data regarding postoperative complications after microtia surgery or tympanoplasty; however, complication rates after pinna reconstruction following tumor resection and comorbidities associated with suboptimal outcomes have not been investigated so far. Objective To examine the incidence of postoperative complications after auricular reconstruction surgery following tumor resection and determine the association between postoperative complications and defect size, patients’ comorbidities, and reconstruction type. Methods and Materials In a retrospective case series ( n = 146, January 2014 to October 2018), we examined the surgical outcome and amount of postoperative complications following auricular surgery as well as the association with different comorbidities. SPSS 16.0 was used for statistical analyses. Results The following early postoperative complications were identified: pain (29.5%), hematoma (4.1%), flap congestion (4.8%), infection (3.4%), and flap/graft necrosis (2.7%). Late complications including cartilage step-offs, helical rim sulcus alteration, granulomas, or ear deformities occurred only in 3.6% of subjects. Reconstructions of large defects (>1 cm2) were associated with a higher incidence of early postoperative complications compared to small defects (<1 cm2) ( P < .001). Neither the presence of smoking or diabetes nor immunosuppression was significantly linked to an increased incidence of early complications. Immunosuppression, however, was associated with a higher incidence of postoperative infection ( P < .001) Conclusion The incidence of early and late postoperative complications after skin tumor resection and external ear reconstruction is low. The occurrence of postoperative infection was not linked with smoking or the presence of diabetes, but strongly associated with a state of immunosuppression, which is why a perioperative antibiotic prophylaxis in immune-compromised patients may be considered.

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A Retrospective Radiographic Evaluation of a Modified Method of Lateral Column Lengthening

Foot & Ankle Specialist ◽

10.1177/1938640020919187 ◽

2020 ◽

pp. 193864002091918

Author(s):

Keith Wapner ◽

Erik Freeland ◽

Gregory Kirwan ◽

Keith Baldwin

Keyword(s):

Weight Bearing ◽

Case Series ◽

Stage Ii ◽

Radiographic Evaluation ◽

Retrospective Case ◽

Lateral Column ◽

Modified Method ◽

Radiographic Outcomes ◽

Alternative Approach ◽

Lateral Column Lengthening

Background: Lateral column lengthening (LCL) is a commonly performed procedure for patients with stage II adult-acquired flatfoot deformity (AAFD) to correct forefoot abduction. This procedure is frequently completed concomitantly with both soft-tissue and bony procedures, including a medial slide calcaneal osteotomy to further reduce hindfoot valgus. The purpose of this study is to investigate and identify the radiographic outcomes of a modified step-cut LCL utilized as an alternative approach for correction of stage II AAFD. Methods: A retrospective radiographic review was performed on 15 feet in 14 patients who underwent correction of stage II AAFD using a step-cut LCL between August 2009 and January 2012. Two independent examiners utilizing 6 radiographic parameters evaluated preoperative and postoperative weight-bearing radiographs of the foot. Results: At a mean follow-up of 13.4 (range 12-16) weeks, weight-bearing radiographs demonstrated a significant median decrease in the lateral talometatarsal angle of 14.4° (P < .001), lateral talocalcaneal angle of 7° (P < .001), anteroposterior talometatarsal angle of 14.5° (P < .001), anteroposterior talocalcaneal angle of 5.5° (P < .001), and talonavicular coverage angle of 26.5° (P < .001). Additionally, a significant median increase in calcaneal pitch of 8.5° (P < .001) was noted. Conclusion: This study demonstrates statistically significant improvement of radiographic outcomes with use of a modified step-cut LCL as an alternative approach for correction of stage II AAFD. Levels of Evidence: Level IV: Retrospective case series

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Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Foot & Ankle Specialist ◽

10.1177/1938640019866322 ◽

2019 ◽

Vol 13 (5) ◽

pp. 397-403 ◽

Cited By ~ 2

Author(s):

Derek Stenquist ◽

Brian T. Velasco ◽

Patrick K. Cronin ◽

Jorge Briceño ◽

Christopher P. Miller ◽

...

Keyword(s):

Weight Bearing ◽

Case Series ◽

Break Point ◽

Retrospective Case ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Retrospective Case Series ◽

Screw Breakage ◽

Tissue Stabilization

Background. Syndesmotic disruption occurs in 20% of ankle fractures and requires anatomical reduction and stabilization to maximize outcomes. Although screw breakage is often asymptomatic, the breakage location can be unpredictable and result in painful bony erosion. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw designed with a controlled break point. Methods. We performed a retrospective review of all patients who underwent syndesmotic fixation utilizing the R3lease Tissue Stabilization System (Paragon 28, Denver, CO) over a 12-month period. Demographic and screw-specific data were obtained. Postoperative radiographs were reviewed, and radiographic parameters were measured. Screw loosening or breakage was documented. Results. 18 patients (24 screws) met inclusion criteria. The mean follow-up was 11.7 months (range = 6.0-14.7 months). 5/24 screws (21%) fractured at the break point. No screw fractured at another location, nor did any fracture prior to resumption of weight bearing; 19 screws did not fracture, with 8/19 intact screws (42.1%) demonstrating loosening. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow-up. No screws required removal during the study period. Conclusion. This study provides the first clinical data on a novel screw introduced specifically for syndesmotic fixation. At short-term follow up, there were no complications and the R3lease screw provided adequate fixation to allow healing and prevent diastasis. Although initial results are favorable, longer-term follow-up with data on cost comparisons and rates of hardware removal are needed to determine cost-effectiveness relative to similar implants. Level of Evidence: Level IV: Retrospective case series

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Inferior Gluteus Maximus Island Flap for Reconstruction of Ischial Pressure Sores

Annals of King Edward Medical University ◽

10.21649/akemu.v23i1.1521 ◽

2017 ◽

Vol 23 (1) ◽

Author(s):

Yawar Sajjad ◽

Beenish Rahat ◽

Salman Hameed

Keyword(s):

Case Series ◽

Gluteus Maximus ◽

Wound Dehiscence ◽

Island Flap ◽

Wound Management ◽

Medical Institute ◽

High Recurrence Rate ◽

Pressure Sores ◽

Retrospective Case ◽

Grade 3

Surgical management of ischial pressure sores has always been a challenge due to high recurrence rate. Ischial pressure sores develop due to unrelieved pressure over the Ischium. Inferior gluteus maximus island flap has been used effectively for coverage of ischial pressure sores.Objective: To describe the efficacy of inferior gluteus maximus flap for reconstruction of ischial pressure sores.Methods: A retrospective case series, consisted of sample of 17 cases. The study was conducted in the Department of Plastic and Reconstructive Surgery, Post Graduate Medical Institute, Lahore General Hospital Lahore, over a period of 8 years from March 2008 to March 2016. The case series included17 patients with grade 3 and grade 4 ischial pressure sores, comprising 12 male and 5 female, with age range of 28 to 64 (mean = 46 years).Follow-up ranged from 1 to 4 years with a mean of 2.5 years. Inferior gluteus maximus island flap was used for reconstruction of Ischial pressure sores.Results: In thirteen (76%) of the seventeen patients, wound healed uneventfully without any complication. Partial wound dehiscence was observed in 2 patients (12%). Both of these healed with conservative wound management. Recurrence was seen in 2 patients (12%) after 8 months. These two patients underwent reoperation and gluteus maximus flap was readvanced that resulted in satisfactory wound coverage.Conclusion: Inferior gluteus maximus island flap can be considered as a reliable option for reconstruction of ischial pressure sores.

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Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171891 ◽

2017 ◽

Vol 3 (3) ◽

pp. 497

Author(s):

Vijaysing S. Chandele ◽

Abhishek P. Bhalotia ◽

Milind V. Ingle ◽

Maroti R. Koichade

Keyword(s):

Functional Outcome ◽

Tibial Plateau ◽

Weight Bearing ◽

Oxford Knee Score ◽

Tibial Plateau Fractures ◽

Knee Score ◽

Early Weight Bearing ◽

Non Union ◽

Approach Time

Background: Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to evaluate the functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach.Methods: Thirty two patients with tibial plateau fractures having posteromedial fracture alone or part of bicondylar fracture was operated with ORIF using Lobenhoffer approach. Time to union, maintenance of alignment, rate of complications and functional outcome was assessed using Oxford knee score.Results: The mean time to healing was 16.4 weeks, without any complication in the form of non-union and infection. Malunion with secondary loss of alignment was seen in only one case due to fracture comminution and early weight bearing. Oxford knee score was good to excellent in all the cases. Conclusions: With recent development in understanding these fractures, ORIF gives excellent to good outcome in all patients operated through Lobenhoffer approach. Long term disability can be prevented by maintenance of adequate alignment and reduction through direct visualization of fracture.

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