scholarly journals Short-Term Results of Lisfranc Injuries Treated with the Suture Button Technique

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Guilherme H. Saito ◽  
Alberto A. M. Mendes ◽  
Danilo R. C. Nishikawa ◽  
Beatriz Devito ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Articular Surface ◽  
Insertion Site ◽  
Hardware Removal ◽  
Short Term ◽  
Suture Button ◽  
Loss Of Reduction ◽  
The Mean ◽  
Lisfranc Injuries

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button. Conclusion: The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

scholarly journals TL 18053 - Short-term results of lisfranc injuries treated with the suture button technique

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 67S
Author(s):  
Guilherme Honda Saito ◽  
Alberto Mendes ◽  
Danilo Nishikawa ◽  
Cesar Cesar Netto ◽  
Beatriz Devito ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Insertion Site ◽  
Short Term ◽  
Radiographic Images ◽  
Suture Button ◽  
Radiographic Outcomes ◽  
Loss Of Reduction ◽  
The Mean ◽  
Lisfranc Injuries

Introduction: Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws. The aim of the present study was to provide short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated using the Mini Tight Rope® (Arthrex, Naples, FL). Medical records and radiographic images were analyzed with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 and the mean VAS was 0.6. All patients but one were able to return to their previous activities. A total of 9 complications were observed in 6 patients, with discomfort at the button insertion site being the most common (4). Other complications included evidence of radiographic arthritis (3), loss of reduction (1) and extensor hallucis longus tendinopathy (1). Only 1 patient required a reoperation for removal of the suture button. Conclusion: Use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

scholarly journals PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 43S
Author(s):  
Guilherme Honda Saito ◽  
Marcelo Pires Prado ◽  
Alberto Abussamra Moreira Mendes ◽  
Danilo Ryuko Nishikawa ◽  
Beatriz Devito ◽  
...  
Keyword(s):  
Hardware Removal ◽  
Ankle Fractures ◽  
Tibiofibular Syndesmosis ◽  
Aofas Score ◽  
Patient Functioning ◽  
Suture Button ◽  
Distal Tibiofibular Syndesmosis ◽  
Tibiofibular Joint ◽  
The Mean

Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.

PLA Screw Fixation of Lisfranc Injuries

2002 ◽  
Vol 23 (11) ◽  
pp. 1003-1007 ◽  
Author(s):  
David B. Thordarson ◽  
Graham Hurvitz
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Tissue Reaction ◽  
X Rays ◽  
Short Term ◽  
Small Series ◽  
Loss Of Reduction ◽  
K Wires ◽  
Lisfranc Injuries

Fourteen patients with Lisfranc injuries were treated with open reduction and internal fixation with PLA absorbable screw fixation by a single surgeon. From one to four PLA screws were used in each case (average two). In four patients, K-wires were inserted and removed at six weeks following surgery for instability of the fourth and/or fifth tarsometatarsal joints. Average follow-up was 20 months (range, three to 45 months). No patient was noted to have a soft tissue reaction to the screws. No evidence of osteolysis was noted on any of the follow-up X-rays at the screw sites. No loss of reduction was noted in any follow-up X-rays compared to immediate postoperative radiographs. The use of absorbable screws in this small series was found to be safe, without reaction and obviated the need for screw removal at short-term follow-up.

Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

2020 ◽  
Vol 132 (6) ◽  
pp. 1914-1924 ◽  
Author(s):  
Liang Li ◽  
Jiantao Yang ◽  
Bengang Qin ◽  
Honggang Wang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Functional Outcomes ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Allograft Reconstruction ◽  
Acellular Nerve Allograft ◽  
The Mean ◽  
Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Treatment of Hallux Valgus Deformity Using a Suture Button Device: A Preliminary Report

2018 ◽  
Vol 3 (4) ◽  
pp. 247301141880695
Author(s):  
Tyler A. Gonzalez ◽  
Jeremy T. Smith ◽  
Eric M. Bluman ◽  
Lauren V. Ready ◽  
William Ciurylo ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Normal Position ◽  
Suture Button ◽  
Soft Tissue Procedure ◽  
Sf 36 ◽  
Second Metatarsal ◽  
Average Change ◽  
The Mean

Background: Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomy. Despite good correction, these procedures have inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis. Suture button fixation has been used for HV treatment. It avoids the risks of corrective osteotomies while maintaining reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation. Methods: The authors retrospectively reviewed the charts and radiographs of 22 patients who had undergone HV correction using a distal soft tissue correction and proximal fixation with a miniature suture button device (Mini TightRope; Arthrex, Inc, Naples, FL). Mean follow-up was 27.7 months. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate postoperative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative complications, and any additional operative procedures performed were also recorded. Results: The mean preoperative IMA and HVA were 16.9 and 32.6 degrees, respectively. The mean immediate postoperative IMA was 5.2 degrees ( P < .0001) and the mean HVA was 9.8 degrees ( P < .0001). At final follow-up, the mean IMA was 8.2 degrees ( P < .0001) and the mean HVA was 16.7 degrees ( P < .0001). The average change in HVA from preoperative to final follow-up was 16.0 degrees and the average change in IMA from preoperative to final follow-up was 8.6 degrees ( P < .0001). Sesamoid station assessment at the 2-week follow-up showed that 22 patients (100%) were in the normal position group; at final follow-up, 17 patients (77%) had normal position and 5 patients (23%) had displaced position. Although there were no clinically symptomatic recurrences, asymptomatic radiographic recurrence was noted in 5 patients (23%) who had a final HVA >20 degrees. All components of the FAAM and the SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant. Three patients experienced complications, including an intraoperative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis. Conclusion: The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy. Level of evidence: Level IV.

scholarly journals Resultats A Court Terme De La Trabeculoplastie Selective Au Laser Chez Les Patients Togolais

2017 ◽  
Vol 13 (30) ◽  
pp. 271
Author(s):  
Dzidzinyo Kossi ◽  
Djagnikpo Akouete ◽  
Ayena Koffi Didier ◽  
Vonor Kokou ◽  
Maneh, Nidain ◽  
...  
Keyword(s):  
Selective Laser Trabeculoplasty ◽  
Treatment Results ◽  
Short Term ◽  
Laser Trabeculoplasty ◽  
The Mean ◽  
Laser Control ◽  
Pre Treatment ◽  
Primary Glaucoma ◽  
Reduction Percentage

Aim: To check the short-term tonometric results of SLT in the treatment of primary glaucoma at the open angle and in charge of ocular hypertonias in Togolese people. Methods: A retrospective study was carried out in an ophthalmology center. The first 130 eyes of 72 patients benefited from the SLT laser procedure. The tonometric controls work object focus on follow-up at 1, 3, and 6 months post laser treatment. Results: 130 eyes of 72 patients were collected. The average age of the patients was 49.74 years (± 17.45) and the ages vary between 10 and 85 years. The average IOP of the laser before the laser (J0) was (24.99 ± 8.41) mm Hg. The mean IOP at the post-laser control at 1 month was (18.79 ± 3.73) mm Hg. The average IOP for the post-laser control at 3 months was (18.44 ± 3.81) mm Hg. The mean IOP at the post-laser control at 6 months was (18.13 ± 3.63) mm Hg. The percentage reduction in intraocular pressure compared to IOP was pretreated from 20.2% to 1 month; 22.1% at 3 months; and 23.3% at 6 months. In 1 month, 49.2% of the eyes we treated showed a reduction in IOP of less than 20% compared to IOP pretreatment. After 3 months and 6 months, it was 55.4% higher. Also, 52.3% have a PIO reduction percentage which is greater than or equal to 20% compared to pre-treatment IOP. Discussion: Selective laser trabeculoplasty, most especially, is interesting in ocular hypertonies. Treatment of over 180 ° allows one patient out of two to have a pressure reduction that is greater than or equal to 20%. Conclusion: The SLT presents a significant advantage for our glaucomatous patients.

Are the Classic and the Congruent Arc Latarjet Procedures Equally Effective for the Treatment of Recurrent Shoulder Instability in Athletes?

2020 ◽  
Vol 48 (9) ◽  
pp. 2081-2089
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Domingo Luis Muscolo ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Bone Block ◽  
Return To Sports ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean ◽  
Anterior Glenohumeral Instability

Background: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. Purpose: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Results: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation ( P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points ( P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up ( P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points ( P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). Conclusion: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

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