scholarly journals Surgical Outcomes in Chronic Lisfranc Injuries without Secondary Degenerative Arthritis: A Systematic Literature Review

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Yantarat Sripanich ◽  
Jesse Steadman ◽  
Nicola Krahenbuhl ◽  
Chamnanni Rungprai ◽  
Justin Haller ◽  
...  
Keyword(s):  
Complication Rates ◽  
Operative Techniques ◽  
Aofas Score ◽  
Degenerative Arthritis ◽  
Radiographic Findings ◽  
Patient Cohort ◽  
Number Of Patients ◽  
Lisfranc Injuries

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Chronic Lisfranc (tarsometatarsal, TMT) joint injuries often present with various clinical symptoms and radiographic findings. If severe post-traumatic arthritis is present, a salvage arthrodesis is an appropriate intervention that provides the favorable outcomes. However, this procedure severely decreases TMT range of motion, a necessary attribute in the complete resolution of functionality, which is desired by many high-demand patients. Conversely, patients with chronic Lisfranc injuries occurred greater than six weeks prior to their diagnosis can present with no radiographic signs of degeneration. For this patient cohort, there is no consensus on a specific operative intervention. Therefore, this article will provide a systematic review of the current surgical options and associated outcomes to guide future clinical decisions in caring for these patients with no degenerative sequelae. Methods: PubMed, ScienceDirect, Scopus, and Embase medical databases were searched from inception through March 5, 2019. Original studies that assessed the outcome of patients treated surgically for chronic Lisfranc injuries without secondary osteoarthritic changes were considered for inclusion. Only studies written in English and German were included. The following data were recorded from each study: number of patients, number of feet, patient age, mechanism of injury, type of injury (purely ligamentous or ligamentous with concomitant bony fractures), time between initial injury and operation, indications for surgery, pre-operative assessment, operative techniques, postoperative follow-up time, time to return to activity or sport, clinical outcome, and study design (prospective vs. retrospective, single vs. multicenter, level of evidence). The modified Coleman Score was used to assess the methodologic quality of included studies. Results: Of the 6,845 screened, ten studies met the above criteria and were analyzed. All inclusions, with the exception of one study, were performed at a single center and were retrospective or prospective case series. The surgical techniques used to treat chronic Lisfranc injuries without arthritis include 1) open reduction and internal fixation with various types of hardware, 2) Lisfranc ligament reconstruction (utilizing the gracilis tendon or half of the extensor hallucis longus tendon), and 3) arthrodesis using screws. Overall, the studies generally reported low complication rates and acceptable functional outcomes. These postoperative outcomes were most frequently measured with the American Orthopaedic Foot & Ankle Society (AOFAS) score. Of the applicable studies, the mean preoperative AOFAS score of 55.7 significantly improved to 88.1 at final follow-up. Conclusion: No definitive consensus remains on how Lisfranc instability without concurrent degenerative arthritis should be surgically managed. Despite the delay in diagnosis, this patient cohort still experiences improved patient outcomes and few post- surgical complications with the operative techniques currently available. While the quality of these studies was satisfactory, a larger patient cohort and prospective analysis could further strengthen arguments for or against certain surgeries.

scholarly journals PO 18213 - Evaluation of hallux valgus treatment through percutaneous

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 46S
Author(s):  
Jorge Eduardo De Schoucair Jambeiro ◽  
Antero Tavares Cordeiro Neto ◽  
Fernando Delmonte Moreira ◽  
José Augusto De Oliveira ◽  
Clara Cristiane Miguelino Sousa ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Surgical Trauma ◽  
Complication Rates ◽  
Percutaneous Surgery ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Percutaneous Procedures ◽  
High Level

Introduction: Hallux valgus (HV) is characterized by the lateral deviation of the first finger, associated with pain and medial exostosis of the first metatarsus. The cause is usually multifactorial. The treatment varies with the degree of deformity and can be conservative or surgical. Percutaneous techniques have gained interest, offering less surgical trauma, fewer complications and faster recovery. The present study aims to evaluate the results of the surgical treatment of hallux valgus through percutaneous surgery.  Methods: A search was performed in PubMed / Medline and BVS, from 2013 to 2018, using as descriptors "hallux valgus" and "percutaneous surgery". Original articles in English, Portuguese and Spanish were included. We excluded systematic reviews, descriptions of surgical technique and publications older than 5 years. The quality of the methodology was evaluated with the help of the STROBE tool, with an emphasis on hallux valgus (HVA), intermetatarsal angle (IMA) and the AOFAS score.  Results: We found 185 references. After applying the inclusion and exclusion criteria, and STROBE tool, 5 articles were eligible, comprising a total of 290 percutaneous procedures. The follow-up time ranged from 6 months to 10 years. We found a reduction of IMA between 3.9º and 9.5º and a reduction of HVA between 12.5º and 26.8º. The AOFAS score ranged from 85 to 97.1 points in the evaluated works.  Discussion: In general, we found a good correction of HV deformity with improvement of HVA, IMA, DMAA and clinical improvement by the postoperative AOFAS score, with low complication rates. However, the heterogeneity of the studies, with variation of techniques and samples did not allow us to generalize the findings. Conclusion: It was possible to note that percutaneous surgery for HV treatment produces good outcomes with low complication rates, but few studies had a high level of evidence demonstrating the efficacy of these techniques, despite encouraging preliminary results.

scholarly journals Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence

2021 ◽  
Vol 10 (10) ◽  
pp. 2121
Author(s):  
Gerardo-Alfonso Márquez-Sánchez ◽  
Bárbara-Yolanda Padilla-Fernández ◽  
Miguel Perán-Teruel ◽  
Pedro Navalón-Verdejo ◽  
Sebastián Valverde-Martínez ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Surgical Techniques ◽  
High Survival ◽  
Complication Rates ◽  
Exact Test ◽  
Number Of Patients ◽  
Male Stress Urinary Incontinence ◽  
Group B

Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

scholarly journals Results of surgical treatment of massive localized lymphedema in severely obese patients

2014 ◽  
Vol 41 (1) ◽  
pp. 018-022 ◽  
Author(s):  
Wilson Cintra Júnior ◽  
Miguel Luiz Antonio Modolin ◽  
Rodrigo Itocazo Rocha ◽  
Thadeu Rangel Fernandes ◽  
Ariel Barreto Nogueira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Morbid Obesity ◽  
Surgical Treatment ◽  
Lymphatic Vessels ◽  
Complication Rates ◽  
Blood Capillaries ◽  
Tissue Edema ◽  
Severely Obese

OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL) in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, with greater range of motion, ambulation with ease and more effective hygiene. Histological analysis demonstrated the existence of a chronic inflammatory process marked by lymphomonocitary infiltrate and severe tissue edema. We observed foci of necrosis, formation of microabscesses, points of suppuration and local fibrosis organization, and pachydermia. The lymphatic vessels and some blood capillaries were increased, depicting a framework of linfangiectasias. CONCLUSION: surgical treatment of MLL proved to be important for improving patients' quality of life, functionally rehabilitating them and optimizing multidisciplinary follow-up of morbid obesity, with satisfactory surgical results and acceptable complication rates, demonstrating the importance of treatment and awareness about the disease.

scholarly journals Education in Neurology Resident Documentation Using Payroll Simulation

2017 ◽  
Vol 9 (2) ◽  
pp. 231-236 ◽  
Author(s):  
John W. Liang ◽  
Vicki L. Shanker
Keyword(s):  
Medical Decision ◽  
Financial Loss ◽  
Income Loss ◽  
Face To Face ◽  
Number Of Patients ◽  
Specific Feedback ◽  
Didactic Lecture ◽  
E Mail

ABSTRACT Background Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. Objective To improve the quality of neurology resident documentation through payroll simulation. Methods A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors. Current E/M level, ideal E/M level, and financial loss were calculated by the evaluators. Ideal E/M level was defined as the highest billable level based on the documented problems, alongside a supporting history and examination. We implemented an educational intervention that consisted of a 1-hour didactic lecture, followed by e-mail feedback “paystubs” every 2 weeks detailing the number of patients seen, income generated, income loss, and areas for improvement. Follow-up charts were assessed in a similar fashion over a 16-week postintervention period. Results Ten of 11 residents (91%) participated. Of 214 charts that were reviewed preintervention, 114 (53%) had insufficient documentation to support the ideal E/M level, leading to a financial loss of 24% ($5,800). Inadequate documentation was seen in all 3 components: history (47%), examination (27%), and medical decision making (37%). Underdocumentation did not differ across residency years. Postintervention, underdocumentation was reduced to 14% of 273 visits (P &lt; .001), with a reduction in the financial loss to 6% ($1,880). Conclusions Improved documentation and increased potential reimbursement was attained following a didactic lecture and a 16-week period in which individual, specific feedback to neurology residents was provided.

scholarly journals Age-Independent Clinical Outcome in Proximal Humeral Fractures: 2-Year Results Using the Example of a Precontoured Locking Plate

2022 ◽  
Vol 11 (2) ◽  
pp. 408
Author(s):  
Rony-Orijit Dey Hazra ◽  
Johanna Illner ◽  
Karol Szewczyk ◽  
Mara Warnhoff ◽  
Alexander Ellwein ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Fracture Reduction ◽  
Complication Rates ◽  
Locking Plate Osteosynthesis ◽  
Group 2 ◽  
Group 1

Introduction: The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this fracture entity. Methods: A consecutive series of patients with surgically treated displaced PHF between 01/2017 and 01/2018 was retrospectively analyzed. Patients were treated by locking plate osteosynthesis. The cohort was divided into two groups: Group 1 (≥65 years) and Group 2 (<65 years). At the follow-up examination, the SSV, CMS, ASES, and Oxford Shoulder Score (OS), as well as a radiological follow-up, was obtained. The quality of fracture reduction is evaluated according to Schnetzke et al. Results: Of the 95 patients, 79 were followed up (83.1%). Group 1 consists of 42 patients (age range: 65–89 years, FU: 25 months) and Group 2 of 37 patients (28–64 years, FU: 24 months). The clinical results showed no significant differences between both groups: SSV 73.4 ± 23.4% (Group 1) vs. 80.5 ± 189% (Group 2). CMS: 79.4 ± 21 vs. 81.9 ± 16, ASES: 77.2 ± 20.4 vs. 77.5 ± 23.1, OS: 39.5 ± 9.1 vs. 40.8 ± 8.2; OS: 39.5 ± 9.1 vs. 40.8 ± 8.2. In the radiological follow-up, fractures healed in all cases. Furthermore, the quality of fracture reduction in both groups is comparable without significant differences. The revision rate was 9.5% in Group 1 vs. 16.2% in Group 2. Discussion: Both age groups show comparable functional outcomes and complication rates. Thus, the locking plate osteosynthesis can be used irrespective of patient age; the treatment decision should instead be based on fracture morphology and individual patient factors.

A study on symptom improvement and efϑicacy of formoterol plus budesonide in the asthma management in northern parts of Tamil Nadu

2021 ◽  
Vol 12 (1) ◽  
pp. 742-748
Author(s):  
Mani Dhandayuthapani ◽  
Murugesh Shivashankar ◽  
Uma K
Keyword(s):  
Tamil Nadu ◽  
Asthma Management ◽  
Symptom Improvement ◽  
Asthmatic Patients ◽  
Severe Asthmatic ◽  
Number Of Patients ◽  
One Year ◽  
Experienced Symptom

The purpose is to study the asthma symptom improvement and efficacy of formoterol (LABA) and Budesonide (ICS) combination in the asthma management in northern districts of Tamilnadu. It is a multicentric, non-comparative, questionnaire and random sampling study was conducted in 145 mild to severe asthmatic patients. They were in Formoterol plus budesonide combination inhalation drugs available in DPI and pMDI. Among the 145 asthmatic patients, 45 patients, 6 patients and 94 patients were in DPI, nebuliser and pMDI devices respectively. During drug initiation, The Asthmatics were in mild (27%), Moderate (57%) and Severe (16%) stages. After one year of follow-up, the number of patients in the mild is 84%, moderate 14% and severe 2%. Among 45 DPI Asthmatic patients, 29 patients, 15 patients and 1 patient have reported the handling the devices as easy, medium and hard respectively. On the other hand, 94 pMDI asthmatic patients, 38 patients, 48 patients and 8 patients have reported the handling of devices as easy, medium and hard respectively. The treatment resulted in 77 patients as good, 65 as satisfactory and 3 as same. After one year, all the 145 asthmatic patients adhered with the treatment and experienced symptom improvement with 53% patients as good, 45% patients as satisfactory and 2% patients as same. The treatment of formoterol and budesonide combination in the northern districts of Tamilnadu have effectively controlled the asthmatic symptoms and improved the quality of life in asthmatics. Moreover, the patient's adherence to the treatment is good in the northern parts of Tamilnadu.

scholarly journals Outcome of the modified Dunn procedure in severe chronic or acute on chronic slipped capital femoral epiphysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Nicola Ebert ◽  
Martin Rupprecht ◽  
Ralf Stuecker ◽  
Sandra Breyer ◽  
Norbert Stiel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Proximal Femur ◽  
Nottingham Health Profile ◽  
Slipped Capital Femoral Epiphysis ◽  
Harris Hip Score ◽  
Outcome Analysis ◽  
Complication Rates ◽  
Femur Geometry

Abstract Background In recent years, the modified Dunn osteotomy has gained popularity to treat slipped capital femoral epiphysis (SCFE) with various complication rates. Most studies included patients with different severities. This study aimed to determine (1) the radiological and clinical outcome, (2) the health-related quality of life, and (3) the incidence of avascular necrosis of the femoral head (AVN) in patients with severe chronic or acute on chronic SCFE treated by the modified Dunn procedure. Methods Out of 150 patients with SCFE treated at our institution between 2001 and 2014, 15 patients (mean age 12.9 years (range 11.8–15)) were treated by the modified Dunn procedure. Eight SCFE were chronic and 7 acute on chronic. All slips were severe with a mean Southwick slip angle (SSA) of 67° (range 60–80). Radiographic and clinical outcomes were measured. Mean time of follow-up was 3.8 years (range 1–10). Results Anatomical reduction was achieved in all cases. Good radiological results according to the Stulberg Classification (grade 1 + 2) and the Sphericity Deviation Score (< 30) were found in 9 out of 13 patients at the last follow-up. Clinical and functional outcome analysis revealed good results in 8 out of 10 patients (Harris Hip Score > 80). The quality of life measured by the Nottingham Health Profile (NHP) was described good in 10 out of 10 patients. Four out of 15 patients developed an AVN. Conclusions The modified Dunn procedure has a great potential to restore proximal femur geometry in severe chronic or acute on chronic SCFE. It should be considered only if there is no other possibility to restore proximal femur geometry, as is the case in severe slips, due to the risk of AVN.

Decision analysis of treatment options for vestibular schwannoma

2011 ◽  
Vol 114 (2) ◽  
pp. 400-413 ◽  
Author(s):  
Robert G. Whitmore ◽  
Christopher Urban ◽  
Ephraim Church ◽  
Michael Ruckenstein ◽  
Sherman C. Stein ◽  
...  
Keyword(s):  
English Language ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Complication Rates ◽  
Online Databases ◽  
Decision Analytical Model ◽  
The Mean ◽  
Meta Regression

Object Widespread use of MR imaging has contributed to the more frequent diagnosis of vestibular schwannomas (VSs). These tumors represent 10% of primary adult intracranial neoplasms, and if they are symptomatic, they usually present with hearing loss and tinnitus. Currently, there are 3 treatment options for quality of life (QOL): wait and scan, microsurgery, and radiosurgery. In this paper, the authors' purpose is to determine which treatment modality yields the highest QOL at 5- and 10-year follow-up, considering the likelihood of recurrence and various complications. Methods The MEDLINE, Embase, and Cochrane online databases were searched for English-language articles published between 1990 and June 2008, containing key words relating to VS. Data were pooled to calculate the prevalence of treatment complications, tumor recurrence, and QOL with various complications. For parameters in which incidence varied with time of follow-up, the authors used meta-regression to determine the mean prevalence rates at a specified length of follow-up. A decision-analytical model was constructed to compare 5- and 10-year outcomes for a patient with a unilateral tumor and partially intact hearing. The 3 treatment options, wait and scan, microsurgery, and radiosurgery, were compared. Results After screening more than 2500 abstracts, the authors ultimately included 113 articles in this analysis. Recurrence, complication rates, and onset of complication varied with the treatment chosen. The relative QOL at the 5-year follow-up was 0.898 of normal for wait and scan, 0.953 for microsurgery, and 0.97 for radiosurgery. These differences are significant (p < 0.0052). Data were too scarce at the 10-year follow-up to calculate significant differences between the microsurgery and radiosurgery strategies. Conclusions At 5 years, patients treated with radiosurgery have an overall better QOL than those treated with either microsurgery or those investigated further with serial imaging. The authors found that the complications associated with wait-and-scan and microsurgery treatment strategies negatively impacted patient lives more than the complications from radiosurgery. One limitation of this study is that the 10-year follow-up data were too limited to analyze, and more studies are needed to determine if the authors' results are still consistent at 10 years.

Ileal Conduit and Continent Ileocecal Pouch for Patients Undergoing Pelvic Exenteration: Comparison of Complications and Quality of Life

2011 ◽  
Vol 21 (2) ◽  
pp. 403-408 ◽  
Author(s):  
Dirk Michael Forner ◽  
Björn Lampe
Keyword(s):  
Quality Of Life ◽  
Urinary Diversion ◽  
Pelvic Exenteration ◽  
Ileal Conduit ◽  
Short Form ◽  
Complication Rates ◽  
Stomal Complications ◽  
Short Form Health

Objectives:Creating a continent urinary pouch has become an alternative to the ileal conduit for patients undergoing exenteration for advanced gynecologic malignancies. The objective of this study was to compare clinical outcomes for the 2 methods.Methods:In this retrospective study, we compared intraoperative and postoperative complications and quality-of-life scores for the modified ileocecal pouch and the ileal conduit in anterior or total pelvic exenteration.Results:In 33 of 100 patients, an ileal pouch (IP) was created; the other 67 were treated by an ileal conduit (IC). Creating an IP prolonged the exenterative procedure by 97 minutes compared to an IC (IC, 453 minutes vs IP, 550 minutes;P= 0.009). Overall complication rates were similar, but patients with an IP had significantly more complications of urinary diversion (48%) than patients with an IC (31%;P= 0.03). Follow-up showed urinary loss and frequency of micturition to be comparable, but in patients with an IP, surgery for stomal complications (n = 2) and treatment of bladderstones were necessary more frequently (n = 3). Quality of life according to the 12-item Short Form Health Survey questionnaire was similar in both groups.Conclusion:A continent IP is an alternative to the IC in cases of pelvic exenteration. Early complications are more frequent with an IP than with an IC. The mode of urinary diversion has little influence on the quality of life in patients with advanced genital cancer.

A systematic review of the complications of contemporary total elbow arthroplasty

2020 ◽  
pp. 175857322090562
Author(s):  
Phoebe Parker ◽  
Nicholas D Furness ◽  
Jonathan P Evans ◽  
Timothy Batten ◽  
William J White ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Infection ◽  
Total Elbow Arthroplasty ◽  
Complication Rates ◽  
Elbow Arthroplasty ◽  
Specific Complication ◽  
Inflammatory Arthropathy ◽  
Cumulative Rate

Background Total elbow arthroplasty is a low volume procedure. We aimed to evaluate complication rates and cumulative percentages associated with the most frequently used contemporary implants and for the commonest indications. Methods A systematic literature search of all studies reporting complications following total elbow arthroplasty with 12-month minimum follow-up was undertaken. Quality of studies was assessed with the Methodological-Index-for-Non-Randomised-studies criteria. British NJR data identified the most common UK prostheses and indications. The complication rates for all undesirable events contributing to patient outcome were extracted and cumulative percentages were calculated. Results One hundred seventeen studies were screened, 12 studies included, totalling 815 procedures. Mean follow-up was 3.8 years. The overall complication cumulative percentage was 60.7%, significantly higher than that seen in other joint arthroplasty, including a 6.5% deep infection rate. Nerve injury was comparable between implants at around 4.1%. Radiographic loosening had a cumulative rate of 17.2%. Revision for symptomatic aseptic loosening was 6.3%. Conclusions This is the largest systematic review of the complications of total elbow arthroplasty. Surgeons should be aware of differing complications related to their implant of choice, each having its own specific complication. Trauma as an indication appears to have an increased complication rates compared to inflammatory arthropathy. There is a lack of literature regarding the independent results of osteoarthritis as a specific indication for total elbow arthroplasty.

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