Four-corner fusion method using a bioabsorbable plate for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists: a case series study

Abstract Background Scaphoid excision and four-corner arthrodesis is an acceptable salvage procedure for the treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, since first popularized in the 1980s. We investigated the potential application of novel bioabsorbable plates and screws made of un-sintered hydroxyapatite/poly-L-lactide composite for the treatment of metacarpal fractures. We used this material for the fixation of four-corner fusions for SLAC or SNAC wrists commencing from April 2009. The purpose of this study was to clarify the controversy in the literature regarding the use of these plates. Methods The surgical procedures and clinical outcomes of four-corner fusions using a bioabsorbable (poly-L-lactic acid and hydroxyapatite) plate were reported. Ten patients (mean age, 59.2 years) with SLAC or SNAC wrists underwent fusions between April 2009 and June 2016. The primary diseases were scapholunate ligament injury, Preiser disease, and scaphoid pseudarthrosis. The mean postoperative follow-up period was 45.9 months (range, 12–86). Results In all patients, bone union was achieved without dislocation or pain. The mean wrist flexion and extension arc improved from 78.5 degrees before surgery to 90.5 degrees after surgery. Mean grip strength improved from 51 to 69% after surgery, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score improved from 53.5 to 14.3. No complications such as infection, avascular swelling, or tendon adhesion were observed. This implant requires no removal of internal fixation devices, produces stable outcomes, and is an effective fusion technique. Conclusions We summarized the outcomes of four-corner arthrodesis using bioabsorbable plates. Satisfactory clinical results were shown, with no obvious complications. This novel plate also serves as a good alternative for patients who are allergic to metals. Furthermore, bioabsorbable plates are advantageous as they do not require removal.

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Treatment of Type II Scaphoid Nonunion Advanced Collapse Lesions by Scaphoid Distal Pole Resection and Proximal Tenodesis of Extensor Brevis Carpi Radialis: Technique Description and Case Series

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0039-1695763 ◽

2019 ◽

Vol 47 (02) ◽

pp. 084-090

Author(s):

Niceas da Silva Gusmão Filho ◽

Ricardo Kaempf de Oliveira

Keyword(s):

Scaphoid Fracture ◽

Case Series ◽

Good Alternative ◽

Definitive Treatment ◽

Type Ii ◽

Scaphoid Nonunion ◽

Wrist Flexion ◽

Proximal Pole ◽

Included Patient ◽

The Mean

Abstract Objective To describe a new surgical technique and treatment outcomes of type II scaphoid nonunion advanced collapse (SNAC) lesions by scaphoid distal resection associated to the tenodesis of the remaining proximal pole with the extensor brevis carpi radialis tendon. Material and Methods This is a retrospective, observational study in which six patients were enrolled and submitted to this original technique, from February 2016 to March 2018. Only those patients with a comprehensive assessment and minimum 6 months postoperative evolution were included. Patient data, such as age, gender, and dominance, along with injury characteristics, previous therapies, complaints, and time span between appearance of the lesion and surgery were all analyzed. Results Among the six patients assessed, four were male, with ages ranging from 28 and 46 years (mean, 38.1 years). The elapsed time between nonunion diagnosis or scaphoid fracture and definitive treatment ranged from 34 to 72 months, with an average of 48.0 months. The mean follow-up time between the surgery and final results assessment was 15.3 months, ranging from 8 to 22 months. Preoperative measured mean pain was 8.8, ranging from 8 to 10. At 6 months postoperatively, mean pain assessment was 1.5, ranging from 0 to 5. We added wrist flexion and extension to assess joint range of motion. Preoperatively, the mean measure was 76.6°, ranging from 55° to 90°. Postoperatively, the mean was 127.1°, ranging from 110° to 140°. One patient had proximal scaphoid necrosis at 8 months postoperatively as a complication. The patient was treated with proximal carpectomy, with good clinical outcome; however, he did not return to his original job activities. The other five patients did return to their previous labor activities. Conclusions Treatment of type II SNAC lesions by resection of the distal scaphoid associated to tenodesis of the remaining proximal pole with a portion of the extensor brevis carpi radialis tendon has proved to be a useful, safe technique. Having low morbidity and few complications, the treatment represents a good alternative to previously described techniques.

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ISOLATED SCAPHOTRAPEZIOTRAPEZOID OSTEOARTHRITIS: PRELIMINARY RESULTS OF TREATMENT USING A PYROCARBON IMPLANT

Hand Surgery ◽

10.1142/s0218810407003523 ◽

2007 ◽

Vol 12 (02) ◽

pp. 73-77 ◽

Cited By ~ 16

Author(s):

A. K. Low ◽

I. A. Edmunds

Keyword(s):

Good Alternative ◽

Pinch Strength ◽

Dash Score ◽

Wrist Flexion ◽

Interposition Arthroplasty ◽

Results Of Treatment ◽

Post Surgery ◽

Flexion Extension ◽

The Mean ◽

Pyrocarbon Implant

The scaphotrapeziotrapezoid (STT) joint is the second most common site in the wrist affected by degenerative arthritis. STT fusion has been the traditional treatment for patients with isolated STT arthritis but there are concerns about the complication rate and loss of wrist movement post-surgery. The current study presents the results of an interposition arthroplasty using a scaphoid trapezium pyrocarbon implant (STPI, BIOProfile). Ten STPI's were implanted in nine patients (mean age 66, 58–76 years) with isolated STT arthritis. The mean follow-up was 16.4 (3–35) months. Following surgery, VAS pain scores improved significantly and most patients had minimal restrictions in function, with a mean DASH score of 21. The mean wrist flexion-extension arc was 126° and radioulnar deviation was 43°. Mean grip strength was 82% and pinch strength 85% compared to the non-operated side. Patients were highly satisfied with the results of their surgery (mean VAS score 9.1). No surgical complications were encountered and no significant changes in carpal alignment were noted on radiographs. The results of this study suggest that STPI interposition arthroplasty may be a good alternative to STT fusion for isolated STT arthritis.

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Can pleural packing be an effective solution for uncontrollable intra or post-operative hemorrhage

International Surgery Journal ◽

10.18203/2349-2902.isj20202808 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2087

Author(s):

Hazem Zribi ◽

Abderrahmen Ammar ◽

Amina Abdelkbir ◽

Imen Bouacida ◽

Sarra Maazaoui ◽

...

Keyword(s):

Thoracic Surgery ◽

Invasive Pulmonary Aspergillosis ◽

Case Series ◽

Good Alternative ◽

Common Point ◽

Retrospective Case ◽

Case Series Study ◽

History Of ◽

The Common ◽

The Mean

Background: Uncontrollable bleeding during thoracic surgery has been a challenging problem faced by surgeons. The aim of this study was to clarify the usefulness of pleural packing as a good alternative to control hemorrhage and to deduce the common point between those patients.Methods: This was a retrospective case series study of eight patients who underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and shock which required intrathoracic packing from January 2014 to December 2019.Results: During the study period, eight patients underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and needed packing. Successful hemostasis was achieved in all cases after pleural packing. The mean age was 58.5 years and six patients were males. The common point was the history of pulmonary tuberculosis which was with invasive pulmonary aspergillosis for two patients. Incision was a posterolateral thoracotomy in all cases and six patients required pulmonary resection (five lobectomy and one bilobectomy), one patient required decortication, and one had tumorectomy of a paragonglioma located in the Barety’s space. The unpacking took place right after 48 hours. An arrest of the bleeding was noticed in all the remaining patients. The mean time of the mechanical ventilation was 11 days. Complications included atelectasis and infectious pneumonitis. We noted one case of death.Conclusions: Intrathoracic packing may be an effective and feasible technique in managing uncontrollable post-operative hemorrhage when the life of patients is in danger. This technique should always be considered for patients with tuberculosis history.

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Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber

Ophthalmology and Eye Diseases ◽

10.4137/oed.s12672 ◽

2013 ◽

Vol 5 ◽

pp. OED.S12672

Author(s):

Kagmeni Giles ◽

Moukouri Ernest ◽

Domngang Christelle ◽

Nguefack-Tsague Georges ◽

Cheuteu Raoul ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Teaching Hospital ◽

Case Series ◽

University Teaching ◽

Case Series Study ◽

The Mean ◽

The University

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.

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Anatomical and Visual Effects of Implantable Phakic Contact Lens on Correction of Myopia

10.21203/rs.3.rs-1245764/v1 ◽

2022 ◽

Author(s):

Mahmoud Ekram ◽

Ahmed Mohamed Kamal Elshafei ◽

Asmaa Anwar Mohamed ◽

Mohamed Farouk Sayed Othman Abdelkader

Keyword(s):

Visual Acuity ◽

Anterior Chamber ◽

Contact Lens ◽

Anterior Segment ◽

Anterior Chamber Depth ◽

Case Series ◽

Care Group ◽

Case Series Study ◽

Significant Difference ◽

The Mean

Abstract Purpose: To evaluate the anatomical effects of implantable phakic contact lens (IPCL) (Care Group, India) on anterior segment and its visual outcomes .Patients and methods: In a prospective interventional case series study, 60 highly myopic eyes of 32 patients were subjected to IPCL implantation in the Ophthalmology Department of Minia University Hospital, Egypt from January 2019 to June 2021. All patients had complete ophthalmic examination and were followed up for 1 year. Pentacam was used for preoperative and postoperative estimation of anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV) and IPCL vault in the 1st, 3rd, and 12th months. Assessment of corneal endothelium was done using specular microscope preoperatively and after 12 months. Preoperative and postoperative refraction and visual acuity were measured. Results: There was a statistically significant decrease in ACD, ACA, and ACV. There was no significant difference between preoperative and postoperative mean intraocular pressure (IOP) by the 12th month (P=0.163). The mean preoperative endothelial cell count (ECD) was significantly reduced from 2929.3±248 cells/mm2 to 2737.9±303 cells/mm2 at the 12th month (P<0.001). with a statistically highly significant improvement of mean Log Mar uncorrected visual acuity (UCVA) from 1.48±0.19 preoperatively to 0.46±0.11 by the end of follow up (P<0.001) with insignificant difference between preoperative best corrected visual acuity (BCVA) and postoperative UCVA (P=0.209). In the 12th month, the mean vault was 240±540 μm. No sight threatening complications occurred.Conclusion: Although IPCL induced anatomical changes, it was safe and effective for correction of high myopia.

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Early and long-term complications following transanal pull through Soave technique in infants with Hirschsprung's diseaseric infants with Hirschsprung's disease

Medicine and Pharmacy Reports ◽

10.15386/mpr-1314 ◽

2019 ◽

Author(s):

Manoochehr Ghorbanpour ◽

Mohammad Ali Seyfrabie ◽

Babak Yousefi

Keyword(s):

Intestinal Obstruction ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Statistical Tests ◽

Case Series ◽

P Value ◽

Short Term ◽

Case Series Study ◽

The Mean

Objective. Patients undergoing Soave surgery for Hirschsprung's disease are at risk for some complications. The aim of this study was to investigate such short-term and long-term complications and evaluate the outcome of the operation in these patients. Methods. A case series study was carried out during the last 12 years, during 2007 to 2018 in Besat hospital of Hamadan. Data collection conducted using a checklist includes questions about demographic information, clinical features, and short-term and long-term complications, and consequences of post-operative surgery. The findings of the study were analyzed using SPSS software version 20 and appropriate statistical tests. P-value less than 0.05 was considered statistically significant. Results. A total of 55 children underwent Soave surgery during the last 12 years in Besat Hospital Hamadan, Iran. The mean age of the patients was 38±10 days during surgery, of which 56.4% were female. The mean hospital stay was 7.3 days. Also, the mean weight of children at birth was 2970±447 gr. Most of the patients were born as NVD (52.7%) and term (74.5%). The most common comorbidity was congenital heart disease. The most common short-term complication was intestinal obstruction in 14 patients (25.5%) and the most frequent long-term complication was intestinal obstruction and constipation (27.3% each cases). The mortality rate of patients in this study was 14.5% in total. Conclusions. One stage surgical procedure in Hirschsprung's disease is a safe and effective method, but care should be taken in choosing patients and patients should be monitored for possible complications, so that they can be considered and implemented for proper treatment.

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Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results

Journal of Wrist Surgery ◽

10.1055/s-0040-1722570 ◽

2021 ◽

Author(s):

Omer Ayik ◽

Mehmet Demirel ◽

Necmettin Turgut ◽

Okyar Altas ◽

Hayati Durmaz

Keyword(s):

Grip Strength ◽

Dash Score ◽

Arthroscopic Debridement ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Hand Grip ◽

Case Series Study ◽

The Mean ◽

Kienbock’S Disease

Abstract Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21–45). The mean follow-up period duration was 36 months (range: 18–60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31–52) and 7.1 (range: 6–8) preoperatively to 13 (range: 8–21) and 2 (range: 0–3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20–60 degrees) and 56 degrees (range: 30–70 degrees; p = 0.009) preoperatively to 34 (range: 10–65 degrees; p = 0.218) and 57 degrees (range: 30–70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9–33) to 23.3 (range: 10–34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.

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Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Journal of Ophthalmology ◽

10.1155/2020/1251203 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hossam M. Moharram ◽

Shaaban Abd-Elhamid Mehany Elwan ◽

Mahmoud M. Nassar ◽

Mohamed F. Abdelkader

Keyword(s):

Case Series ◽

Neovascular Glaucoma ◽

Panretinal Photocoagulation ◽

Case Series Study ◽

Triple Procedure ◽

Distant Visual Acuity ◽

Pars Plana ◽

The Mean ◽

Series Study

Purpose. One of the most difficult refractory glaucomas is the neovascular type (NVG), and its association with dense cataract adds to this difficulty. This study aimed to provide results of the triple surgical procedure for such conditions. Methods. 12 eyes of 12 patients with NVG and dense cataract were included in this case series study. The mean age of patients was 57.25 ± 5.9 years. The mean preoperative intraocular pressure (IOP) was 47.25 ± 4.04 mmHg with maximum antiglaucoma therapy. The mean best corrected distant visual acuity (BCDVA) in LogMAR was 2.13 ± 0.38. All patients received intravitreal injection of 1.25 mg (0.05 ml) bevacizumab followed by phacoemulsification, pars plana vitrectomy (PPV) including panretinal photocoagulation (PRP), and trabeculectomy with mitomycin C (MMC). Mean IOP and BCDVA changes were the main outcome results of this study. Results. The follow-up period was 2 years. The mean BCDVA was improved to 1.22 ± 0.35, 1.13 ± 0.34, 1.12 ± 0.37, 1.06 ± 0.38, and 1.01 ± 0.37 at 1, 3, 6, 12, and 24 months, respectively, after this procedure. This improvement was statistically significant when compared with preoperative BCDVA (P<0.0001). The mean postoperative IOP was dropped to 20.08 ± 4.1, 17.08 ± 2.1, 17.17 ± 5, 15.75 ± 4.7, and 16.17 ± 6.1 mmHg, respectively. At the last follow-up, the mean IOP was statistically significantly lower than preoperative IOP (P<0.0001) at the previously mentioned time points. The success rate was complete in 90.9% of eyes and qualified in 100% of eyes. Iris and angle neovascularization had regressed significantly in all patients, and no serious complications occurred during the follow-up period. Conclusions. This triple surgery can safely improve patients with NVG and dense cataract regarding BCDVA and IOP control. This trial is registered with NCT04143620.

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Mobile App for Pre- and Intraoperative Assessment of Astigmatism Correction with Toric Intraocular Lenses in Cataract Surgery

Journal of Ophthalmology ◽

10.1155/2020/8354140 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Francisco Aecio Fernandes Dias ◽

Vinicius Jose Fernandes Dias ◽

Barbara de Araujo Lima Dutra ◽

Anna Christina Siqueira Marques ◽

Edgar Marçal ◽

...

Keyword(s):

Cataract Surgery ◽

Case Series ◽

Mobile App ◽

Mean Difference ◽

Ease Of Use ◽

Intraocular Lenses ◽

Toric Iol ◽

Astigmatism Correction ◽

Case Series Study ◽

The Mean

Purpose. To develop a mobile app that allows capturing and editing of photographs, performs image transposition and projection of a protractor with 360° axis markings, and permits accurate visualization of programmed alignment for the positioning of toric intraocular lenses (IOLs). Methods. In this prospective case series study, a codesign methodology was chosen to develop the Eye Axis Check application. After app development, measurements were obtained and comparisons were made between manual marks and toric IOL alignment without and with the app in 30 eyes that had undergone cataract surgery with toric IOLs. The mobile app was made available to 15 ophthalmic surgeons in different cities to assess its usability. Results. The users approved the developed application for its ease of use and utility. The mean difference between the markings made manually and those made with the app was 1° (±2°; range: 0°–5°), and the mean difference between the IOL position and the assessment made by the app was 3° (±3°; range: 0°–12°). Upon comparison of the agreement between the app measurements and the manual measurements for the IOL angle, no significant differences were found, and an excellent concordance (0.997) and a strong positive linear correlation (0.995) were observed. Conclusion. A mobile app for preoperative planning and intraoperative toric IOL alignment was developed and revealed to be useful and easy to use.

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Clinical profile of SUNCT/SUNA in Japan: A clinic-based study

Cephalalgia Reports ◽

10.1177/2515816319829907 ◽

2019 ◽

Vol 2 ◽

pp. 251581631982990 ◽

Cited By ~ 1

Author(s):

Shoji Kikui ◽

Junichi Miyahara ◽

Hanako Sugiyama ◽

Kentaro Yamakawa ◽

Yoshihiro Kashiwaya ◽

...

Keyword(s):

Case Series ◽

Japanese Patients ◽

Preventive Therapy ◽

Short Term ◽

Case Series Study ◽

Clinical Profiles ◽

The Mean ◽

Series Study ◽

Headache Center

Objectives: This study aimed to report the clinical profiles of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache attacks with cranial autonomic (SUNA) in a Japanese population by surveying those enrolled at a regional headache center in Japan. Methods: In this consecutive case series study, the clinical characteristics of patients with SUNCT (eight men, three women; mean age: 59.5 ± 20.5 years) and SUNA (five men, four women; mean age: 51.3 ± 18.4 years) who visited Tominaga Hospital from February 2011 to January 2017 were examined. Headaches were diagnosed according to the International Classification of Headache Disorders, Third edition (ICHD-3) guidelines. Results: Brief clusters of separate attacks were reported by all patients. The mean duration of attacks was 91.9 ± 87.9 s. Ipsilateral rhinorrhea was observed in 9 of 20 (45.0%) cases and facial sweating was observed in 1 of 20 (5.0%) cases. An eminent response to lamotrigine was observed in 9 of 9 (100%) patients; however, adverse events were only reported in 2 of 9 (22.2%) cases. An intravenous infusion of lidocaine was demonstrated to be completely successful for short-term prevention in 5 of 6 (83.3%) SUNCT cases. Conclusions: Lamotrigine can successfully treat most patients, and intravenous lidocaine is useful for the short-term preventive therapy of severe recalcitrant attacks in Japanese patients with SUNCT/SUNA.

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