scholarly journals Comparative study of the functional outcomes of combined medial-lateral approach arthrolysis with or without external fixation for severe elbow stiffness

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dan Xiao ◽  
Maoqi Gong ◽  
Chen Chen ◽  
Yejun Zha ◽  
Ting Li ◽  
...  
Keyword(s):  
External Fixation ◽  
Functional Outcomes ◽  
Operation Time ◽  
Lateral Approach ◽  
Elbow Stiffness ◽  
Level Of Evidence ◽  
Open Arthrolysis ◽  
Hinged External Fixation ◽  
Elbow Arthrolysis

Abstract Background To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. Methods We retrospectively collected and analyzed the clinical data of patients with severe elbow stiffness who were treated in our institution from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. Results The average follow-up time was 28.4 ± 3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and treatment cost of the patients without external fixation were significantly lower than patients with external fixation. Conclusion Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. Level of evidence Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

scholarly journals Comparative Study of the Functional Outcomes of Combined Medial-lateral Approach Arthrolysis With or Without External Fixation for Severe Elbow Stiffness

2021 ◽  
Author(s):  
Dan Xiao ◽  
Maoqi Gong ◽  
Chen chen ◽  
Yejun Zha ◽  
Ting Li ◽  
...  
Keyword(s):  
External Fixation ◽  
Functional Outcomes ◽  
Operation Time ◽  
Lateral Approach ◽  
Elbow Stiffness ◽  
Level Of Evidence ◽  
Open Arthrolysis ◽  
Hinged External Fixation ◽  
Elbow Arthrolysis

Abstract Background: To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. Methods: We retrospectively collected and analysed the clinical data of patients with severe elbow stiffness who were treated in our center from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. Results: The average follow-up time was 28.4±3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and cost of the patients without external fixation were significantly lower than patients with external fixation. Conclusion: Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. Level of Evidence: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

scholarly journals A 10-Year Follow-Up of Two-Incision and Modified Watson-Jones Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Shih-Jie Lin ◽  
Tsan-Wen Huang ◽  
Po-Chun Lin ◽  
Feng-Chih Kuo ◽  
Kuo-Ti Peng ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Large Scale ◽  
Operation Time ◽  
Harris Hip Score ◽  
Total Hip ◽  
Radiographic Parameters

Long-term data and information indicating whether minimally invasive surgery (MIS) approaches are safe and effective with total hip arthroplasty (THA) are lacking. Between 2004 and 2006, 75 patients with alcohol-related osteonecrosis of the femoral head (ONFH) who underwent 75 THAs with the two-incision approach were studied. The medical records, radiographic parameters, and functional outcomes were collected prospectively. All data were compared with those for matched patients who underwent a modified Watson-Jones (WJ) approach. THA using the two-incision approach was associated with longer operation time, more blood loss, more lateral femoral cutaneous nerve injury, and more periprosthetic femoral fractures (p<0.05for all four) than the modified WJ approach. The Harris Hip Score (HHS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) increased significantly from the period preoperatively to 6 weeks postoperatively and thereafter up to the last follow-up in both groups. However, there were no significant differences in terms of radiographic parameters and functional outcomes between the two groups throughout the study period. Both the two-incision and the modified WJ approach provided satisfactory results and survival rates at a mean follow-up of 10.8 years. A prospective, randomized, large-scale cohort study is still warranted for evidence-based recommendations.

scholarly journals Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing ： A retrospective cohort study

2019 ◽  
Author(s):  
Yiliang Cui ◽  
Xingyi Hua ◽  
Florian Schmidutz ◽  
Jian Zhou ◽  
Zongsheng Yin ◽  
...  
Keyword(s):  
Blood Loss ◽  
Intramedullary Nailing ◽  
Functional Outcomes ◽  
Operation Time ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Special Surgery ◽  
Tibial Shaft Fractures

Abstract Background: Tibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach. Methods: Retrospective analysis was performed in patients with tibial shaft fractures that were treated with IMN through a SP or IP approach between 01/01/2014 and 31/12/2016. The clinical and functional outcomes of the knee were assessed with the Hospital for Special Surgery (HSS) Knee Score. Secondary outcomes included the operation time and intraoperative blood loss. Results: A total of 50 patients/fractures (26 IP and 24 SP) with a minimum follow-up of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score ( P = 0.62) between them. Sub analysis of all the HSS components scores revealed no significant differences between pain ( P = 0.57), the stand and walk ( P = 0.54), the need for walking stick ( P = 0.60) and extension lag ( P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group ( P = 0.04) suggesting a higher ROM. Conclusions: Both SP and IP approach results in equivalent overall HSS knee scores. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.

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.

scholarly journals Results after Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0019
Author(s):  
Wolfram Grün ◽  
Marius Molund ◽  
Fredrik Nilsen ◽  
Are Stødle
Keyword(s):  
Subtalar Joint ◽  
Operation Time ◽  
Clinical Results ◽  
Lateral Approach ◽  
Calcaneal Fractures ◽  
Invasive Approach ◽  
Extensile Lateral Approach ◽  
Arthroscopically Assisted ◽  
American Orthopaedic

Category: Arthroscopy, Trauma Introduction/Purpose: Surgical treatment of calcaneal fractures using the extensile lateral approach is associated with high rates of infection and soft tissue complications. During the last years there was a trend towards less invasive fixation methods. Percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) combines the advantages of good visualization of the posterior facet of the subtalar joint with a minimally invasive approach. We have performed this technique since 2014 in selected Sanders II and III fractures. Methods: We conducted a clinical and radiographic follow-up of 19 patients with 20 calcaneal fractures which had been treated by PACO with a minimum follow-up of 12 months. The follow-up rate was 66% (19 of 29 patients). 18 men and 1 woman with a median age of 44 years (range, 21-65) and a follow-up period of 18 months (12-33) were examined. There were 11 Sanders II and 9 Sanders III fractures. Radiographs of all feet were obtained at final follow-up to evaluate the reduction of the fractures as well as the presence of osteoarthritis of the subtalar joint. Our primary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcomes were the Calcaneus Fracture Scoring System (CFSS), the Manchester- Oxford Foot Questionaire (MOxFQ), the Visual Analog Scale (VAS) for pain and the incidence of complications. Results: The patients were operated on after a median of 4 days after injury (range, 1-12). The operation time was 139.5 minutes (98-234). The patients were discharged 3 days (1-6) postoperatively. Postoperative radiographs showed a Böhler angle of 29.5 degrees (0-40). However, the follow-up radiographs showed subsidence of the fractures and a Böhler angle of 21 degrees (-16-36). 95% of the operated feet showed signs of posttraumatic subtalar osteoarthritis. There were no wound healing complications. Two patients were reoperated with screw removal due to prominent screws. The AOFAS score was 85 (50-100), the CFSS score 85 (26-100), the MOxFQ score 26.6 (0-73.4). The VAS pain score was 0 (0-5.7) at rest and 4 (0-8.2) during activity. Conclusion: Only a few articles have reported the outcome after percutaneous artroscopically assisted calcaneal osteosynthesis. Our results suggest that PACO gives good clinical results and a reduced risk of complications in selected calcaneal fractures. However, since this technique is technically challenging and has a steep learning curve, we expect to be able to further improve our results over time. Prospective longterm studies will be necessary to better document the potential advantages and limitations of this operating technique.

scholarly journals Functional Outcomes after Corrective Osteotomy of Symptomatic Distal Radius Malunions in Children

2019 ◽  
Vol 09 (02) ◽  
pp. 136-140
Author(s):  
C. A. Selles ◽  
M. A. M. Mulders ◽  
G. R. Roukema ◽  
C. H. van der Vlies ◽  
B. I. Cleffken ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Wrist Joint ◽  
Corrective Osteotomy ◽  
Cast Immobilization ◽  
Level Of Evidence ◽  
Secondary Displacement ◽  
Score Range

Abstract Background Closed reduction and cast immobilization of displaced distal radius fractures carries the risk of secondary displacement, which could result in a symptomatic malunion. In patients with a symptomatic malunion, a corrective osteotomy can be performed to improve pain and functional impairment of the wrist joint. Objective The aim of this study was to assess the functional outcomes of children who underwent a corrective osteotomy due to a symptomatic malunion of the distal radius. Methods Between 2009 and 2016, all consecutive corrective osteotomies of the distal radius of patients younger than 18 years were reviewed. The primary outcome was functional outcome assessed with the ABILHAND-Kids score. Secondary outcomes were QuickDASH (Quick Disabilities of Arm, Shoulder, and Hand) score, range of motion, complications, and radiological outcomes. Results A total of 13 patients with a median age of 13 years (interquartile range [IQR]: 12.5–16) were included. The median time to follow-up was 31 months (IQR: 26–51). The median ABILHAND-Kids score was 42 (range: 37–42), and the median QuickDASH was 0 (range: 0–39). Range of motion did not differ significantly between the injured and the uninjured sides for all parameters. One patient had a nonunion requiring additional operative treatment. The postoperative radiological parameters showed an improvement of radial inclination, radial height, ulnar variance, dorsal tilt, and dorsal tilt. Conclusion Corrective osteotomy for children is an effective method for treating symptomatic malunions of the distal radius. Level of Evidence This is a Level IV study.

scholarly journals Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing: a retrospective cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yiliang Cui ◽  
Xingyi Hua ◽  
Florian Schmidutz ◽  
Jian Zhou ◽  
Zongsheng Yin ◽  
...  
Keyword(s):  
Blood Loss ◽  
Intramedullary Nailing ◽  
Functional Outcomes ◽  
Operation Time ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Special Surgery ◽  
Tibial Shaft Fractures

Abstract Background Tibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach. Methods Retrospective analysis was performed in patients with tibial shaft fractures that were treated with IMN through a SP or IP approach between 01/01/2014 and 31/12/2016. The clinical and functional outcomes of the knee were assessed with the Hospital for Special Surgery (HSS) Knee Score. Secondary outcomes included the operation time and intraoperative blood loss. Results A total of 50 patients/fractures (26 IP and 24 SP) with a minimum follow-up of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score (P = 0.62) between them. Sub analysis of all the HSS components scores revealed no significant differences between pain (P = 0.57), the stand and walk (P = 0.54), the need for walking stick (P = 0.60) and extension lag (P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group (P = 0.04) suggesting a higher ROM. Conclusions Both SP and IP approach results in equivalent overall HSS knee scores. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.

Predictors of Patient-Reported Function and Pain Outcomes in Operative Ankle Fractures

2017 ◽  
Vol 38 (5) ◽  
pp. 496-501 ◽  
Author(s):  
Daniel M. Dean ◽  
Bryant S. Ho ◽  
Albert Lin ◽  
Daniel Fuchs ◽  
George Ochenjele ◽  
...  
Keyword(s):  
Risk Factors ◽  
Physical Function ◽  
Functional Outcomes ◽  
Case Series ◽  
Ankle Fractures ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Class B ◽  
Pain Outcomes

Background: Risk factors associated with short-term functional outcomes in patients with operative ankle fractures have been established. However, no previous studies have reported the association between these risk factors and functional outcomes outside of the first postoperative year. We identified predictors of functional and pain outcomes in patients with operative ankle fractures using the Patient Reported Outcomes Measurement System (PROMIS) physical function (PF) and pain interference (PI) measures. Methods: We retrospectively reviewed a multicenter cohort of patients ≥18 years old who underwent operative management of closed ankle fractures from 2001 to 2013 with a minimum of a 2-year follow-up. Patients with pilon variants, Maisonneuve fractures, Charcot arthropathy, prior ankle surgery, and chronic ankle fractures were excluded. Patients meeting inclusion criteria were contacted and evaluated using the PROMIS PF and PI computerized adaptive tests. Patient demographic and injury characteristics were obtained through a retrospective chart review. Univariate and multivariate regression models were developed to determine independent predictors of physical function and pain at follow-up. Included in this study were 142 patients (64 women, 78 men) with a mean age of 52.7 years (SD = 14.7) averaging 6.3 years of follow-up (range 2-14). Results: Patients had a mean PF of 51.9 (SD = 10.0) and a mean PI of 47.8 (SD = 8.45). Multivariate analysis demonstrated that independent predictors of decreased PF included higher age (B = 0.16, P = .03), higher American Society of Anesthesiologists (ASA) class (B = 10.3, P < .01), and higher body mass index (BMI; B = 0.44, P < .01). Predictors of increased PI included higher ASA class (B = 11.5, P < .01) and lower BMI (B = 0.41, P < .01). Conclusion: At follow-up, increased ASA class, increased BMI, and higher age at time of surgery were independently predictive of decreased physical function. Factors that were associated with increased pain at follow-up include lower BMI and higher ASA class. ASA class had the strongest effect on both physical function and pain. Level of Evidence: Level IV, case series.

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