scholarly journals Tips and Tricks in surgical reduction of the posterior column of AO/OTA C3 pilon fractures

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Moran Huang ◽  
Qiuke Wang ◽  
Junjie Guan ◽  
Kexin Liu ◽  
Yunfeng Chen ◽  
...  
Keyword(s):  
Posterior Column ◽  
Posterolateral Approach ◽  
Foot And Ankle ◽  
Two Stage ◽  
Aofas Score ◽  
Second Stage ◽  
Controversial Topic ◽  
The Mean ◽  
Ankle Function ◽  
Pilon Fractures

Abstract Background Accurate posterior column reduction remains a challenging and controversial topic in the management of complex pilon fractures (AO/OTA C3). We aim to report the outcomes of surgical treatment for 22 AO/OTA C3 pilon fracture cases between January 2015 and May 2017 and highlight some traps and tips. Methods Three patients underwent two-stage early plating on the posterior column through a posterolateral approach. The remaining 19 patients were treated with two-stage delayed plating on the posterior column: 11 patients were treated with a posterolateral approach, five patients with a modified posteromedial approach, and three patients with a single anterior approach. The reduction of the posterior column was evaluated according to the Burwell-Charnley’s radiographic criteria, and functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scores. Results Posterior column malreduction occurred in five cases, including in one case that was re-adjusted immediately and in another case that was re-adjusted during a two-staged delayed operation. According to Burwell-Charnley’s criteria, the satisfactory rate of fracture reduction was 81.8%. After 1 year, the mean AOFAS score was 81.9 (81.9 ± 9.9); the outcome was excellent in three (20.0%), good in nine (60.0%), and fair in three (20.0%). Excellent or good outcomes were noted in 12 patients (80.0%). Conclusions The combined anterior and posterior approach is suggested in the second stage of plating so that the posterior column fragments can be re-adjusted intraoperatively, if necessary. Following these procedures, satisfactory reduction and recovery of good ankle function can be anticipated.

scholarly journals Management of mal-united Pilon fractures with joint-sparing osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Guang-rong Yu
Keyword(s):  
Type Ii ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Vas Score ◽  
Articular Surfaces ◽  
Significant Difference ◽  
The Mean ◽  
American Orthopaedic ◽  
Time From Injury ◽  
Pilon Fractures

Category: Ankle Introduction/Purpose: To explore the effectiveness and operative methods to treat various mal-united Pilon fractures with joint-sparing osteotomy. Methods: Between January 2011 and October 2016, 21 patients with mal-united Pilon fractures were treated with joint-sparing osteotomy. There were 13 males and 8 females with an average age of 38.4 years (range, 22-48 years). 14 were left feet and 7, right. The time from injury to reconstructive operation was 4 months to 10 years. 17 received operative treatment previously, and 4 were treated by plaster fixation. According to Rüedi-Allgöwer classification, 16 were rated as type II (including 6 medial Pilon fractures, 5 anterior, 5 posterior) and 5, type III. All patients received standardized postoperative managements. Results: All patients were followed up for more than 1 year. All the fractures were reunited in an average time of 13.8 weeks (range 9 to 18 weeks). The mean visual analogue scale (VAS) score was 2.42 (range 0 to 5) and the mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 78.81(range 65 to 92) 6 months after operation. The VAS score was 5.27 (range 2 to 7) and the AOFAS score was 57.26 (range 20 to 81) before. Comparing to preoperative data, statistically significant difference was found postoperatively (P<0.05). Conclusion: Results by joint-sparing osteotomy to realign and reconstruct articular surfaces of ankles are acceptable. Functions and symptoms are improved significantly after operation. Joint-sparing osteotomy can be a considerable option for treating mal-united Pilon fractures.

scholarly journals RELATIONSHIP BETWEEN THE KNEE AND HINDFOOT AXES IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS

2020 ◽  
Vol 28 (5) ◽  
pp. 229-232 ◽  
Author(s):  
HENRIQUE MANSUR ◽  
FELIPE ALMEIDA ROCHA ◽  
PEDRO GUILME TEIXEIRA DE SOUSA FILHO ◽  
ISNAR MOREIRA DE CASTRO JUNIOR
Keyword(s):  
Mean Value ◽  
Foot And Ankle ◽  
Moderate Correlation ◽  
Varus Knee ◽  
Aofas Score ◽  
Level Of Evidence ◽  
The Mean ◽  
American Orthopaedic ◽  
Ankle Function ◽  
Angular Deformities

ABSTRACT Objective: To evaluate the correlation between knee axis and hindfoot axis in patients with advanced gonarthrosis, and the association between ankle function and angular deformities. Methods: 72 patients were enrolled in the study: 66% were women, and mean age was 58.7 years. The anatomical axis of the knee and hindfoot were measured by short knee radiographs and long axial view of the hindfoot. Results: Among the study group, 79.2% presented varus knee (mean 15º ± 7.69º) and 20.8% valgus (mean 15.9º ± 7.7º). 63.9% had hindfoot varus (mean 8.5º ± 6.07º) and 36.1% valgus (mean 3.9º ± 3.92º) (p < 0.05). The mean value for the American Orthopaedic Foot and Ankle Society (AOFAS) score was 74.26 points, and values were significantly higher among patients with hindfoot varus (p < 0.05). We found no correlation between gender or AOFAS score and knee and hindfoot axes, nor between deformities in the knee and hindfoot axes (p > 0.05). The subgroup genu valgum - hindfoot varus presented a moderate correlation (r = 0.564; p < 0.05). Conclusion: We found no association between the anatomical axes of the knee and hindfoot. Patients with gonarthrosis and hindfoot varus presented a better ankle function. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

scholarly journals Treatment of AO/OTA 43-C3 Pilon Fracture: Be Aware of Posterior Column Malreduction

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Junjie Guan ◽  
Moran Huang ◽  
Qiuke Wang ◽  
Yunfeng Chen ◽  
Lei Wang
Keyword(s):  
Soft Tissue ◽  
Wound Care ◽  
Articular Surface ◽  
Plantar Flexion ◽  
Posterior Column ◽  
Ankle Motion ◽  
Second Stage ◽  
Tibial Pilon ◽  
Ankle Function ◽  
Pilon Fractures

Treatment of pilon fractures remains challenging due to the difficulty of fracture reduction and associated soft tissue complications. The aim of this study was to evaluate the pitfalls and strategies of posterior column reduction in the treatment of complex tibial pilon fractures (AO/OTA 43-C3). Thirteen AO/OTA classification 43-C3 type pilon fractures treated between January 2013 and January 2016 were retrospectively analyzed. Nine cases were treated by external fixation within 26 hours (range, 6–56 hours) after injury. The definitive open reduction and internal fixation (ORIF) was performed after the wound was healed without infection and soft tissue swelling had subsided. During the delayed/second-stage operation, the articular surface of the distal tibial plafond was reduced through the posterolateral and anterior approaches. X-ray and CT scans were performed pre- or postoperatively. The reduction quality was evaluated using Burwell–Charnley’s radiographic criteria. The follow-up was performed routinely and all complications were recorded. Ankle function was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. During the delayed/second-stage operation, primary reduction of the posterior column was performed entirely through posterolateral approaches. However, poor posterior column reduction was revealed by fluoroscopy in four cases, three of which were readjusted through the posterolateral and anterior approaches, and the fourth was adjusted directly through the anterior approach. Postoperative CT scan revealed that the step-off of the articular surface was less than 2 mm in 12 cases, and in only one case the step-off was greater than 2 mm but less than 5 mm. The satisfactory rate was 92.3% according to Burwell–Charnley’s reduction criteria. Eleven patients were followed up regularly; superficial infections occurred in two cases but healed after wound care treatment in 3 and 5 weeks, respectively. All eleven fractures were healed within an average of 3.6 months (range, 2.6–5 months). The average range of ankle motion was 19° of dorsiflexion and 28° of plantar-flexion. The mean AOFAS ankle-hindfoot score was 82 (range, 61–92). In our opinion, we suggest that the reduction of the articular surface should be performed through combined posterolateral and anterior approaches in a delayed operation, with flexible fixation of the posterior column. If the posterior column is poorly reduced, the articular surface can easily be manipulated through anterior approaches. According to this strategy, satisfactory outcomes of AO/OTA C3 pilon fractures would be anticipated.

scholarly journals TL 18209 - Relationship between the knee and hindfoot axes among patients with advanced gonarthrosis

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 111S
Author(s):  
Henrique Mansur ◽  
Felipe Almeida Rocha ◽  
Isnar Moreira de Castro Junior
Keyword(s):  
Genu Valgum ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Hindfoot Alignment ◽  
Significance Level ◽  
Joint Axis ◽  
Total Knee ◽  
The Mean ◽  
Ankle Function ◽  
The Relationship

Introduction: The relationship between knee and hindfoot alignment is intuitive, but the number of studies on associated deformities remains limited. The objective of this study is to assess the correlation between the femorotibial joint axis and the hindfoot axis in patients with advanced gonarthrosis. Methods: The knee and hindfoot axes were assessed in 72 patients with indications for total knee replacement. Knee radiographs and long axial view radiographs of the hindfoot were acquired from all patients. The hindfoot/ankle function of the patients was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale. Statistical analysis was performed at a maximum significance level of 5%. Results: The sample included 24 (33.3%) men and 48 (66.7%) women with a mean age of 58.7 years. The results showed that 79.2% subjects had genu varum (mean: 15º±7.69), and 20.8% had genu valgum (mean: 15.9º) (p>0.05); 46 (63.89%) patients had hindfoot varus (mean: 8.5º±6.07), and 26 (36.11%) had hindfoot valgus (mean: 3.9º±3.92). We observed a significant association between the knee and hindfoot axes (p<0.05). There was no significant correlation only between genu valgum–hindfoot varus (p<0.05). The mean AOFAS score was 74.26 points, with significantly higher scores among patients with hindfoot varus. The AOFAS score was correlated with the hindfoot and knee axes (P<0.05). Conclusion: The knee and hindfoot axes were associated in patients with advanced gonarthrosis. In addition, the patients with hindfoot varus showed better ankle function according to the AOFAS score.

A Two-Stage Combination Model for Wind Power Forecasting

2015 ◽  
Vol 737 ◽  
pp. 9-13
Author(s):  
Jun Zhang ◽  
Yuan Hao Wang ◽  
Ying Yi Li ◽  
Feng Guo
Keyword(s):  
Neural Network ◽  
Bp Neural Network ◽  
Wind Farm ◽  
General Trend ◽  
Two Stage ◽  
Combination Model ◽  
Second Stage ◽  
Combination Forecasting ◽  
The Mean ◽  
Power Sequence

With the wind farm data from the southeast coast this paper builds a two-stage combination forecasting model of output power based on data preprocessing which include filling up missing data and pre-decomposition. The first stage is a composite prediction of decomposed power sequence in which a time series and optimized BP neural network predict the general trend and the correlation of various factors respectively. The second stage is BP neural network with its input is the results of first stage. The effectiveness and accuracy of the two-stage combination model are verified by comparing the mean square error of the combination model and other models.

scholarly journals Comparison of estimators in one-phase two-stage Poisson sampling in forest inventories

2012 ◽  
Vol 42 (10) ◽  
pp. 1865-1871 ◽  
Author(s):  
Daniel Mandallaz ◽  
Alexander Massey
Keyword(s):  
Small Area ◽  
Two Stage ◽  
Random Sample Size ◽  
Poisson Sampling ◽  
Second Stage ◽  
Forest Inventories ◽  
Unbiased Estimates ◽  
The Mean ◽  
Concentric Circles ◽  
Better Than

In the context of Poisson sampling, numerous adjustments to classical estimators have been proposed that are intended to compensate for inflated variance due to random sample size. However, such adjustments have never been applied to extensive forest inventories. This work investigates the performances of four estimators for the timber volume in one-phase two-stage forest inventories, where trees in the first stage are selected, at the plot level, by concentric circles or angle-count methods and a subset thereof are selected by Poisson sampling for further measurements to get a better estimation. The original two-stage estimator is the sum of two components: the first is the mean of Horwitz–Thompson estimators using simple volume approximations, based on diameter and species alone, of all first-stage trees in each inventory plot, and the second is the mean of Horwitz–Thompson estimators based on the differences between the simple volume approximations and refined volume determinations based on further diameter and height measurements on the second-stage trees within each inventory plot. This two-stage estimator is particularly useful because it provides unbiased estimates even if the simple prediction model is not correct, which is particularly important for small area estimation. The other three estimators rely on adjustments of the second component of the original estimator that are adapted from estimators proposed in the literature by L.R. Grosenbaugh and C.-E. Särndal. It turns out that these adjustments introduce a negligible bias and that the original simple estimator performs just as well or even better than the new estimators with respect to the variance.

scholarly journals Evidence for a two-stage model of microbial infection

1968 ◽  
Vol 66 (2) ◽  
pp. 273-280 ◽  
Author(s):  
G. G. Meynell ◽  
Joan Maw
Keyword(s):  
Standard Error ◽  
Stage Model ◽  
Microbial Infection ◽  
Two Stage ◽  
Second Stage ◽  
Initial Stage ◽  
The Mean ◽  
Pass Through

SUMMARYColony counts on mice given the same number ofSalmonellaalways differ considerably. However, the standard error of the mean log count does not increase after the first 1·5 hr. of infection until the 8th or 10th day. These infections therefore appear to pass through an initial stage lasting a few hours, in which a varying proportion of the inoculum is killed, followed by a prolonged second stage in which the scatter in individual colony counts remains constant.

scholarly journals Physiotherapy Questionnaires App to Deliver Main Musculoskeletal Assessment Questionnaires: Development and Validation Study (Preprint)

2017 ◽  
Author(s):  
Nestor Cavalcante Teixeira Neto ◽  
Yuri Lopes Lima ◽  
Gabriel Peixoto Leão Almeida ◽  
Márcio Almeida Bezerra ◽  
Pedro Olavo De Paula Lima ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Assessment Tools ◽  
Foot And Ankle ◽  
Paper Version ◽  
Second Stage ◽  
Patient Reported ◽  
The Mean ◽  
American Orthopaedic ◽  
Paper Format ◽  
Development And Validation

BACKGROUND Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, the Physiotherapy Questionnaires app was developed. OBJECTIVE This study aims to explain the development of the app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. METHODS In the first stage, the app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were selected to validate the app. In total, 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study’s outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. RESULTS The app was approved by experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients’ data. In regards to validity, the mean of the total scores of the FAOS were 91.54% (SD 8.86%) for the paper version and 91.74% (SD 9.20%) for the app. There was no statistically significant differences in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 (SD 8.47) for the paper version and 93.96 (SD 8.48) for the app. No statistically significant differences were found for the total scores for the AOFAS or the subscales (P>.99). The app showed excellent agreement with the paper version of the FAOS, with an ICC value of 0.98 for the total score (95% CI 0.98-0.99), which was also found for the AOFAS with the ICC for the total score of 0.99 (95% CI 0.98-0.99). For compliance, 72% (36/50) of the participants in the FAOS group and 94% (47/50) in the AOFAS group preferred the app version. CONCLUSIONS The Physiotherapy Questionnaires app showed validity and high levels of compliance for the FAOS and AOFAS, which indicates it is not inferior to the paper version of these two questionnaires and confirms its viability and feasibility for use in clinical practice.

scholarly journals Treatment outcomes of buttress plating for posterior pilon fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Ming-Zhu Zhang ◽  
Guang-rong Yu
Keyword(s):  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Ct Scans ◽  
Posterolateral Approach ◽  
The Mean ◽  
Buttress Plate ◽  
Pilon Fractures

Category: Ankle Introduction/Purpose: The purpose of current study was to retrospectively analyze the clinical outcomes of buttress plate treatment of posterior pilon fractures. Methods: Between January 2005 and December 2016, 58 patients with posterior pilon fractures underwent buttress plate fixation. There were 32 males and 26 females and the mean age was 40.2years (range, 23 to 73 years). Preoperative radiographs, CT scans and three dimensional reconstructions were used to evaluate the fracture patterns. On the basis of the extension of the fracture lines presented on the CT scans, a posterolateral approach or a combination of both posterolateral and posteromedial approaches were used to reduce and fixate the posterior malleolar fragments. Clinical and radiographic examinations were used for postoperative follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Visual Analogue Scale (VAS) were used to evaluate the functional outcomes. Results: According to the CT scan images, the posterior pilon fractures were classified into 3 types. 51 patients were available for follow-up. The mean time of follow-up was 44.8 months. The mean AOFAS score was 84.3 points, and the mean VAS score was 1.6 points. One patient was found with ankle joint swelling and long term walking discomfort at 2-year follow-up. Other patients received favorable functional outcomes. No hardware failure occurred. Conclusion: The clinical outcomes of buttress plate treatment of posterior pilon fractures were satisfactory. Buttress plating availed the patients to return to earlier weight-bearing and functional exercises.

scholarly journals Effect of C/N Ratio on the Removal of Nitrogen and Microbial Characteristics in the Water Saturated Denitrifying Section of a Two-Stage Constructed Rapid Infiltration System

2018 ◽  
Vol 15 (7) ◽  
pp. 1469 ◽  
Author(s):  
Qinglin Fang ◽  
Wenlai Xu ◽  
Gonghan Xia ◽  
Zhicheng Pan
Keyword(s):  
Extracellular Polymeric Substances ◽  
Oxygen Demand ◽  
Denitrifying Bacteria ◽  
Major Constituent ◽  
Two Stage ◽  
Second Stage ◽  
Microbial Characteristics ◽  
The Mean ◽  
Water Saturated ◽  
Nitrogen Pollutants

The aim of this study was to improve the removal of nitrogen pollutants from artificial sewage by a modeled two-stage constructed rapid infiltration (CRI) system. The C/N ratio of the second stage influent was elevated by addition of glucose. When the C/N ratio was increased to 5, the mean removal efficiency of total nitrogen (TN) reached up to 75.4%. Under this condition, the number of denitrifying bacteria in the permanently submerged denitrifying section (the second stage) was 22 times higher than that in the control experiment without added glucose. Elevation of the C/N ratio resulted in lower concentrations of nitrate and TN in the second stage effluent, without impairment of chemical oxygen demand removal. The concentration of nitrate and TN in effluent decreased as the abundance of denitrifying bacteria increased. Moreover, the bacterial biofilms that had formed in the sand of the second stage container were analyzed. The secretion of extracellular polymeric substances, a major constituent of biofilms, was enhanced as a result of the elevated C/N ratio, which lead to the improved protection of the bacteria and enhanced the removal of pollutants.

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