Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients

Abstract Background Open reduction and internal fixation remains the standard treatment for displaced unstable ankle fractures. Plate fixation represents the most frequently used instrumentation option in fibula fractures and favourable outcomes have been reported. Recently, intramedullary nailing techniques have been suggested as a viable alternative resulting in less soft tissue disruption. The objectives of this study are to describe the surgical technique and to evaluate the safety and efficacy of using an intramedullary nail in patients undergoing surgical fixation of their fibula fracture. Methods A total of 30 skeletally mature patients with unstable ankle fracture who underwent intramedullary fixation of their fibula fractures from February 2016 to July 2017 were included in this retrospective study. Patients were evaluated using the Short Form-36 (SF-36) and the American Orthopaedic Foot and Ankle Society (AOFAS) at 18 months after surgery. Results All patients went on to fracture union. Two patients required a secondary surgical procedure. No patient included in this series developed any wound complications. The mean Physical Component Summary (PCS) of the SF-36 was 53.90 ± 13.3 and the mean Mental Component Summary Score (MCS) was 52.63 ± 11.12. The AOFAS subscale scores were 34.67 ± 1.03 for pain, 42.40 ± 0.2997 for function and 9.50 ± 0.2785 for alignment. Conclusions Our study demonstrates promising outcomes associated with intramedullary nail fixation of unstable fibula fractures. We recommend intramedullary nail fixation of fibula fractures to be a safe procedure with a low complication rate. Level of evidence Level 4 retrospective case series.

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Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles

The American Journal of Sports Medicine ◽

10.1177/0363546519887957 ◽

2019 ◽

Vol 48 (1) ◽

pp. 153-158 ◽

Cited By ~ 6

Author(s):

Seung-Won Choi ◽

Gun-Woo Lee ◽

Keun-Bae Lee

Keyword(s):

Functional Outcomes ◽

Short Form ◽

Arthroscopic Surgery ◽

Case Series ◽

Osteochondral Lesions ◽

Study Cohort ◽

Arthroscopic Microfracture ◽

Sf 36 ◽

The Mean

Background: Arthroscopic microfracture for osteochondral lesions of the talus (OLT) has shown good functional outcomes. However, some studies have reported that functional outcomes deteriorate over time after surgery. Purpose: To use various functional scoring systems to evaluate functional outcomes in a large sample of patients with OLT treated by arthroscopic microfracture. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 165 ankles (156 patients) that underwent arthroscopic microfracture for small to mid-sized OLT. The mean lesion size was 73 mm2 (range, 17-146 mm2), and the mean follow-up period was 6.7 years (range, 2.0-13.6 years). The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS) for pain, and 36-Item Short Form Health Survey (SF-36) were used to compare the functional outcomes between the preoperative and final follow-up assessments. Results: The mean FAOS significantly improved in regard to all subscores ( P < .001). The AOFAS ankle-hindfoot scale showed an improvement from 71.0 points (range, 47.0-84.0) preoperatively to 89.5 points (range, 63.0-100) at the final follow-up ( P < .001). The VAS score showed an improvement from 6.2 points (range, 4.0-9.0) preoperatively to 1.7 points (range, 0-6.0) at the final follow-up ( P < .001). The mean SF-36 score improved from 62.4 points (range, 27.4-76.6) preoperatively to 76.2 points (range, 42.1-98.0) at the final follow-up ( P < .001). Among 165 ankles, 22 ankles (13.3%) underwent repeat arthroscopic surgery for evaluation of repaired cartilage status. Conclusion: Arthroscopic microfracture showed good functional outcomes and improved quality of life with maintenance of satisfactory outcomes at a mean follow-up of 6.7 years. Therefore, arthroscopic microfracture seems to be reliable as a first-line treatment for OLT at an intermediate-term follow-up.

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Early Functional, Radiological Outcomes and Satisfaction Rates of Total Ankle Arthroplasty in an Asian Population

Foot & Ankle Specialist ◽

10.1177/1938640017750252 ◽

2018 ◽

Vol 11 (5) ◽

pp. 425-432 ◽

Cited By ~ 1

Author(s):

Shi Ming Tan ◽

Hamid Rahmatullah Bin Abd Razak ◽

Inderjeet Singh Rikhraj

Keyword(s):

Patient Satisfaction ◽

Short Form ◽

Mental Component Summary Score ◽

Asian Population ◽

Summary Score ◽

Total Ankle Arthroplasty ◽

Ankle Arthroplasty ◽

Sf 36 ◽

The Mean ◽

Satisfaction Rates

Background. Few studies have outlined the outcomes and complications in Asians undergoing total ankle arthroplasty. This study reports the functional, radiological outcomes and satisfaction rates in our Asian population. Methods. Patients who underwent primary total ankle arthroplasty from 2007 to 2013 were recruited. Outcomes evaluated were the AOFAS Ankle-Hindfoot Score (AHS), Visual Analogue Scale (VAS), and the Short Form 36 (SF-36)questionnaire. Outcome scores were collected prospectively up to 2 years. Patient satisfaction was evaluated on a 6-point scale based on North American Spine Society Low Back Pain Instrument and classified as satisfied or unsatisfied. Results. Forty-one patients underwent primary total ankle arthroplasty. All patients experienced improvements in AHS, VAS, and Mental Component Summary score of the SF-36 at both 6-month and 2-year postoperative interval. The mean AHS score improved from 35 ± 19 points preoperatively to 64 ± 24 at 6 months (P<.001) and 72 ± 26 at 24 months (P <.001). VAS scores improved from 7 ± 2 preoperatively to 3 ± 3 (P < .001) at 6 and 24 months. The Physical Component Summary (PCS) of the SF-36 has an established minimum clinically important difference (MCID) of 5. The mean improvement in PCS in our cohort met this MCID for the PCS; 63% and 71% of patients were satisfied with the procedure at 6 months and 2 years postoperatively, respectively. Revision rate in this series was 9.7%. Conclusion. Total ankle arthroplasty has good patient satisfaction rates, with favorable early clinical outcome in Asian patients. Levels of Evidence: Therapeutic, Level II

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Functional and quality of life assessment of patients with ankle ulcers subjected to complete Achilles tendon resection

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.971 ◽

2019 ◽

Vol 13 (2) ◽

pp. 172-178

Author(s):

Wrgelles Godinho Bordone Pires ◽

Philipe Eduardo Carvalho Maia ◽

Felipe Daniel Vasconcelos de Carvalho ◽

Rodrigo Simões Castilho ◽

Fernando Araújo Silva Lopes ◽

...

Keyword(s):

Quality Of Life ◽

Achilles Tendon ◽

Functional Status ◽

Short Form ◽

Case Series ◽

Life Assessment ◽

Diabetic Patients ◽

Sf 36 ◽

The Mean

Objective: To assess the quality of life and functional status of patients subjected to debridement of ulcers in the posterior ankle who required complete Achilles tendon resection without any type of reconstruction or tendon transfer. Method: This is a case series of 5 (mostly diabetic) patients who underwent complete Achilles tendon resection due to an ulcer in the posterior ankle region. Preservation of the Achilles tendon was prevented due to tendon exposure, extensive degeneration and the need for infection control. Patients answered the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS-BR) questionnaire and the 36-item Short-Form Health Survey (SF-36) during the postoperative period, and follow-up varied between 6 and 24 months. The ATRS-BR ranges from 0 to 100, and higher scores indicate fewer symptoms and limitations. The SF-36 consists of 36 questions comprising 8 domains, which are independently assessed and given a score of up to 100 points, with higher scores indicating better health status. Results: The mean age of patients was 70 years. The mean score on the SF-36 physical functioning domain was 70 (50-95) points. The mean value of the ATRS-BR was 54.6 (31-88) points; however, the patients had few complaints about their functional status. Conclusion: Non-reconstruction of the Achilles tendon in predominantly diabetic elderly patients with posterior ankle ulcers presents encouraging functional outcomes. This study suggests that complete Achilles tendon resection is a viable option for ulcer treatment in this population. Level of Evidence IV; Therapeutic Studies; Cases Series.

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Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05687-w ◽

2019 ◽

Vol 28 (1) ◽

pp. 141-147 ◽

Cited By ~ 3

Author(s):

Kaj T. A. Lambers ◽

Jari Dahmen ◽

Mikel L. Reilingh ◽

Christiaan J. A. van Bergen ◽

Sjoerd A. S. Stufkens ◽

...

Keyword(s):

Rating Scale ◽

Short Form ◽

Case Series ◽

Ct Scans ◽

Osteochondral Defects ◽

Effective Treatment Option ◽

Level Of Evidence ◽

Sf 36 ◽

The Mean

Abstract Purpose The purpose of this study was to describe the mid-term clinical and radiological results of a novel arthroscopic fixation technique for primary osteochondral defects (OCD) of the talus, named the lift, drill, fill and fix (LDFF) technique. Methods Twenty-seven ankles (25 patients) underwent an arthroscopic LDFF procedure for primary fixable talar OCDs. The mean follow-up was 27 months (SD 5). Pre- and post-operative clinical assessments were prospectively performed by measuring the Numeric Rating Scale (NRS) of pain in/at rest, walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) were used to assess clinical outcome. The patients were radiologically assessed by means of computed tomography (CT) scans pre-operatively and 1 year post-operatively. Results The mean NRS during running significantly improved from 7.8 pre-operatively to 2.9 post-operatively (p = 0.006), the NRS during walking from 5.7 to 2.0 (p < 0.001) and the NRS in rest from 2.3 to 1.2 (p = 0.015). The median FAOS at final follow-up was 86 for pain, 63 for other symptoms, 95 for activities of daily living, 70 for sport and 53 for quality of life. A pre- and post-operative score comparison was available for 16 patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 to 50.1. Of the CT scans at 1 year after surgery, 81% showed a flush subchondral bone plate and 92% of OCDs showed union. Conclusion Arthroscopic LDFF of a fixable primary talar OCD results in excellent improvement of clinical outcomes. The radiological follow-up confirms that fusion of the fragment is feasible in 92%. This technique could be regarded as the new gold standard for the orthopedic surgeon comfortable with arthroscopic procedures. Level of evidence Prospective case series, therapeutic level IV.

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Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up

Neurosurgical FOCUS ◽

10.3171/2015.11.focus15435 ◽

2016 ◽

Vol 40 (2) ◽

pp. E13 ◽

Cited By ~ 72

Author(s):

Michael Y. Wang ◽

Jay Grossman

Keyword(s):

Minimally Invasive ◽

General Anesthesia ◽

Open Surgery ◽

Interbody Fusion ◽

Short Form ◽

Case Series ◽

Sf 36 ◽

Clinical Series ◽

The Mean

OBJECTIVE One of the principal goals of minimally invasive surgery has been to speed postoperative recovery. In this case series, the authors used an endoscopic technique for interbody fusion combined with percutaneous screw fixation to obviate the need for general anesthesia. METHODS The first 10 consecutive patients treated with a minimum of 1 year's follow-up were included in this series. The patients were all treated using endoscopic access through Kambin's triangle to allow for neural decompression, discectomy, endplate preparation, and interbody fusion. This was followed by percutaneous pedicle screw and connecting rod placement using liposomal bupivacaine for long-acting analgesia. No narcotics or regional anesthetics were used during surgery. RESULTS All patients underwent the procedure successfully without conversion to open surgery. The patients' average age was 62.2 ± 9.0 years (range 52–78 years). All patients had severe disc height collapse, and 60% had a Grade I spondylolisthesis. The mean operative time was 113.5 ± 6.3 minutes (range 105–120 minutes), and blood loss was 65 ± 38 ml (range 30–190 ml). The mean length of hospital stay was 1.4 ± 1.3 nights. There were no intraoperative or postoperative complications. Comparison of preoperative and final clinical metrics demonstrated that the Oswestry Disability Index improved from 42 ± 11.8 to 13.3 ± 15.1; the 36-Item Short Form Health Survey (SF-36) Physical Component Summary improved from 47.6 ± 3.8 to 49.7 ± 5.4; the SF-36 Mental Component Summary decreased from 47 ± 3.9 to 46.7 ± 3.4; and the EQ-5D improved from 10.7 ± 9.5 to 14.2 ± 1.6. There were no cases of nonunion identified radiographically on follow-up imaging. CONCLUSIONS Endoscopic fusion under conscious sedation may represent a feasible alternative to traditional lumbar spine fusion in select patients. Larger clinical series are necessary to validate that clinical improvements are sustained and that arthrodesis rates are successful when compared with open surgery. This initial experience demonstrates the possible utility of this procedure.

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Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

Journal of International Medical Research ◽

10.1177/0300060520920407 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052092040

Author(s):

Yao Lu ◽

Teng Ma ◽

Cheng Ren ◽

Zhong Li ◽

Liang Sun ◽

...

Keyword(s):

External Fixation ◽

Locking Plate ◽

Short Form ◽

Clinical Results ◽

Bone Transport ◽

Fixation Index ◽

Fixation Time ◽

Sf 36 ◽

Health Related ◽

The Mean

Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.

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Evolution of a Novel Tissue Preservation Protocol to Optimize Osteochondral Transplantation Outcomes

Cartilage ◽

10.1177/1947603518812557 ◽

2018 ◽

Vol 12 (1) ◽

pp. 31-41 ◽

Cited By ~ 1

Author(s):

David Cinats ◽

Sue Miller ◽

Ziad Abusara ◽

S. Mark Heard ◽

Carol Hutchison ◽

...

Keyword(s):

Short Form ◽

Case Series ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Tissue Preservation ◽

Tissue Storage ◽

Tissue Quality ◽

Cross Sectional ◽

Sf 36

Objective Osteochondral allograft transplantation is a procedure to treat focal osteochondral lesions (OCLs), but is limited by tissue availability, the quality of transplanted tissue, and inconsistent storage protocols. The objective of this study was to assess the clinical outcomes of a novel tissue procurement, storage, and quality control protocol in treating OCLs. Design Prospective case series. Donor cadaveric tissue was processed, stored, and the tissue quality analyzed using the unique tissue preservation protocol developed at our institution. Advanced cross-sectional imaging was used to size match donor tissue with recipient patients. Osteochondral allografts were transplanted using the Arthrex Allograft OATS. Patients were evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), and 36-Item Short Form Survey (SF-36) preoperatively and at 1 year and 2 years postoperatively. Results Twenty patients (17 knees, 3 shoulders) were included in the study. There was a significant improvement in the following scores: overall WOMAC score, WOMAC function and pain subcategories; KOOS pain, knee-related symptoms, activities of daily living, sports and recreation, and quality of life; SF-36 physical functioning, physical role, pain, and social functioning subcategories; and VAS at all time points postoperatively. There was a significant improvement in WOMAC stiffness at 2 years postoperatively. There were 2 failures, defined by graft subsidence and persistent pain requiring reoperation. Conclusion The protocol developed at our institution for OAT resulted in significant clinical improvement in patients with OCLs and is an improvement on existing tissue storage techniques.

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Perceived functioning, well-being and psychiatric symptoms in patients with stable schizophrenia treated with long-acting risperidone for 1 year

The British Journal of Psychiatry ◽

10.1192/bjp.187.2.131 ◽

2005 ◽

Vol 187 (2) ◽

pp. 131-136 ◽

Cited By ~ 63

Author(s):

W. Wolfgang Fleischhacker ◽

Jonathan Rabinowitz ◽

Georg Kemmler ◽

Mariëlle Eerdekens ◽

Angelika Mehnert

Keyword(s):

Mental Component Summary ◽

Psychiatric Symptoms ◽

Short Form ◽

Mental Component Summary Score ◽

Well Being ◽

Psychotic Symptoms ◽

Open Label ◽

Sf 36 ◽

Patient Reported ◽

Long Acting

BackgroundThe extent to which antipsychotics improve patients' well-being is uncertain.AimsTo examine psychopathology and patient-rated functioning and well-being in patients treated with risperidone.MethodIn a 1-year, open-label, international multicentre trial of long-acting risperidone in 615 stable adult patients with schizophrenia, self-rated functioning and well-being were measured every 3 months using the Short Form 36-item questionnaire (SF–36). Psychopathology was quantified using the Positive and Negative Syndrome Scale (PANSS).ResultsSignificant improvements were found on the SF–36 mental component summary score and vitality and social functioning scales. PANSS and mental component summary scores were moderately correlated.ConclusionsPatient-reported functioning and well-being appear to differ from investigator-rated psychotic symptoms. Patient-rated well-being should be assessed with symptoms to help measure treatment outcomes.

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Development and Testing of the UK SF-12

Journal of Health Services Research & Policy ◽

10.1177/135581969700200105 ◽

1997 ◽

Vol 2 (1) ◽

pp. 14-18 ◽

Cited By ~ 227

Author(s):

Crispin Jenkinson ◽

Richard Layte

Keyword(s):

Health Status ◽

Short Form ◽

Community Sample ◽

Mental Component Summary Score ◽

Well Being ◽

Summary Score ◽

Sf 36 ◽

Patient Groups ◽

The Uk ◽

Component Scores

Objectives: The 36 item short form health survey (SF-36) has proved to be of use in a variety of settings where a short generic health measure of patient-assessed outcome is required. This measure can provide an eight dimension profile of health status, and two summary scores assessing physical function and mental well-being. The developers of the SF-36 in America have developed algorithms to yield the two summary component scores in a questionnaire containing only one-third of the original 36 items, the SF-12. This paper documents the construction of the UK SF-12 summary measures from a large-scale dataset from the UK in which the SF-36, together with other questions on health and lifestyles, was sent to randomly selected members of the population. Using these data we attempt here to replicate the findings of the SF-36 developers in the UK setting, and then to assess the use of SF-12 summary scores in a variety of clinical conditions. Methods: Factor analytical methods were used to derive the weights used to construct the physical and mental component scales from the SF-36. Regression methods were used to weight the 12 items recommended by the developers to construct the SF-12 physical and mental component scores. This analysis was undertaken on a large community sample ( n = 9332), and then the results of the SF-36 and SF-12 were compared across diverse patient groups (Parkinson's disease, congestive heart failure, sleep apnoea, benign prostatic hypertrophy). Results: Factor analysis of the SF-36 produced a two factor solution. The factor loadings were used to weight the physical component summary score (PCS-36) and mental component summary score (MCS-36). Results gained from the use of these measures were compared with results gained from the PCS-12 and MCS-12, and were found to be highly correlated (PCS: ρ = 0.94, p < 0.001; MCS: ρ = 0.96, p < 0.001), and produce remarkably similar results, both in the community sample and across a variety of patient groups. Conclusions: The SF-12 is able to produce the two summary scales originally developed from the SF-36 with considerable accuracy and yet with far less respondent burden. Consequently, the SF-12 may be an instrument of choice where a short generic measure providing summary information on physical and mental health status is required. Crispin Jenkinson DPhil, Deputy Director

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Early Outcomes Following Dorsal Denervation of the Midfoot for Management of Arthritic Pain

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00383 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0038

Author(s):

Glenn G. Shi ◽

Arun Kumar ◽

Meredith A. Williams ◽

Benjamin K. Wilke ◽

Joseph L. Whalen ◽

...

Keyword(s):

Pain Relief ◽

Functional Outcomes ◽

Nonoperative Management ◽

Short Form ◽

Safe Alternative ◽

Sf 36 ◽

The Mean ◽

Protective Sensation ◽

And Function ◽

Complications Rate

Category: Midfoot/Forefoot Introduction/Purpose: Debilitating midfoot arthritic pain is reported to affect up to 12% of adults over 50 years. After failure of nonoperative management, midfoot arthrodesis has been favored as the primary operative treatment producing acceptable outcomes with associated potentially long postoperative immobilization and 17% major complications rate. The aim of this study was to evaluate the pain and functional outcomes of dorsal midfoot surgical denervation by deep peroneal neurectomy as a safe alternative for management of dorsal midfoot pain. Methods: In this retrospective study, 18 patients (21 feet) who underwent dorsal denervation of the midfoot by deep peroneal neurectomy by a single surgeon were evaluated. There were 13 women and 5 men with mean age 70.4 (range, 47 to 88) at the time of surgery. Indications for the procedure include painful midfoot arthritis, lack of radiographic collapse, intact plantar protective sensation, failed nonoperative management for 6 months, and greater than 75% transient pain relief from preoperative diagnostic block of deep peroneal nerve. Preoperative and postoperative (3 months, 6 months) Visual Analog Scale (VAS), Short- Form 36 (SF-36), and Foot and Ankle Outcome Score (FAOS) were reviewed. Complications were recorded. Results: The mean VAS score improved from 7.4 +/-1.9 to 1.9 +/-1.9 at 3 months and 1.4 +/-1.9 at 6 months (p<0.001). Six patients reported being pain free (VAS=0) at 3 months. All subscales of FAOS showed significant improvement at both 3 and 6 months (Table 1). The mean SF-36 total score improved from 51.4 +/-17.9 to 72.5 +/-7.6 and 74.5 +/-7.5 at 3 and 6 months respectively (p<0.001). Available radiographs at 6 months showed no further collapse. Complications include one patient with delayed wound healing and another patient with inadequate pain relief. No patients reported symptomatic paresthesia. Conclusion: Deep peroneal neurectomy for dorsal midfoot denervation is a safe and effective alternative to arthrodesis for management of dorsal arthritic midfoot pain showing significant improvements in both pain and functional outcomes at early follow up. Our study demonstrated clinical and function outcomes similar to those previously reported for arthrodesis yet with the advantages of earlier postoperative weightbearing and lower complication rate.

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