scholarly journals 3-D generated anatomic custom talar cement spacers: case reports, technical tips and literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kimberly K. Broughton ◽  
Bonnie Chien ◽  
Derek Stenquist ◽  
Caroline Williams ◽  
Christopher P. Miller ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Case Reports ◽  
Treatment Options ◽  
Three Dimensional ◽  
Implant Design ◽  
Cement Spacer ◽  
Antibiotic Cement ◽  
Fracture Nonunion ◽  
Lower Extremity Reconstruction

Abstract Background With today’s expanding use of total ankle arthroplasty, the ever-present trauma patient, and patients with uncontrolled comorbid conditions, surgeons face significant challenges for lower extremity reconstruction. These patients highlight some of those who may present with unique anatomy, bone loss, infection, and various other local and systemic factors that affect treatment options for successful outcomes. Three dimensional (3-D) printing for medical devices is allowing for new and customized ways to meet patient and surgeon goals of limb salvage and reconstruction. Case presentations While the majority of 3-D printing is done for the purpose of implantation, we present a technical tip for designing a 3-D printed mold from which to create an antibiotic cement spacer for implantation. With two case illustrations including a talus fracture nonunion and infected subtalar arthrodesis nonunion, we describe the process of patient selection, implant design, fabrication, and implantation of a custom molded antibiotic cement talus. Discussion Case illustrations present two successful limb salvage patients while giving a thorough explanation of our technique, learned tips and tricks. This applied technology builds on prior use of antibiotic cement in limb salvage of the lower extremity, most of which are joint sacrificing. 3-D printing the mold for an anatomic talus cement spacer results in a joint sparing limb salvage solution. Innovative 3-D printing technology is merged with current, pertinent literature regarding antibiotic cement to offer surgeons expanded options for temporary or definitive reconstructive techniques in some of the most challenging patients.

scholarly journals 3-D Generated Anatomic Custom Talar Cement Spacers: Case Reports, Technical Tips and Literature Review

2021 ◽  
Author(s):  
Kimberly K Broughton ◽  
Bonnie Chien ◽  
Derek Stenquist ◽  
Caroline Williams ◽  
Christopher Miller ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Case Reports ◽  
Treatment Options ◽  
Three Dimensional ◽  
Implant Design ◽  
Cement Spacer ◽  
Antibiotic Cement ◽  
Fracture Nonunion ◽  
Lower Extremity Reconstruction

Abstract Background: With today’s expanding use of total ankle arthroplasty, the ever-present trauma patient, and patients with uncontrolled comorbid conditions, surgeons face significant challenges for lower extremity reconstruction. These patients highlight some of those who may present with unique anatomy, bone loss, infection, and various other local and systemic factors that affect treatment options for successful outcomes. Three dimensional (3-D) printing for medical devices is allowing for new and customized ways to meet patient and surgeon goals of limb salvage and reconstruction. Case Presentations: While the majority of 3-D printing is done for the purpose of implantation, we present a technical tip for designing a 3-D printed mold from which to create an antibiotic cement spacer for implantation. With two case illustrations including a talus fracture nonunion and infected subtalar arthrodesis nonunion, we describe the process of patient selection, implant design, fabrication, and implantation of a custom molded antibiotic cement talus. Discussion: Case illustrations present two successful limb salvage patients while giving a thorough explanation of our technique, learned tips and tricks. This applied technology builds on prior use of antibiotic cement in limb salvage of the lower extremity, most of which are joint sacrificing. 3-D printing the mold for an anatomic talus cement spacer results in a joint sparing limb salvage solution.Innovative 3-D printing technology is merged with current, pertinent literature regarding antibiotic cement to offer surgeons expanded options for temporary or definitive reconstructive techniques in some of the most challenging patients.

scholarly journals Antibiotic Cement-Coated interlocking Intramedullary Nails in the Treatment of Septic Complex Lower Extremity Reconstruction; A Retrospective Analysis with Two year Minimum Follow up

2020 ◽  
Vol 5 (4) ◽  
pp. 176-183
Author(s):  
Asim M. Makhdom ◽  
Joshua Buksbaum ◽  
S. Robert Rozbruch ◽  
Rachael Da Cunha ◽  
Austin T. Fragomen
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Complication Rate ◽  
Bone Union ◽  
Salvage Procedure ◽  
Intramedullary Nails ◽  
Antibiotic Cement ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

Abstract. Background: To report on our experience with antibiotic cement coated interlocking intramedullary nails (ACC-IMNs) for limb salvage in septic complex lower extremity reconstruction with a minimum of 2-year follow up.Methods: We retrospectively reviewed the records of all consecutive patients who underwent a limb salvage procedure with ACC-IMNs. We reviewed patients' demographics, the preoperative infecting organism, and host type, time to bone union, complications, limb salvage rates, and infection control rates.Results: There were 28 patients with a mean age of 62 years (range 22-88). The mean follow up period was 40 months (range 28-84). The ACC-IMNs were used in 14 patients (50 %) to achieve knee fusion after failed revisions of infected total knee arthroplasty, in 8 patients (28%) for septic tibial nonunion, and in 6 patients (21%) with ankle fusion nonunions. Bony union/fusion was achieved in 87 % (21/24) of patients. The infection was controlled in 80% (21/26) of patients. Four out the five patients who had recurrent infection were type B hosts (p=0.63). The limb salvage rate was 89% (25/28). The overall complication rate was 32%.Conclusions: The use of ACC-IMNs was an effective treatment strategy and associated with high limb salvage and bone union rates. Furthermore, the infection recurrence rate was low. Knee fusion patients after failed TKA should be counseled preoperatively for a potential high complication rate.

scholarly journals Diagnosis and Management of Infected Total Knee Arthroplasty§

2011 ◽  
Vol 5 (1) ◽  
pp. 86-91 ◽  
Author(s):  
Niraj V Kalore ◽  
Terence J Gioe ◽  
Jasvinder A Singh
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Treatment Options ◽  
Molecular Diagnostic ◽  
Cement Spacer ◽  
Antibiotic Cement ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee ◽  
Diagnostic Modalities ◽  
Bone Scans

Infection following total knee arthroplasty can be difficult to diagnose and treat. Diagnosis is multifactorial and relies on the clinical picture, radiographs, bone scans, serologic tests, synovial fluid examination, intra-operative culture and histology. Newer techniques including ultrasonication and molecular diagnostic studies are playing an expanded role. Two-stage exchange arthroplasty with antibiotic cement and 4-6 weeks of intravenous antibiotic treatment remains the most successful intervention for infection eradication. There is no consensus on the optimum type of interval antibiotic cement spacer. There is a limited role for irrigation and debridement, direct one-stage exchange, chronic antibiotic suppression and salvage procedures like arthrodesis and amputation. We examine the literature on each of the diagnostic modalities and treatment options in brief and explain their current significance.

External Fixation: Indications in Lower Extremity Reconstruction and Limb Salvage

2009 ◽  
Vol 123 (4) ◽  
pp. 160e-161e ◽  
Author(s):  
Pranay M. Parikh ◽  
Melanie M. Hall ◽  
Christopher E. Attinger ◽  
Derek L. Masden ◽  
John S. Steinberg
Keyword(s):  
Lower Extremity ◽  
External Fixation ◽  
Limb Salvage ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

Lower Extremity Reconstruction Following Tumor, Burns and Infections

2020 ◽  
Author(s):  
Dennis P Orgill
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
New Technologies ◽  
Severe Infection ◽  
Case Examples ◽  
Reconstructive Ladder ◽  
Extremity Trauma ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Complex Wounds

Advances in plastic surgery have allowed for limb salvage in most cases of severe infection or tumor.  This often involves moving adjacent or distant vascularized soft tissue into the area.  Traditionally, surgeons have used the "Reconstructive Ladder" as a paradigm to consider various options to treat complex wounds.  Common flaps in the lower extremity will be reviewed as well as case examples to illustrate the principles of reconstruction.  New technologies such as dermal scaffolds, Negative Pressure Wound Therapy and Advanced biologics have all changed how we manage these conditions.  Advances in the microanatomy of skin has allowed surgeons to design a wide array of new flaps simplifying the extent of surgical innovation.  This review contains 6 figures, 2 tables, and 27 references. Keywords:lower extremity, wound, infection, tumor, osteomyelitis, sarcoma, lower extremity trauma, amputation, limb salvage

scholarly journals Elsberg Syndrome in the Setting of Asymptomatic SARS-CoV-2 infection: Case Report

2020 ◽  
Author(s):  
Rory M. C. Abrams ◽  
Fiona Desland ◽  
Helaina Lehrer ◽  
Anne Yeung ◽  
Winona Tse ◽  
...  
Keyword(s):  
New York ◽  
Lower Extremity ◽  
Motor Unit ◽  
Muscle Activation ◽  
Case Reports ◽  
Treatment Options ◽  
Lower Extremity Weakness ◽  
Electrodiagnostic Testing ◽  
First Case ◽  
Elsberg Syndrome

Abstract Background: Elsberg syndrome is a rare cause of lumbosacral radiculitis with concomitant thoracic or lumbosacral myelitis that can be seen following an acute or reactivated viral infection. COVID-19 disease, caused by the SARS-CoV-2 virus, has quickly spread to a global pandemic since its first discovery in the winter of 2019. During this time, there has been an increasing number of case reports describing SARS-CoV-2 associated neuroinflammatory disease.Case Presentation: A 68-year-old man presented in June 2020 with a fall due to progressive lower extremity weakness and numbness, occurring shortly after the initial coronavirus surge in New York City. He developed ascending numbness to the level of the lower abdomen over the preceding month. He subsequently experienced low back pain, and gastrointestinal and genitourinary dysfunction. An extensive laboratory and radiologic evaluation ensued which was notable for elevated SARS-CoV-2 IgG antibodies despite an absence of preceding COVID-19 symptoms. Initial electrodiagnostic testing was notable for absent late responses in the lower extremity nerve conductions with normal distal sensorimotor conductions, and incomplete muscle activation with otherwise normal motor unit morphology and recruitment on electromyography. Repeat testing two weeks later revealed similar nerve conductions, but also the interval development of active neurogenic changes and reduced motor unit recruitment in the L3-L4 myotomes. This was suggestive of a lower thoracic and lumbosacral myelopathy and lumbosacral polyradiculopathy without peripheral neuropathy. A diagnosis of Elsberg syndrome was made and treatment with intravenous methylprednisolone yielded mild clinical improvement and the electrodiagnostic re-emergence of the lower extremity late responses.Conclusions: We report here, to our knowledge, the first case of suspected COVID-19 associated Elsberg syndrome, which may help to shed light on ways in which to approach diagnostic and treatment options in COVID-19 patients presenting with uncommon neurological and autonomic manifestations.

Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important?

2019 ◽  
Author(s):  
Saïd C. Azoury ◽  
John T. Stranix ◽  
Stephen J. Kovach ◽  
L. Scott Levin
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Treatment Team ◽  
Management Protocol ◽  
Lower Extremity Reconstruction ◽  
Tissue Reconstruction ◽  
Extremity Reconstruction

Abstract Background Regardless of the antecedent etiology, lower extremity salvage and reconstruction attempts to avoid amputation, restore limb function, and improve quality of life outcomes. This goal requires a treatment team well versed in neurovascular pathology, skeletal and soft tissue reconstruction, and physical rehabilitation. Methods A review was performed of historical milestones that lead to the development of orthoplastic extremity reconstruction, principles of current management and the evidence that supports an orthoplastic approach. Based on available evidence and expert opinion, the authors further sought to provide insight into the future of the field centered around the importance of a multidisciplinary management protocol. Results Historically, orthopaedic and plastic surgeons worked separately when faced with challenging reconstructive cases involving lower extremity skeletal and soft tissue reconstruction. With time, many embraced that their seemingly separate skill-sets and knowledge could be unified in a collaborative orthoplastic approach in order to offer patients the best possible chance for success. First coined by the senior author (LSL) in the early 1990s, the collaborative orthoplastic approach between orthopaedic and plastic surgeons in limb salvage for the past several decades has resulted in a unique field of reconstructive surgery. Benefits of the orthoplastic approach include decreased time to definitive skeletal stabilization/soft tissue coverage, length of hospital stay, post-operative complications, need for revision procedures and improved functional outcomes. Conclusion The orthoplastic approach to lower extremity reconstruction is a collaborative model of orthopaedic and plastic surgeons working together to expedite and optimize care of patients in need of lower extremity reconstruction. The implementation of protocols, systems, and centers that foster this approach leads to improve outcomes for these patients. We encourage centers to embrace the orthoplastic approach when considering limb salvage, as the decision to amputate is irreversible.

scholarly journals Characteristics and Treatment Challenges of Non-Clear Cell Renal Cell Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3807
Author(s):  
Pierangela Sepe ◽  
Arianna Ottini ◽  
Chiara Carlotta Pircher ◽  
Andrea Franza ◽  
Melanie Claps ◽  
...  
Keyword(s):  
Renal Cell ◽  
Kinase Inhibitors ◽  
Clear Cell ◽  
Case Reports ◽  
Treatment Options ◽  
Single Agent ◽  
Growth Factor Receptor ◽  
Mtor Inhibitors ◽  
Cell Renal Cell Carcinoma ◽  
Clear Cell Rcc

Non-clear cell renal cell carcinomas (RCC) comprise several rare and poorly described diseases, often characterized by bad prognosis and with no standard treatments available. The gap in their clinical management is linked to the poor molecular characterization in handling the treatment of non clear-cell RCC with untailored therapies. Due to their rarity, non-clear RCC are in fact under-represented in prospective randomized trials. Thus, treatment choices are based on extrapolating results from clear cell RCC trials, retrospective data, or case reports. Over the last two decades, various options have been considered as the mainstay for the treatment of metastatic RCC (mRCC), including angiogenesis inhibitors, vascular endothelial growth factor receptor inhibitors, other tyrosine kinase inhibitors (TKIs), as well as MET inhibitors and mammalian targeting of rapamycin (mTOR) inhibitors. More recently, the therapeutic armamentarium has been enriched with immunotherapy, alone or in combination with targeted agents that have been shown to significantly improve outcomes of mRCC patients, if compared to TKI single-agent. It has been widely proven that non-clear cell RCC is a morphologically and clinically distinct entity from its clear cell counterpart but more knowledge about its biology is certainly needed. Histology-specific collaborative trials are in fact now emerging to investigate different treatments for non-clear cell RCC. This review summarizes pathogenetic mechanisms of non-clear cell RCC, the evolution of treatment paradigms over the last few decades, with a focus on immunotherapy-based trials, and future potential treatment options.

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