Closed arthrodesis in infected neuropathic ankles using Ilizarov ring fixation

2020 ◽  
Vol 102-B (4) ◽  
pp. 470-477 ◽  
Author(s):  
Yaser Alammar ◽  
Anatoliy Sudnitsyn ◽  
Andrey Neretin ◽  
Sergey Leonchuk ◽  
Nikolay Mikhailovich Kliushin
Keyword(s):  
Operating Time ◽  
Deformity Correction ◽  
Ankle Arthrodesis ◽  
Ilizarov Method ◽  
Foot And Ankle ◽  
Ring Fixator ◽  
Ilizarov Ring Fixator ◽  
Group A ◽  
American Orthopaedic ◽  
Group B

Aims Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. Methods We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. Results The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. Conclusion We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470–477.

scholarly journals Effect of Weight-Bearing in Conservative and Operative Management of Fractures of the Base of the Fifth Metatarsal Bone

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Jae-Yong Park ◽  
Hyong-Nyun Kim ◽  
Yoon-Suk Hyun ◽  
Jun-Sik Park ◽  
Hwan-Jin Kwon ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Weight Bearing ◽  
Operative Management ◽  
Foot And Ankle ◽  
Early Weight Bearing ◽  
Group A ◽  
Vas Scores ◽  
American Orthopaedic ◽  
Group B ◽  
Underlying Diseases

Background. There is no established principle regarding weight-bearing in conservative and operative management of fifth metatarsal base fractures. Methods. We reviewed 86 patients with acute fifth metatarsal base fractures. Conservatively treated late or early weight-bearing patients were assigned to Group A or C, respectively. Operatively treated late or early weight-bearing patients were assigned to Group B or D, respectively. Results were evaluated by clinical union, bone resorption, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) scores. Results. All 4 groups had bone union at a mean of 6.9 weeks (range, 5.1–15.0). There were no differences between the groups in the AOFAS and VAS scores. In the early weight-bearing groups, there were fewer cases of bone resorption, and the bone unions periods were earlier. Conclusions. Early weight-bearing may help this patient population. Moreover, conservative treatment could be an option in patients with underlying diseases.

Arthroscopic Ankle Arthrodesis

2007 ◽  
Vol 28 (6) ◽  
pp. 695-706 ◽  
Author(s):  
Nikolaos E. Gougoulias ◽  
Filon G. Agathangelidis ◽  
Stephen W. Parsons
Keyword(s):  
Sagittal Plane ◽  
Deformity Correction ◽  
Frontal Plane ◽  
Ankle Arthrodesis ◽  
Valgus Deformity ◽  
Postoperative Treatment ◽  
Average Hospital ◽  
Superficial Wound ◽  
Group A ◽  
Group B

Background: Arthroscopic arthrodesis has been used mainly for in situ fusion of arthritic ankles without deformity. This paper presents the application of arthroscopic arthrodesis of ankles with marked deformity. Methods: The results of 78 consecutive cases of arthroscopic ankle arthrodeses, performed in 74 patients, were retrospectively evaluated. Forty-eight ankles had minor deformity (group A), whereas 30 ankles had a varus or valgus deformity of more than 15 degrees (maximum 45 degrees) (group B). The average hospital stay was 3.8 and 3.4 days in groups A and B, respectively ( p = 0.74). Postoperative treatment included ankle immobilization for 3 months. Progressive weightbearing was initiated at 2 weeks. Mean followup was 21.1 months. Results: Fusion occurred in 47 of 48 (97.9%) ankles in group A at an average time of 13.1 ± 5.8 weeks and in 29 of 30 (96.7%) ankles at 11.6 ± 2.4 weeks in group B ( p = 0.19). Unplanned operative procedures were required in 11 ankles (14.1%). One superficial wound infection occurred. Symptomatic arthritis from the adjacent joints developed in six ankles (7.7%). Postoperative ankle alignment in the frontal plane averaged 0.7 and 0.4 degrees of valgus ( p = 0.41), whereas the sagittal plane angle averaged 106 ± 4 degrees and 104.5 ± 7 degrees in groups A and B, respectively ( p = 0.22). The outcome was graded as very good in 79.2% (38 feet) in group A and 80% (24 feet) in group B, fair in 18.8% (9 feet) in group A and 16.7% (5 feet) in group B and poor in one ankle in each group ( p = 0.68). Conclusions: The arthroscopic technique offered high fusion rates and low morbidity. Deformity correction was achieved with good results.

The Charcot Reconstruction Preoperative Prognostic Score's Evaluation with Complication Rate and Functional Outcome

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Necip Selcuk Yontar ◽  
Lercan Aslan ◽  
Ata Can ◽  
Tahir Ogut
Keyword(s):  
Medical Records ◽  
Functional Outcomes ◽  
Prognostic Score ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Group A ◽  
Patient’S Outcome ◽  
American Orthopaedic ◽  
Group B

Background Charcot's neuroarthropathy (CN) treatment is still controversial, and the results are controversial. Owing to patient comorbidities, surgical intervention carries a high risk of complications. Thus, foreseeing the possible results of planned treatment is crucial. We retrospectively evaluated the Charcot Reconstruction Preoperative Prognostic Score (CRPPS) in patients with surgically treated CN. Methods Twenty-two feet of 20 patients were included in the study. Two groups were formed according to their CRPPS. Twelve patients with values less than 4 were defined as group A, and eight patients with values of 4 or greater were defined as group B. Mean follow-up was 61 months (range, 5–131 months). Groups were compared according to American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Disability Index (FADI) scores, and complication rates. Results Group A and B mean AOFAS scores were 76.83 (range, 71–85) and 70.5 (range, 20–85), respectively. All of the patients were improved according to AOFAS and FADI scores, but no correlation was found with the CRPPS. None of the group A patients required additional intervention, but five patients in group B underwent revision surgery. No amputations were performed. Conclusions The CRPPS is focused on feasibility. The data needed to fill the scoring system is easily obtainable from medical records even retrospectively, and the score is helpful to predict a patient's outcome after CN-related surgery. Herein, CRPPS values of 4 or greater were related to high complication rates and lower functional outcomes.

scholarly journals Preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid of foot and ankle wounds improves outcome of reconstructive skin flap surgery

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xu Gao ◽  
Hailei Yin ◽  
Jixia Sun
Keyword(s):  
Inflammatory Response ◽  
Skin Flap ◽  
Foot And Ankle ◽  
Flap Surgery ◽  
Local Inflammatory Response ◽  
Drainage Fluid ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Vacuum Sealing Drainage

Abstract Objectives By observing the infection and soft tissue defect on the wound surface of the foot and ankle, this paper attempts to explore the effect of preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid (abPI-VSD) on the bacterial quantity and the local inflammatory response at the flap, and further to provide a basis for applying this technique before a reconstructive skin flap surgery of foot and ankle wounds. Methods Seventy-five patients were randomly divided into two groups, and all surgeries were done by one physician. The flap reconstructions were done to 31 cases with the abPI-VSD being used (group A); the flap reconstructions were done to the rest 44 cases after wound cleaning using antibiotic irrigation solution without the use of the abPI-VSD (group B). Quantitative bacteriology was made to group A before and after the use of abPI-VSD; quantitative bacteriology was made to group B before and after wound cleaning. Then, the reconstructive skin flap surgery was done. After the surgeries, the time of local inflammatory response at the flap in both groups were recorded. The measured bacterial quantity was evaluated in logarithm and by t test. Results The bacterial quantity was 3.2 ± 1.9 × 107 cfu/g in group A before the use of abPI-VSD and 2.3 ± 2.0 × 107 in group B (P > 0.05) before debridement. The bacterial quantity was 1.2 ± 2.0 × 104 cfu/g in group A after abPI-VSD and was 2.9 ± 4.0 × 106 in group B after wound cleaning (P < 0.05). The time of postoperative inflammatory response in the flap was 8 ± 2.5 days in group A and 13 ± 3.4 days in group B (P < 0.05). Conclusions abPI-VSD can distinctly reduce the bacterial quantity on the surface of the wound, provide a good condition of tissue bed for the flap reconstruction, and effectively control the local inflammatory response at the flap and hence improve the survival quality of the flap.

Endoscopic Versus Open Excision of Os Trigonum for the Treatment of Posterior Ankle Impingement Syndrome in an Athletic Population: A Randomized Controlled Study With 5-Year Follow-up

2017 ◽  
Vol 45 (6) ◽  
pp. 1388-1394 ◽  
Author(s):  
Dimitrios Georgiannos ◽  
Ilias Bisbinas
Keyword(s):  
Impingement Syndrome ◽  
Foot And Ankle ◽  
Open Procedure ◽  
Os Trigonum ◽  
Athletic Population ◽  
Randomized Controlled ◽  
Posterior Ankle Impingement ◽  
Group A ◽  
Group B ◽  
Open Excision

Background: Open surgical excision of the os trigonum has been the traditional treatment for posterior ankle impingement syndrome (PAIS). However, the endoscopic excision has recently become quite popular. Purpose/Hypothesis: The purpose of our study was to compare the results of endoscopic versus open excision of a symptomatic os trigonum for the treatment of PAIS in an athletic population. It was hypothesized that the endoscopic technique would be superior to the open technique regarding functional outcomes, pain, and time to return to training and the previous sports level. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: From 2008 to 2011, 52 athletes underwent a symptomatic os trigonum excision; 26 athletes had an open procedure (group A) and 26 had an endoscopic procedure (group B). The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the Visual Analog Score–Foot and Ankle (VAS-FA) were obtained, and the time to return to training and to previous sports level was recorded. Results: Patients in group B appeared to have significant improvement of AOFAS hindfoot score compared with those in group A ( P < .05), whereas no statistical significance was found for the postoperative VAS-FA scores between the 2 groups. The mean ± SD time to return to training was 9.58 ± 3.98 weeks for group A and 4.58 ± 1.47 weeks for group B ( P < .001). The time to return to previous sports level was 11.54 ± 3.89 weeks for group A and 7.12 ± 2.25 weeks for group B ( P < .001). The overall complication rate was 23% for group A (6 cases) and 3.8% for group B (1 case). Conclusion: Both the open procedure and the endoscopic approach yielded acceptable outcomes in terms of function and pain. However, complication rates were remarkably lower with endoscopic treatment, and the time to return to full activities was much shorter. Endoscopic excision of the os trigonum is a safe and effective treatment option for athletes who require early return to their previous sports level.

scholarly journals COMPARATIVE ANALYSIS OF NON-DESCENT VAGINAL HYSTERECTOMY VERSUSTOTALABDOMINAL HYSTERECTOMY IN BENIGN UTERINE DISORDERS AT DMCH, LAHERIASARAI, BIHAR

2020 ◽  
pp. 1-2
Author(s):  
Suchandra Suchandra ◽  
Renu Jha ◽  
Kumudini Jha ◽  
Debarshi Jana
Keyword(s):  
Postoperative Complications ◽  
Vaginal Hysterectomy ◽  
Intraoperative Complications ◽  
Operating Time ◽  
Early Mobilization ◽  
Laparoscopic Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Invasive Technique ◽  
Group A ◽  
Group B

Background: Hysterectomy is the most common operation performed by gynecologist, next to caesarean section. Currently, there are three main types of hysterectomy operations in practice for benign diseases-Abdominal hysterectomy (AH), vaginal hysterectomy (VH) and Laparoscopic hysterectomy (LH). Vaginal route for non-descentuterus is an acceptable method of hysterectomy. The objective of present study was to compare the operating time, intraoperative and postoperative complications between VH and TAH in non-descent uterus. Methods: The study was conducted in the Department of Obstetrics Gynaecology for a period of 18months at Darbhanga Medical College & Hospital, Laheriasarai, Bihar. Results: Over the study period 100 patients were taken, 50 patients underwent non-descent vaginal hysterectomy andlabelled as group A and 50 patients were under went total abdominal hysterectomy and labelled as group B. It wasseen that intraoperative complications and postoperative complications were less in group A patients and operating time is also less with group A patients when compared with group B patients. Conclusions: From the present study, it was concluded that NDVH is associated with less blood loss during surgery, quicker recovery, and early mobilization, less operative and less postoperative morbidity when compared to TAH. NDVH is a less invasive technique with shorter hospital stay and faster convalescence.

scholarly journals APENDECTOMY;

2017 ◽  
Vol 24 (05) ◽  
pp. 690-696
Author(s):  
Abdullah Bin Saeed ◽  
Ahmad Raees ◽  
Shoukat Ali
Keyword(s):  
Standard Deviation ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Safe Procedure ◽  
Laboratory Findings ◽  
Medical College ◽  
Operative Duration ◽  
Group A ◽  
Group B

Introduction: Appendicitis is one of the most common cause of an acuteabdomen in young adults. Open appendectomy (OA) has been the gold standard for thetreatment of acute appendicitis since its introduction by Charles McBurney in 1889.Laproscopicappendectomy (LA) was first performed by Semn in 1983.After its introduction laparoscopicappendectomy (LA) proved to be a feasible and safe procedure. Objective: To compare theoutcome of Open appendectomy and Laparoscopic appendectomy in terms of mean visualanalogue score of postoperative pain and mean operative duration in the treatment of acuteappendicitis. Study Design: Randomized clinical trial. Setting: Punjab Medical College andaffiliated Hospitals, Faisalabad. Duration: Study was carried out for one year from 01-01-2016to 31-12-2016. Subjects and Method: A total of 70 patients with Appendicitis were includedin the study. All patients were diagnosed clinically and confirmed with Laboratory findings. 35patients underwent open appendectomy and laparoscopic appendectomy was used in 35.Outcome in terms of pain and operating time was compared in both groups. Results: Meanage in group A was 27.74 years with a standard deviation of 12.040. Mean age of patients ingroup B was 29.26 years with a standard deviation of 12.650. Post-Operative pain using VisualAnalog Scale was 7.34±2.014 in group A and 3±1.94 in group B. Operative duration in groupA was 42.33±4.25(minutes) and group B had a duration of 34.48±3.5(minutes). Conclusion:Outcome of Laparoscopic appendectomy is better than open appendectomy in terms of painand operative duration in patients undergoing Appendectomy.

Comparison of the long-term outcome of cemented Charnley low-friction arthroplasty with hybrid arthroplasty in patients with congenital hip disease

2019 ◽  
Vol 101-B (9) ◽  
pp. 1050-1057
Author(s):  
Kalliopi Lampropoulou-Adamidou ◽  
George Hartofilakidis
Keyword(s):  
Operating Time ◽  
Long Term Results ◽  
Low Friction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Hip Disease ◽  
Group A ◽  
Group B

Aims To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. Patients and Methods Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. Results At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). Conclusion We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050–1057.

Surgical Site Infections in Abdominal Surgeries - A Clinicopathological Prospective Study

2021 ◽  
Vol 8 (02) ◽  
pp. 69-74
Author(s):  
Biswaranjan Mohapatra ◽  
Dipesh Kumar Padhihari ◽  
Mrutynjay Das ◽  
Sai Barath Sunkara ◽  
Saikh Kasif Sahajada
Keyword(s):  
Prospective Study ◽  
Surgical Site Infection ◽  
Medical Science ◽  
Operating Time ◽  
Surgical Techniques ◽  
Surgical Site Infections ◽  
Purulent Discharge ◽  
Site Infection ◽  
Group A ◽  
Group B

BACKGROUND Surgical site infection still remains a nightmare for most surgeons even in these times despite many advances in medical science, surgical techniques & better operating room environment. Surgical site infection (SSI) is defined as ‘an infection occurring within 30 days of a surgery (or within 1 year if an implant is left in place after procedure) and affecting either incision or deep tissues at the operation site. METHODS A single observer, cross sectional, prospective study was carried out in the Dept. of General Surgery, in collaboration with Microbiology & Pathology Departments of Hi-tech Medical College and Hospital, Bhubaneswar, Odisha. The study included all patients who underwent laparotomy during the period of study, patients of all age groups except neonates and patients with post-operative surgical site infections. RESULTS The prospective study involved culture and sensitivity of 114 patients undergoing clean-contaminated surgeries (group A), contaminated-surgeries (group B) in the Department of Surgery at our institute. The study shows that the maximum number of cases were between 21 to 60 yrs. of age. (78 %) and the mean age in the group A was 39.2 years while in group B, it was 39.8 years. There was a total of 90 patients between 21 - 60 yrs. of age. Mean hospital stay in group A was 5.7 days and group B was 8.9 days. The sex ratio is quite evenly matched, 63 male patients and 51 female patients out of 114 cases. Amongst the 114 subjects, group A comprised of 58.77 % (67) while group B consisted of 41.22 % (47.13) patients. Out of 67, 13 from group A came back as sterile, in group B sterile samples were 10. CONCLUSIONS This study concludes that age, sex, class of wound, peri-operative management, operating time and co-morbidities of the patient, all have a significant effect on the incidence of surgical site infections. KEYWORDS Surgical Site Infection, Laparotomy, Purulent Discharge, Drain

Outcome Of Manual Vacuum Aspiration Vs Surgical Evacuation

2019 ◽  
Vol 09 (04) ◽  
pp. 303-307
Author(s):  
Fozia Akmal ◽  
Sadia Suboohi ◽  
Saba Pario ◽  
Sugra Abbasi ◽  
Shahanaz Hassan Siddiqui
Keyword(s):  
Patient Satisfaction ◽  
Operating Time ◽  
P Value ◽  
Uterine Perforation ◽  
Excessive Bleeding ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration ◽  
Surgical Evacuation ◽  
Group A ◽  
Group B

Objective: To compare the safety, efficacy and complications of manual vacuum aspiration (MVA ) versus surgical evacuation in low resource set up. Study Design and Setting: This crossectional study conducted at Department of Obstetrics & Gynaecology at Kulsoom Bai Valika Social Security SITE Hospital Karachi from January to June 2017. Methodology: A total of one hundred patients with less than 12 weeks of gestation and diagnosis of missed miscarriage, incomplete miscarriage, blighted ovum or with retained products of conception (RPOCs) were recruited and randomly allocated to MVA without anesthesia (Group A) and surgical evacuation under general Anesthesia in Operation theatre (Group B).Both groups were compared in terms of demographic and obstetric data, clinical course (need of anaesthesia, operating time, approximate blood loss and stay in hospital) ,complications(excessive bleeding, uterine perforation, need for re-evacuation/ failed procedure, sepsis and maternal death ) and patient satisfaction. Results: Mean age of patients was 28.68 in Group A and 26.90 in Group B ( P value-0.136). Average gestational age in weeks at which procedure was performed in Group A found to be 8.32 and 9.546 for Group B ( P value-0.007 ). Parity was comparable in both groups (P value-0.746). Most of the patients were literate. Mean operating time and amount of blood loss comparison among groups had no statistical difference. Average hospital stay was significantly short in MVA Group ( P value-0.001). No maternal death or uterine perforation observed in both the groups,6% and 8% of patients had excessive bleeding in Group A & Group B respectively, one patient underwent re-evacuation in MVA group and one had sepsis after surgical evacuation. Post procedure satisfaction was comparable in both the groups. Conclusion: Manual Vacuum Aspiration is comparable to surgical evacuation in terms of safety, efficacy, complications, patient satisfaction and superior in shorter hospital stay, no need of anesthesia and access to operation theater

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