Femoro-pedal distraction in staged reconstructive treatment of tibial aplasia

2020 ◽  
Vol 102-B (9) ◽  
pp. 1248-1255
Author(s):  
Andrea Laufer ◽  
Adrien Frommer ◽  
Georg Gosheger ◽  
Robert Roedl ◽  
Jan Niklas Broeking ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Limb Salvage ◽  
External Fixator ◽  
Weight Bearing ◽  
Functional Results ◽  
Reconstructive Operations ◽  
Tibial Aplasia ◽  
The Mean ◽  
Staged Reconstruction

Aims The treatment of tibial aplasia is controversial. Amputation represents the gold standard with good functional results, but is frequently refused by the families. In these patients, treatment with reconstructive limb salvage can be considered. Due to the complexity of the deformity, this remains challenging and should be staged. The present study evaluated the role of femoro-pedal distraction using a circular external fixator in reconstructive treatment of tibial aplasia. The purpose of femoro-pedal distraction is to realign the limb and achieve soft tissue lengthening to allow subsequent reconstructive surgery. Methods This was a retrospective study involving ten patients (12 limbs) with tibial aplasia, who underwent staged reconstruction. During the first operation a circular hexapod external fixator was applied and femoro-pedal distraction was undertaken over several months. Subsequent surgery included reconstruction of the knee joint and alignment of the foot. Results The mean follow-up was 7.1 years (2 to 10). The mean age of the patients at the time of the application of the fixator was 2.3 years (1.1 to 5.0). The mean time under distraction was 139.7 days (81.0 to 177.0). A mean fibular distalization of 38.7 mm (14.0 to 67.0) was achieved. Pin infections occurred in four limbs (33.3%) and osteitis in one. A femoral fracture occurred in one patient. Premature removal of the frame was not required in any patient. Sufficient realignment of the leg as well as soft tissue lengthening was achieved in all patients, allowing subsequent reconstruction. All patients were able to mobilize fully weight bearing after reconstruction. Functional outcome was limited in all limbs, and five patients (50.0%) required additional reconstructive operations. Conclusion Regarding the functional results in the treatment of tibial aplasia, amputation remains superior to limb salvage. The latter procedure should only be performed in patients whose parents refuse amputation. Femoro-pedal distraction efficiently prepares the limb by realigning the leg and soft tissue lengthening. Minor complications are frequent, but usually do not hinder the continuation of distraction. Even though a fully weight-bearing limb is achieved, the functional outcome of reconstructive treatment remains limited. Recurrent deformities frequently occur and may require further operations. Cite this article: Bone Joint J 2020;102-B(9):1248–1255.

scholarly journals Non-locking buttress plate in distal tibial metaphyseal fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 87-91
Author(s):  
Norman Lamichhane ◽  
Bhogendra Bahadur KC ◽  
Chandra Bahadur Mishra ◽  
Sabita Dhakal
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Delayed Union ◽  
Full Weight Bearing ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Metaphyseal Fractures

Background: Treatment of distal tibial metaphyseal fractures is often challenging and no single technique has been unanimously advocated. Open reduction and internal fixation with plates and screws allows better restoration of anatomical alignment but with more soft tissue complication. Simultaneous fixation of the fibula is not universally carried out. This study aims at evaluation of the outcome of plating technique and the effect of fixation of fibula fracture in treatment of distal tibial metaphyseal fractures. Material and methods: Thirty-one cases (14 cases in Group A with concomitant distal fibula fracture and 17 cases in Group B without distal fibula fracture) were analyzed retrospectively for the mean duration of full weight bearing, mean union time and complications, and compared. Results: The mean time for full weight bearing and radiological union in our study was 14.2 weeks (15.9 in Group A and 13.1 in Group B) and 23.8 weeks (26.6 in Group A and 21.5 in Group B) respectively. 16.1% of cases had post-operative complications including one case of deep infection and malalignment of 6 degree varus (following delayed union) was seen in one case of Group A. Range of motion (ROM) at ankle was not problem in any of the cases except the one delayed union which had 5 degrees of dorsiflexion and 15 degrees of plantiflexion. Conclusion: Open reduction and internal fixation with plate and screws in distal tibial metaphyseal fracture is more economic means of treatment modality with comparable incidence of post-union malalignment and union time,though more soft tissue complications compared to other modalities. Fixation of fibula fracture aids in reducing the incidence of malalignment.

scholarly journals Role of leukocyte free platelet rich plasma in planter fasciitis: a prospective study

2017 ◽  
Vol 5 (12) ◽  
pp. 5432
Author(s):  
Chandre Shekhar ◽  
Alamgir Jhan ◽  
Ganesh Singh ◽  
Pankaj Singh ◽  
Shailendre S. Bhandhari
Keyword(s):  
Placebo Group ◽  
Functional Outcome ◽  
Platelet Rich Plasma ◽  
Functional Results ◽  
Visual Analogue Scale Pain ◽  
Functional Score ◽  
Outcome Scores ◽  
The Mean ◽  
Post Graduate Institute

Background: Planter fasciitis, is by definition, inflammation of planter fascia. Most of the cases are well treated conservatively and a few responds to surgery only. Objectives of present study were evaluating the efficacy of a single injection of leukocyte free platelet rich plasma in plantar fasciitis and to derive a correlation between the clinical and radiological outcome.Methods: The present study consisted of 120 patients of bilateral (PF), (240 feet). These patients were divided into two groups PRP group of 60 patients and Placebo group of 60 patients. The study was conducted on patients attending Orthopaedics outpatient department Post Graduate Institute of Medial Education and Research (PGIMER) from July 2011 to June 2012. A primary efficacy criterion was changes from baseline in pain using (VAS). Functional results, level of satisfaction and outcome were measured by – AOFAS Foot Scale. Correlation of clinical with radiological outcome were performed.Results: There was a significant decrease in the visual analogue scale (pain score) in the PRP. Group while in placebo group it was increased significantly at the end of 6 month. Functional outcome scores were improved significantly from their baseline values in PRP group while in placebo group the mean functional score were deteriorated at 6 months follow up. There was no improvement seen in functional status with normal saline injection. In PRP group the mean heal pad thickness was reduced significantly at 6 months follow up while in placebo group was not changed significantly at 6 months follow up. Correlation between radiological parameters and VAS was found to be positive while it was found negative with other functional outcome scores like AOFAS.Conclusions: Platelet-rich plasma (PRP), which is a natural concentrate of autologous growth factors,plays a role in the regeneration process in treatment of (PF).

Cross-Sectional Study to Assess the Functional Outcome of Neglected Bimalleolar Fracture

2016 ◽  
Vol 10 (6) ◽  
pp. 509-512
Author(s):  
Rajeev Shukla ◽  
Ravi Kant Jain ◽  
Shravan Patidar ◽  
Nikhil Jain ◽  
Pranav Mahajan
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Rating Scale ◽  
Weight Bearing ◽  
Functional Results ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Results Of Treatment ◽  
Trimalleolar Fractures

Introduction. Ankle fracture is the most common intra-articular fracture of a weight-bearing joint and accounts for 9% of all fractures. Ankle fractures are classified into 3 subgroups: unimalleolar, bimalleolar, and trimalleolar fractures. Accurate reduction and stable internal fixation is necessary in bimalleolar fractures; otherwise, it may lead to posttraumatic painful restriction of movements or osteoarthritis. The purpose of this study is to assess the functional outcome and results of treatment of neglected bimalleolar fracture. Materials and Methods. Seventeen neglected bimalleolar fracture patients were treated with open reduction and internal fixation. Patients were followed-up at 1, 2, and 5 years and functional ability was assessed by using the modified Weber Rating Scale. Results. The mean age of patients was 41.4 ± 13.28 years. After 2 year of surgery, 13 out of 17 patients showed excellent results and 4 patients had fair results. Conclusion. Good to excellent functional results were observed after long-term follow-up in neglected bimalleolar fracture treated with open reduction and internal fixation, and we advise surgical intervention in all such patients. Levels of Evidence: Therapeutic, Level III: Retrospective Cohort study

Distraction-Lengthening of Digital Rays Using a Small External Fixator

1998 ◽  
Vol 23 (6) ◽  
pp. 781-784 ◽  
Author(s):  
M. SALOM ◽  
J. E. AROCA ◽  
V. CHOVER ◽  
R. ALONSO ◽  
R. VILAR
Keyword(s):  
External Fixator ◽  
Corrective Osteotomy ◽  
Functional Results ◽  
Iliac Crest Graft ◽  
Work Accident ◽  
The Mean ◽  
High Level ◽  
Gradual Distraction ◽  
Very High ◽  
Frequent Reason

We present 19 ray lengthenings in 14 patients done with a small external fixator. In six cases the thumb was lengthened and in the other 13 cases, other digital rays. The most frequent reason for lengthening was an amputation sustained in a work accident. All the lengthenings were done by an osteotomy and subsequent gradual distraction with a small external fixator. The mean lengthening achieved was 20 mm (range, 0–32). An iliac-crest graft was needed in nine cases, corrective osteotomy in five cases and a deepening of the web in the six cases of thumb lengthening. In five cases an additional technique was needed to achieve bony consolidation. We have analysed the functional results and the ability to perform activities of daily living and resume employment. Although most of the patients had multiples injuries, the results have been very favourable, achieving a very high level of patient satisfaction.

scholarly journals Soft Tissue Sarcoma of Lower Extremity: Functional Outcome and Quality of Life

2021 ◽  
Author(s):  
Gilber Kask ◽  
Jussi P. Repo ◽  
Erkki J. Tukiainen ◽  
Carl Blomqvist ◽  
Ian Barner-Rasmussen
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Lower Extremity ◽  
Functional Outcome ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Related Factors ◽  
Cross Sectional ◽  
The Mean

Abstract Background Few studies have focused on patient-related factors in analyzing long-term functional outcome and health-related quality of life (HRQoL) in patients with postoperative lower extremity soft tissue sarcoma (STS). Objective The purpose of this study was to investigate factors associated with postoperative functional outcome and HRQoL in patients with lower extremity STS. Methods This cross-sectional study was performed in a tertiary referral center using the Toronto Extremity Salvage Score (TESS), Quality-of-Life Questionnaire (QLQ)-C30 and 15 Dimension (15D) measures. Functional outcome and HRQoL data were collected prospectively. All patients were treated by a multidisciplinary team according to a written treatment protocol. Results A total of 141 patients who had undergone limb-salvage surgery were included. Depending on the outcome measure used, 19–51% of patients were completely asymptomatic and 13–14% of patients had an unimpaired HRQoL. The mean score for TESS, 15D mobility score, and QLQ-C30 Physical Functioning scale were 86, 0.83, and 75, respectively, while the mean score for 15D was 0.88, and 73 for QLQ-C30 QoL. Lower functional outcome was statistically significantly associated with higher age, higher body mass index (BMI), and the need for reconstructive surgery and radiotherapy, while lower HRQoL was statistically significantly associated with higher age, higher BMI, and reconstructive surgery. Conclusion Functional outcome and HRQoL were generally high in this cross-sectional study of patients with STS in the lower extremity. Both tumor- and treatment-related factors had an impact but patient-related factors such as age and BMI were the major determinants of both functional outcome and HRQoL.

scholarly journals Demography and Short Term Functional Outcome of Soft Tissue Sarcoma Treated with Limb Salvage Surgery

2020 ◽  
Vol 16 (4) ◽  
pp. 238-245
Author(s):  
Suresh Pandey
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Functional Outcome ◽  
Limb Salvage ◽  
Negative Correlation ◽  
Salvage Surgery ◽  
Demographic Data ◽  
Functional Score ◽  
Limb Salvage Surgery ◽  
Positive Correlation

Background: Limb salvage surgery with or without radiotherapy and/or chemotherapy is the mainstay of treatment of Soft Tissue Sarcoma (STS). Though, many studies are found regarding the demographics and result of such malignancy from other parts of the world, such data is not available from our country. This study aimed to analyze the demographic data and functional outcome of STS treated with limb salvage surgery. Methods: It is a retrospective review of 16 cases of soft tissue sarcoma of extremities and trunk managed with limb salvage surgery followed by adjuvant radiotherapy and/or chemotherapy in indicated cases from 2012 to 2017. Demographic data and functional score after 2 years of surgery were analysed and presented. Results: There were 14 male and 2 female cases of STS with mean age of 32.88 years. The most common STS was liposarcoma (37.5%) followed by rhabdomyosarcoma (25%) and synovial sarcoma (18.8%). Extremity and lower limb were the most common sites. Mean MSTS functional score at the last follow up was 24.56 (81.83%) with range from 19-29 (63.33%-96.66%). There were good to excellent results in 13 cases (81.25%) and moderate result in 3 cases (18.75%) according to MSTS functional score. There was positive correlation of MSTS with age, radiotherapy, chemotherapy and negative correlation with grade of tumor. Conclusions: This study showed good to excellent functional results in 81.25% of cases as per Musculoskeletal Tumor Society Score (MSTS) with positive correlation with radiotherapy, chemotherapy, age and negative correlation with grade of tumor.

Use of circular external skeletal fixator constructs to stabilize tarsometatarsal arthrodeses in three dogs

2004 ◽  
Vol 17 (04) ◽  
pp. 204-209 ◽  
Author(s):  
D. D. Lewis ◽  
R. W. Jones ◽  
R. C. Hill ◽  
G. M. Anderson ◽  
K. B. Halling
Keyword(s):  
Functional Outcome ◽  
Weight Bearing ◽  
Antibiotic Administration ◽  
Systemic Antibiotic ◽  
The Mean ◽  
Mean Time

SummaryThis report describes the use of circular external skeletal fixator (CESF) constructs for the stabilization of unilateral tarsometatarsal arthrodeses in three dogs with traumatic intertarsal or tarsometatarsal fracture/luxation injuries. The application of the CESF was performed following a limited approach to the intertarsal and tarsometatarsal joints. All three of the dogs developed post-operative wire tract inflammation with drainage and two dogs developed osteomyelitis. These complications resolved with systemic antibiotic administration, debridement, and/or wire removal, after which all of the dogs tolerated the CESF well and resumed weight-bearing on the affected limb. The mean time to CESF removal was 16 weeks. The CESF construct provided sufficient stabilization for progressive union of the tarsometatarsal arthrodeses with a good long-term functional outcome in all three of the dogs.

scholarly journals Intra-articular soft-tissue sarcoma of the knee: Is extra-articular resection and tumor endoprosthetic reconstruction the solution? A retrospective report on eight cases

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Markus Nottrott ◽  
Arne Streitbürger ◽  
Georg Gosheger ◽  
Wiebke Guder ◽  
Gregor Hauschild ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Knee Joint ◽  
Limb Salvage ◽  
Soft Tissue Sarcomas ◽  
Rare Condition ◽  
Functional Results ◽  
Extensor Mechanism ◽  
Complication Rates ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Intra-articular sarcoma of the knee joint is a very rare condition. Extra-articular resection and reconstruction with a tumor prosthesis is usually performed. This report describes the results with this rare surgical procedure. This retrospective study evaluated the clinical and functional results after extra-articular resection of the knee joint in eight patients with soft-tissue sarcomas of the knee that were reconstructed using a tumor endoprosthesis. Five of the eight patients (62.5%) ultimately had to undergo amputation, mainly due to periprosthetic infection. In addition, two patients experienced periprosthetic fractures. The mean Musculoskeletal Tumor Society score was 18 (range 10-22), as function was impaired due to a weak extensor mechanism. These results suggest that in patients with intraarticular soft-tissue sarcomas, limb salvage procedures with tumor prostheses after extra-articular resection are associated with very high complication rates. In most cases, long-term limb salvage was not possible. When limb salvage is successful, function is also poor due to a weak extensor mechanism in the knee joint. The indication for this procedure should therefore be considered critically.

scholarly journals Functional Outcome in Limb-Salvage Surgery for Soft Tissue Tumours of the Foot and Ankle

Sarcoma ◽  
1997 ◽  
Vol 1 (2) ◽  
pp. 67-74 ◽  
Author(s):  
Nigel R. Colterjohn ◽  
Aileen M. Davis ◽  
Brian O'Sullivan ◽  
Charles N. Catton ◽  
Jay S. Wunder ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Limb Salvage ◽  
Local Control ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
Foot And Ankle ◽  
Soft Tissue Tumours ◽  
Limb Preservation ◽  
Good Functional Outcome

Discussion. Thirty of 36 patients (83%) presenting with foot and ankle STS or fibromatosis were candidates for limb preservation. With excellent local control and good functional outcome demonstrated in this study, limb salvage should be a primary goal in the management of selected patients with STS and fibromatosis of the foot and ankle.

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