Modified method for reconstruction of thumb abduction function in children undergoing surgical treatment of thumb duplication

Purpose This study was performed to evaluate a modified method of reconstructing the thumb abduction function in children undergoing surgical treatment of thumb duplication. Methods This retrospective study included 33 children (38 thumbs) with Wassel type III to VII thumb duplication who underwent excision of the polydactylism and osteotomy of the preserved thumb. Among them, 16 children (19 thumbs) underwent reconstruction of the attachment of the articular capsule and collateral ligament of the metacarpophalangeal joint, abductor pollicis brevis and flexor pollicis brevis by the anchor technique (Group A), while 17 children (19 thumbs) underwent suturing the attachment of the above-mentioned soft tissues to the periosteum (Group B). All children were followed up for six years after surgery. The appearance, function and joint stability of the preserved thumb were compared between the two groups; the bone alignment and development were observed. Results The deformity rate of preserved thumbs and the positive rate of lateral stress test were significantly lower in Group A than B (p < 0.05). The modified Tada score and the distance of first web were significantly higher in Group A than B (p < 0.05). Flexion, extension, adduction, abduction and palmar movement of the thumbs were good; bone alignment and development were good and no osteophyte or anchor shadow was left in the preserved thumbs in Group A. Conclusion Reconstruction of the abduction function using the anchor technique is effective in children undergoing surgical treatment for Wassel type III to VII thumb duplication and it may be superior to the conventional technique. Level of evidence III

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Outcomes after anatomic reconstruction of the radioulnar ligaments for distal radioulnar joint instability

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420942668 ◽

2020 ◽

Vol 45 (9) ◽

pp. 909-915 ◽

Cited By ~ 1

Author(s):

Lisa M. Frantz ◽

Elizabeth A. Helsper ◽

Harry A. Morris ◽

Bernard F. Hearon

Keyword(s):

Joint Instability ◽

Stress Test ◽

Distal Radioulnar Joint ◽

Tendon Graft ◽

Anatomic Reconstruction ◽

Joint Stability ◽

Level Of Evidence ◽

Radioulnar Joint ◽

High Satisfaction ◽

Graft Rupture

This retrospective study investigated the clinical outcomes of patients treated for chronic distal radioulnar joint instability with open anatomic reconstruction of the palmar and dorsal radioulnar ligaments. After the midpoint of a tendon graft is anchored at the ulnar fovea, the two graft limbs traverse the distal radioulnar joint. One limb is woven into the palmar wrist capsule and the other is secured to the dorsal wrist capsule and retinaculum to stabilize the joint. Of 30 patients (31 wrists) treated with this technique, 19 were followed longitudinally for a mean of 10 years (range 3–21). In this long-term cohort, there were statistically significant improvements in ulnar-sided wrist pain on the visual analogue scale and in distal radioulnar joint stability on the dorsopalmar stress test. The modified Mayo Wrist Scores were classified as three excellent, 12 good, three fair and one poor. Of the 30 patients studied, failure occurred in four patients, two from graft rupture and two from distal radioulnar joint arthrosis. We conclude that anatomic reconstruction of the palmar and dorsal radioulnar ligaments is an effective treatment for distal radioulnar joint instability and is associated with high satisfaction and durable outcomes. Level of evidence: IV

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Clinical Outcomes of Operative Repair for Patients Who Fail to Conserve the Complete Rupture of the Collateral Ligament in the Proximal Interphalangeal Joint

Soonchunhyang Medical Science ◽

10.15746/sms.21.019 ◽

2021 ◽

Vol 27 (2) ◽

pp. 81-84

Author(s):

Young Hwan Kim

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Stress Test ◽

Visual Analog Scale Score ◽

Proximal Interphalangeal Joint ◽

Joint Stability ◽

Collateral Ligament ◽

Complete Rupture ◽

Pip Joint

Objective: The purpose of this study was to compare the preoperative and postoperative outcomes of surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the proximal interphalangeal (PIP) joint.Methods: A complete rupture of the collateral ligament was confirmed by a radiologist using ultrasound or magnetic resonance imaging for patients who had symptoms after 4 weeks of conservative treatment. Eleven patients underwent operative collateral ligament repair using an anchor. All patient was followed up for at least 6 months postoperatively. We evaluated clinical outcomes preoperatively and at 6 months follow-up: (1) range of motion of the PIP, (2) joint stability, (3) Visual Analog Scale score, (4) fusiform index of the PIP joint, and (5) functional & cosmetic satisfaction.Results: There was no instability in the lateral stress test at 6-month follow-up. The ranges of motion of the PIP were not statistically different between preoperative and at 6-month follow-up. Patients had less pain but the cosmetic appearance of the PIP joint did not improve. Functional satisfaction differed statistically, but there was no difference in cosmetic satisfaction.Conclusion: Surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the PIP joint can provide good joint stability, functional recovery.

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TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172506168821 ◽

2017 ◽

Vol 25 (6) ◽

pp. 283-286

Author(s):

ROBERTO YUKIO IKEMOTO ◽

JOEL MURACHOVSKY ◽

ROGÉRIO SERPONE BUENO ◽

LUIS GUSTAVO PRATA NASCIMENTO ◽

ADRIANO BORDINI CARMARGO ◽

...

Keyword(s):

Surgical Treatment ◽

Case Series ◽

Functional Results ◽

Terrible Triad ◽

Level Of Evidence ◽

Mayo Elbow Performance Score ◽

Results Of Treatment ◽

Type Iv ◽

Flexion Extension ◽

Elbow Injuries

ABSTRACT Objective: To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). Methods: We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. Results: Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). Conclusion: When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

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A comparative study on outcome of conservative and surgical treatment of type III supracondylar fracture of humerus in children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202529 ◽

2020 ◽

Vol 6 (4) ◽

pp. 817

Author(s):

Vinay N. ◽

Manjunatha A. ◽

Anand Kumar B. S.

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Supracondylar Fracture ◽

Type Iii ◽

Wire Fixation ◽

Group A ◽

Group B ◽

Cross Wire ◽

Conservative And Surgical Treatment ◽

Better Than

Background: Supracondylar fracture of humerus is most common of all the fractures around the elbow in children. They occur most commonly in children more so in male child with the peak around 5-8 years. Objective of this study was to compare the outcome of 3 different modalities of treatment for supracondylar fracture of humerus.Methods: Children with type III supracondylar fracture of humerus were categorized into group A, group B, group C based on conservative, closed reduction and percutaneous K wire fixation and open reduction and K wire fixation modalities of treatment given. All the children were followed for 6 months and the outcome of treatment was evaluated using Flynn’s criteria.Results: 40 children were treated with 3 different modalities of treatment. The rate of complications was less in children who were operated on first day of admission (p=0.02). Group B and group C had 80% and 61.11% excellent results and group A had 47.05% poor results. The outcome was better with cross K wire pinning than lateral pinning (p=0.015).Conclusions: Supracondylar fracture of humerus should be operated as early as possible to reduce the rate of complications. The outcome of surgical treatment was better than conservative treatment evaluated in terms of Flynn’s criteria. Cross wire pinning was better than lateral pinning in terms of outcome, but the rate of neuropraxias was more with cross wire pinning.

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WHAT IS THE BEST DISTAL LEVEL OF ARTHRODESIS IN LUMBAR FUSION IN PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS: L3 OR L4?

Coluna/Columna ◽

10.1590/s1808-185120191803197205 ◽

2019 ◽

Vol 18 (3) ◽

pp. 200-204

Author(s):

MURILO TAVARES DAHER ◽

NILO CARRIJO MELO ◽

VINÍCIO NUNES NASCIMENTO ◽

PEDRO FELISBINO JR ◽

BRENDA CRISTINA RIBEIRO ARAÚJO ◽

...

Keyword(s):

Surgical Treatment ◽

Lumbar Fusion ◽

Statistical Significance ◽

Lumbar Curve ◽

Coronal Alignment ◽

Level Of Evidence ◽

Significant Difference ◽

Idiopathic Adolescent Scoliosis ◽

Group A ◽

Group Fusion

ABSTRACT Objective To evaluate coronal alignment in patients with idiopathic adolescent scoliosis with structured lumbar curves submitted to surgical treatment by comparing coronal alignment in the group fusion up to L3 and the group fusion up to L4. Methods Retrospective cohort study. We evaluated patients submitted to surgical treatment with arthrodesis of the lumbar curve with high density of screws with at least 6 months of follow-up. Radiographically, coronal alignment, shoulder height and functional outcome were analyzed through SRS30 questionnaire. Results A total of 25 patients were analyzed, of which 23 were female and 2 were male, with a mean age of 15.2 years (12 to 29 years) at the time of surgery. The patients were divided into two groups. Group A, n = 15: Distal level of fusion in L3 and Group B, n = 10: distal level of fusion in L4. There was no statistically significant difference between Groups A and B when compared to coronal alignment (balanced vs. unbalanced). However, when compared with the coronal alignment (CA) values, lower values of CA were observed in Group A, with statistical significance. No difference was observed between Groups A and B with respect to the SRS30 questionnaire. Conclusions Patients with idiopathic adolescent scoliosis submitted to arthrodesis of the lumbar curve have a better coronal alignment when the distal fusion level is L3. Level of evidence III; Comparative Retrospective Study (based on prospectively collected data).

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RESULTS OF TREATMENT OF OPEN FRACTURES IN PATIENTS WITH POLYTRAUMA IN A REGIONAL TRAUMA SYSTEM

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2018-25-3-28-33 ◽

2018 ◽

Vol 25 (3) ◽

pp. 28-33

Author(s):

A. N. BLAZHENKO ◽

S. N. KURINNYI ◽

M. L. MUKHANOV ◽

M. YU. AGEEV ◽

A. V. GORBUNOV ◽

...

Keyword(s):

Surgical Treatment ◽

Soft Tissues ◽

Trauma System ◽

Treatment Strategies ◽

Infectious Complications ◽

Open Fractures ◽

Skeletal Traction ◽

Type Iii ◽

Results Of Treatment ◽

Traction System

Aim. To analyze options for treatment tactics for open fractures of bones, implemented in a regional trauma system in theKrasnodar Territory.Materials and methods. Retrospective analysis includes the results of treatment of 82 patients with polytrauma and severe open fractures of the shin bones aged from 18 to 60 years, of whom 23 in unstable or critical condition, hospitalized in 2016-2017 in the Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital № 1.Results. Treatment tactics for patients with severe polytrauma and open fractures type IIIA and B according to the classification of Gustilo-Andersen adopted in trauma center of level I, reduces the total number of infectious complications to 9,09% for fractures of type III A and 53,84% of IIIB fractures compared to option treatment strategies adopted in trauma centres II, III where the level of infection reaches 58,06% fractures type III A and 93,75% of IIIB fractures. The typical mistakes made in primary surgical treatment in patients with polytrauma and severe open fractures were revealed: incomplete revision of the wound with leaving foreign bodies, non-viable soft tissues, unstable fixation of the fracture with the help of a skeletal traction system, incomplete external fixation of the fracture with a device or plaster bandage, suturing of the wound with relaxing skin incisions during soft tissue swelling, absence of drains or passive drainage of the open fracture.Conclusion. The usage of primary surgical treatment in a reduced volume, with the application of VAC-dressings, in patients with polytrauma and severe open fractures of the limb bones can reduce the overall incidence of infectious complications.

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Comparison of Shape Memory Staple and Gelled Platelet-Rich Plasma versus Shape Memory Staple alone for the Treatment of Waist Scaphoid Nonunion: A Single-Center Experience

Joints ◽

10.1055/s-0040-1710387 ◽

2020 ◽

Author(s):

Rocco De Vitis ◽

Marco Passiatore ◽

Andrea Perna ◽

Giulio Fioravanti Cinci ◽

Giuseppe Taccardo

Keyword(s):

Surgical Treatment ◽

Shape Memory ◽

Platelet Rich Plasma ◽

Level Of Evidence ◽

Single Center Experience ◽

Upper Limb Function ◽

Mayo Wrist Score ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Purpose The aim of this study was to analyze the results of two different methods of surgical treatment of waist scaphoid nonunions (SNUs). We retrospectively analyzed data from 87 patients referred to our department from January 2010 to December 2017 who were surgically treated for waist SNU. Methods The mean period of time passed from trauma was 11.2 (±5.6) months. Patients were divided into two groups based on surgical treatment received: volar exposure osteosynthesis with shape memory staple (SMS) (group A) and volar exposure osteosynthesis with SMS and gelled platelet-rich plasma (GPRP) application at the bone defect level (group B). A cast (thumb excluded) was maintained for 4 weeks. Healing was checked clinically (pain, QuickDASH [Disabilities of the Arm, Shoulder, and Hand] score, Mayo Wrist Score) and radiologically (standard X-ray). Results Union was achieved in 40 patients in group A (95.2%) and in all patients in group B (45 patients; 100%). A statistically significant difference was observed in the improvement of the Mayo Wrist Score, QuickDASH score, and pain (measured through the visual analog scale) after 3 months from surgery (p = 0.02). Conclusion SMS is effective in treating waist SNU at more than 6 months from trauma. GPRP application can improve bone healing and upper limb function. Level of Evidence This is a retrospective observational Level III study.

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Arthroscopic thermal stabilization for distal radioulnar joint instability: 3 to 19 years follow-up

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420927882 ◽

2020 ◽

Vol 45 (9) ◽

pp. 916-922

Author(s):

Elizabeth A. Helsper ◽

Lisa M. Frantz ◽

Jessica M. Adams ◽

Harry A. Morris ◽

Bernard F. Hearon

Keyword(s):

Joint Instability ◽

Stress Test ◽

Thermal Stabilization ◽

Distal Radioulnar Joint ◽

Thermal Shrinkage ◽

Joint Stability ◽

Early Failure ◽

Level Of Evidence ◽

Radioulnar Joint

This retrospective study investigated the clinical outcomes of patients treated for chronic distal radioulnar joint instability with arthroscopic thermal annealing of the superficial radioulnar ligaments, ulnar palmar wrist ligaments, and dorsoulnar wrist capsule using a radiofrequency probe. Sixty patients (62 wrists) were treated over an 18-year period. At mean follow-up of 10 years (range 3 to 19), 30 of 33 patients were satisfied with their surgical outcomes. There were statistically significant improvements in ulnar-sided wrist pain on a visual analogue scale and in distal radioulnar joint stability on the dorsopalmar stress test after surgery compared with preoperative status. The modified Mayo Wrist Score and Quick Disabilities of the Arm, Shoulder, and Hand score of the patients were favourable. Early failure occurred in 11 of 62 wrists. Nine of these 11 wrists needed a secondary procedure. We conclude that arthroscopic thermal shrinkage is effective for the majority of the patients with mild to moderate chronic distal radioulnar joint instability in long-term follow-up. Secondary open ligament reconstruction is an option in the case of early failure. Level of evidence: IV

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HETEROTOPIC OSSIFICATION IN ACETABULAR FRACTURES: SYSTEMATIC REVIEW AND META-ANALYSIS OF PROPHYLAXIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212906244689 ◽

2021 ◽

Vol 29 (6) ◽

pp. 331-340

Author(s):

THIAGO SANCHEZ PIRES BUENO ◽

GABRIEL PARIS DE GODOY ◽

REBECA BARROS FURUKAVA ◽

NICOLE TAKAKURA GAGGIOLI ◽

MARCEL JUN SUGAWARA TAMAOKI ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Heterotopic Ossification ◽

Soft Tissues ◽

Meta Analysis ◽

Acetabular Fractures ◽

Common Complication ◽

Insufficient Evidence ◽

Level Of Evidence ◽

Intervention Level

ABSTRACT Objective: Heterotopic ossification is defined as the formation of trabecular bone in soft tissues. It is a common complication after surgical treatment of acetabular fractures. However, its prophylaxis and treatment are still controversial. The objective of this research is to evaluate the effectiveness of actions to prevent the development of heterotopic ossification after surgical correction of acetabular fractures. Methods: A systematic review was carried out with research in the databases PubMed/MEDLINE, Embase, LILACS and Cochrane until August 4, 2020, without restrictions on language and year of publication. Only randomized clinical studies carried out in humans without restrictions based on the dosage of treatments, use and duration of prophylaxis were included in this review. Results: Two studies compared the use of radiotherapy and indomethacin and three compared the use of indomethacin with a placebo or non-indomethacin group. The meta-analysis calculations did not indicate statistical differences between radiotherapy versus indomethacin (RR 1.45, IC 95% 0.97 to 2.17, p = 0,55) and indomethacin versus placebo or not indomethacin (RR 0.85, IC 95% 0.68 to 1.06, p = 0,59). Conclusion: There is insufficient evidence to affirm that the use of radiotherapy or indomethacin are effective to prevent the formation of heterotopic ossification after surgery for fractures of the acetabulum. In addition, the number of complications was higher in the indomethacin group when compared to placebo or no intervention. Level of Evidence I, Systematic Review.

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Paradoxical Hypotension during Dobutamine Infusion for Myocardial Perfusion Scintigraphy

Nuklearmedizin ◽

10.1055/s-0038-1632347 ◽

1998 ◽

Vol 37 (08) ◽

pp. 268-271

Author(s):

B. Caner ◽

E. Atalar ◽

A. Karanfil ◽

L. Tokgözoğlu ◽

E. L. Ergün

Keyword(s):

Blood Pressure ◽

Myocardial Perfusion ◽

Systolic Blood Pressure ◽

Myocardial Perfusion Scintigraphy ◽

Stress Test ◽

Dobutamine Infusion ◽

Perfusion Scintigraphy ◽

Tilt Table ◽

Study Results ◽

Group A

Summary Aim: Dobutamine as a predominant beta-1 agonist increases heart rate and myocardial contractility and at sufficient high doses, it also increases systolic blood pressure. This study was undertaken to describe instances of paradoxical hypotension during dobutamine infusion for TI-201 myocardial perfusion SPECT study and the relationship between scintigraphic findings and hypotension occurred during dobutamine infusion. Methods: In 201 consecutive patients unable to perform adequate exercise, dobutamine TI-201 myocardial SPECT was performed. Dobutamine was infused starting from 10 μg/kg/min increasing to 40 μg/kg/min. Paradoxical hypotension was defined as a decrease in systolic blood pressure ≥ 20 mmHg compared with baseline study. Results: Paradoxical hypotension was observed in 40 patients (Group A) out of 201 (19.9%) while no significant change in systolic blood pressure was detected in the remaining 161 patients (Group B). Mean maximum fall in systolic blood pressure was 39 ± 18 mmHg (range: 20-90). In 33 of 40 patients (83%) with paradoxical hypotension, scintigraphy was normal compared to 131 (81%) of the remaining 161 patients. In patients of Group A, angiography, echocardiography and tilt table tests were performed in 13, 11 and 6 patients respectively. Nine of 13 angiographic evaluations (69%), 10 of 11 echocardiographic evaluations (91%), all of the tilt table tests were normal. Additionally, all of the patients of Group A were clinically followed up at least 6 months after the myocardial perfusion scintigraphy. None of the patients had a cardiac event except one patient during the follow-up period. Conclusion: Paradoxical hypotension during dobutamine infusion for myocardial scintigraphy is not an uncommon finding and up to 19.9% patients may develop such hypotension. To maximize test safety, precautions should be taken during dobutamine myocardial stress test, since remarkable decrease in systolic blood pressure may occur. Unlike hypotension occurring with exercise test, hypotension response to dobutamine is not always a marker for coronary artery disease.

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