scholarly journals Outcomes following endoscopic-assisted Woodward procedure for Sprengel deformity

2021 ◽  
pp. 1-6
Author(s):  
Francisco Soldado ◽  
Sergi Barrera-Ochoa ◽  
Paula Diaz-Gallardo ◽  
Trong-Quynh Nguyen ◽  
Dinh-Hung Nguyen ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Comparative Studies ◽  
Effective Technique ◽  
Level Of Evidence ◽  
Recorded Data ◽  
Woodward Procedure ◽  
Therapeutic Study ◽  
Shoulder Elevation ◽  
Grade Iii

Purpose An endoscopic-assisted approach for Sprengel deformity has been previously reported. Our objective was to assess outcomes of the endoscopic Woodward procedure in a series of patients. Methods Retrospective analysis was performed of children with a Sprengel deformity treated between November 2014 and February 2018. Recorded data were demographic, pre- and postoperative active shoulder elevation and deformity severity according to Cavendish. Results A total of 12 children (four girls and eight boys, ten right-sided/two left-sided) with a mean age of nine years two months (3 years 5 months to 16 years 1 month) and mean follow-up 19.8 months (10 to 48) were assessed. Nine children were classified as Cavendish Grade III and three as grade IV, respectively. Mean preoperative active shoulder forward elevation was 100.8° (70° to 120°), while postoperatively it increased to 149.2° (100° to 170°). Mean preoperative scapular high difference was 4.5 cm (2.8 to 5.2), while postoperatively it was 1.33 cm (0 to 2.8). Conclusion The endoscopic assisted Woodward procedure is an effective technique. Further comparative studies will ascertain advantages in functional and cosmetic results compared to the standard Woodward procedure. Level of Evidence Therapeutic study, Level IV

Dorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instability

2020 ◽  
Vol 45 (7) ◽  
pp. 666-672
Author(s):  
Grégoire Micicoi ◽  
Lolita Micicoi ◽  
Nicolas Dreant
Keyword(s):  
Retrospective Study ◽  
Retrospective Analysis ◽  
Good Option ◽  
Level Of Evidence ◽  
Independent Observer ◽  
Scapholunate Instability ◽  
Early Stages ◽  
Mayo Wrist Score ◽  
Radiological Data

The purpose of this study was to assess the results of dorsal intercarpal ligament capsulodesis (Mayo technique) for cases of chronic scapholunate instability and to specify the indications according to the severity of instability. A retrospective analysis was conducted and examined dorsal intercarpal ligament capsulodesis procedures performed for chronic scapholunate instability without intercarpal or radiocarpal arthritis. One-hundred and twenty patients were examined by an independent observer (48 predynamic, 48 dynamic and 24 static scapholunate instabilities). The follow-up period averaged 54 months (range 24–127). Mean final Mayo wrist score was 70, mean final Patient-Rated Wrist Evaluation was 27 and mean final QuickDASH score was 26. Functional, clinical and radiological data were improved for the operated patients. We concluded that dorsal intercarpal ligament capsulodesis is a good option for treating early stages of scapholunate instability. Level of evidence: IV

scholarly journals Saphenous Artery Perforator/Propeller Flap in the Reconstruction of Perigenual Soft Tissue Defects

2019 ◽  
Vol 52 (03) ◽  
pp. 330-336
Author(s):  
T. M. Balakrishnan ◽  
Aishwarya Vadakencherry Lakshmi Narayanan ◽  
J. Jaganmohan
Keyword(s):  
Cadaver Study ◽  
Level Of Evidence ◽  
Propeller Flap ◽  
Evidence Type ◽  
Therapeutic Study ◽  
Type V ◽  
Artery Perforator ◽  
Saphenous Artery

Abstract Introduction In this article, we investigate the saphenous artery perforator propeller flap for the reconstruction of perigenual defects. We describe the anatomy of the saphenous artery and the method of raising a perforator propeller flap based on our study and early clinical experience. Aim To assess the effectiveness of the saphenous artery perforator propeller flap in the reconstruction of perigenual defects. Materials and Methods A preliminary cadaver dissection and injection study was conducted to discern the anatomical details of the perforator system of the saphenous vessel in 35 cadaveric specimens in 18 fresh cadavers. From March 2016 to March 2018, 16 clinical cases (5 females and 11 males, in the average age group of 33.5 years) with perigenual defects were reconstructed with saphenous artery perforator propeller flap. They were followed up for an average period of 12.5 months. Results Cadaver study established anterior sartorial perforators as the dominant system of the saphenous vessel and brought to the forefront the type 2 blood supply of the saphenous nerve. All patients had well-settled flaps at the end of the follow-up period, with good return of knee function. Conclusion Saphenous artery perforator propeller flap is a viable option for the reconstruction of defects around the knee joint. Level of Evidence Type V, therapeutic study.

scholarly journals Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

2017 ◽  
Vol 06 (04) ◽  
pp. 294-300 ◽  
Author(s):  
Avanthi Mandaleson ◽  
Michael Wagels ◽  
Stephen Tham
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Pinch Grip ◽  
The Mean ◽  
Therapeutic Study

Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67–78; SD 4.6). Mean follow-up time was 48.2 months (34–59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30–40 degrees), extension of 30 degrees (range: 20–42 degrees), radial deviation of 18 degrees (range: 10–30 degrees), and ulnar deviation of 15 degrees (range: 0–25 degrees). The mean key pinch was 4.2 kg (range: 0.5–10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0–19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence Level IV, therapeutic study.

The K-Wire Fixation Technique for Endoscopic Brow Lift: A Long-Term Follow-Up

2019 ◽  
Vol 40 (10) ◽  
pp. 1051-1060 ◽  
Author(s):  
Paul E Chasan ◽  
Adam T Hauch
Keyword(s):  
Fixation Technique ◽  
Effective Technique ◽  
Level Of Evidence ◽  
Brow Lift ◽  
Wire Fixation ◽  
Aesthetic Results ◽  
Long Term Follow Up ◽  
Endoscopic Brow Lift

Abstract Background Many techniques have been presented for fixation during endoscopic brow lift, but no singular technique has become dominant. Objectives The authors described a technique for fixation for endoscopic brow lift that is inexpensive, easy to use, and versatile and has minimal morbidity. Methods The charts of 284 patients who underwent the K-wire fixation technique between December 1996 and September 2018 were reviewed. This technique employs a transcutaneous K-wire to hold the brow in position until tissue adhesion creates a lasting elevation of the brow. Results A total of 284 patients underwent K-wire fixation for endoscopic brow lifting. Two patients had hematomas and 5 patients (1.8%) required a second unilateral brow lift procedure. Long-term elevation of the brow was maintained in all patients. Conclusions K-wire fixation for endoscopic brow lift is a simple, safe, and effective technique for fixation during endoscopic brow lifting that provides long-term aesthetic results. Level of Evidence: 4

Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

2021 ◽  
Author(s):  
Jaak Warlop ◽  
Maarten Van Nuffel ◽  
Luc De Smet ◽  
Ilse Degreef
Keyword(s):  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Visual Analog Scale Score ◽  
Distal Radioulnar Joint ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Therapeutic Study ◽  
And Function

Abstract Background A painful unstable distal radioulnar joint (DRUJ) can seriously compromise hand and wrist function. The semiconstrained prosthesis was developed to restore DRUJ function. To date, most outcome reports are coauthored by the designer. Questions Does independent reporting confirm the promising results of the semiconstrained DRUJ prosthesis? Are complication and failure rates acceptable? Patients and Methods We evaluated patients with the semiconstrained DRUJ implant and a minimum follow-up of 2 years. We monitored patient satisfaction and function with functionality questionnaires and measured wrist range of motion, grip, and key pinch strength. Statistical analysis was done using descriptive statistics, Pearson correlation coefficients, linear and logistic regression. Results We included 41 patients with 42 implants. Mean follow-up was 46 months (range: 24–102 months). Eighty percent of wrist had undergone previous surgery. We found a mean pronation of 83 degrees (0–90 degrees), supination of 70 degrees (0–90 degrees), flexion of 42 degrees (0–90 degrees), extension of 49 degrees (0–90 degrees), ulnar deviation of 24 degrees (0–60 degrees), and radial deviation of 14 degrees (0–40 degrees). Grip and key pinch strength were 20.1 (1–50 kg) and 6 kg (1–12 kg), respectively. Average patient-rated wrist and hand evaluation score was 42.7 (0–95), disabilities of the arm, shoulder and hand score was 38 (0–88), and visual analog scale score was 3.6 (0–8). We found a 43% complication rate (mostly minor: ulnar or radial tendinopathy, temporary hypoesthesia) with 24% reoperation and 92% prosthesis survival rate. Conclusion The linked semiconstrained DRUJ prosthesis has its value in the surgical treatment of DRUJ failure. Currently, most implants are used in secondary surgery and multioperated wrists. More research is required to assess the value of the DRUJ prosthesis as a primary procedure. Level of evidence This is a level IV, therapeutic study.

scholarly journals Platelet-Rich Plasma Augmentation to Microfracture Provides a Limited Benefit for the Treatment of Cartilage Lesions: A Meta-analysis

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091050 ◽  
Author(s):  
Angelo Boffa ◽  
Davide Previtali ◽  
Sante Alessandro Altamura ◽  
Stefano Zaffagnini ◽  
Christian Candrian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Comparative Studies ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Assessment Tools ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Cartilage Lesions

Background: Microfracture is the most common first-line option for the treatment of small chondral lesions, although increasing evidence shows that the clinical benefit of microfracture decreases over time. Platelet-rich plasma (PRP) has been suggested as an effective biological augmentation to improve clinical outcomes after microfracture. Purpose: To evaluate the clinical evidence regarding the application of PRP, documenting safety and efficacy of this augmentation technique to improve microfracture for the treatment of cartilage lesions. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed in PubMed, EBSCOhost database, and the Cochrane Library to identify comparative studies evaluating the clinical efficacy of PRP augmentation to microfracture. A meta-analysis was performed on articles that reported results for visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC), and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Risk of bias was documented through use of the Cochrane Collaboration Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions assessment tools. The quality assessment was performed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: A total of 7 studies met the inclusion criteria and were included in the meta-analysis: 4 randomized controlled trials, 2 prospective comparative studies, and 1 retrospective comparative study, for a total of 234 patients. Of the 7 studies included, 4 studies evaluated the effects of PRP treatment in the knee, and 3 studies evaluated effects in the ankle. The analysis of all scores showed a difference favoring PRP treatment in knees (VAS, P = .002 and P < .001 at 12 and 24 months, respectively; IKDC, P < .001 at both follow-up points) and ankles (both VAS and AOFAS, P < .001 at 12 months). The improvement offered by PRP did not reach the minimal clinically important difference (MCID). Conclusion: PRP provided an improvement to microfracture in knees and ankles at short-term follow-up. However, this improvement did not reach the MCID, and thus it was not clinically perceivable by the patients. Moreover, the overall low evidence and the paucity of high-level studies indicate further research is needed to confirm the potential of PRP augmentation to microfracture for the treatment of cartilage lesions.

Microfat and Nanofat Grafting in Genital Rejuvenation

2020 ◽  
Author(s):  
Sophie Menkes ◽  
Mounia SidAhmed-Mezi ◽  
Jean Paul Meningaud ◽  
Laurent Benadiba ◽  
Guy Magalon ◽  
...  
Keyword(s):  
Health Index ◽  
Inclusion Criteria ◽  
Effective Technique ◽  
Level Of Evidence ◽  
Genitourinary Syndrome Of Menopause ◽  
Sexual Distress ◽  
Perimenopausal Women ◽  
Vaginal Health ◽  
Genitourinary Syndrome

Abstract Background Genitourinary syndrome of menopause (GSM) is a major problem in many post- or perimenopausal women. Lipofilling has long been considered to be an effective technique for restoring volume, but the discovery of its trophic proprieties has made it the most widely utilized method in regenerative medicine. Objectives The authors aimed to assess the safety and efficacy of microfat and nanofat grafting for vulvovaginal rejuvenation. Methods Women with GSM who met the inclusion criteria were enrolled. Women received microfat in the labia majora and nanofat in the vagina; follow-up was conducted 1, 3, 6, 12, and 18 months. The vaginal health index (VHI) and Female Sexual Distress (FSD) were utilized to assess improvement in vulvovaginal atrophy, orgasm, and sexual desire posttreatment. Results Fifty women were included; their average age was 53 years (range, 45-63 years). The VHI score significantly increased at 1 and 3 months after treatment (P &lt; 0.0001). Moreover, the average FSD score showed a significant improvement at 1 and 3 months posttreatment. This score stabilized from 6 to 12 months but showed further improvement at 18 months. At 6 months posttreatment, for both scales, data pertaining to 80% of patients appeared normalized. There was a particular benefit noted for dryness and dyspareunia. At 18 months, the results remained stable for all of patients. No major side effects were observed. Conclusions There are now many ways to rejuvenate the intimate sphere, but microfat and nanofat grafting seem to offer good results with an autologous procedure. Their utilization appears promising for genital rejuvenation. Level of Evidence: 4

scholarly journals Temporary spanning plate across the elbow for complex fractures of the distal humerus

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ashraf N. Moharram ◽  
Mostafa Mahmoud ◽  
Ahmed Lymona ◽  
Ahmed Afifi ◽  
Mostafa Ezzat ◽  
...  
Keyword(s):  
Bone Loss ◽  
Internal Fixation ◽  
Early Mobilization ◽  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Dash Score ◽  
Level Of Evidence ◽  
The Mean ◽  
Therapeutic Study

Abstract Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study

scholarly journals Surgical Treatment of Cubital Tunnel in Pediatric Athletes

2018 ◽  
Vol 10 (02) ◽  
pp. 82-85 ◽  
Author(s):  
Daniel Quinn ◽  
Alex Gu ◽  
Jeffrey Greenberg ◽  
Thomas Fischer ◽  
Gregory Merrell
Keyword(s):  
Age Of Onset ◽  
Cubital Tunnel Syndrome ◽  
Surgical Decompression ◽  
Cubital Tunnel ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Tunnel Syndrome ◽  
Therapeutic Study ◽  
Nerve Entrapment Syndrome

Abstract Background Cubital tunnel syndrome is the second most common upper extremity peripheral nerve entrapment syndrome. In particular, cubital tunnel has been documented occasionally in young, throwing athletes. Materials and Methods Billing databases were searched for patients undergoing surgical decompression of the ulnar nerve at the elbow, who were age 18 or younger at the time of surgery. Charts were reviewed and patients were included if they had an isolated mononeuropathy consistent with cubital tunnel syndrome and were symptomatic. Data on age of onset, duration of symptoms, Dellon classification, nerve subluxation, provocative testing results, nerve conductions, and exacerbating activities were abstracted. Patients were contacted for a postsurgical follow-up questionnaire. Results Seven patients were identified. The average age was 16, and duration of symptoms was 7 months. All seven patients had normal electrodiagnostic studies and had failed a course of conservative treatment. All were satisfied with surgery and felt improvement. One stopped playing their sport, and three had mild symptoms with varied activities. Conclusion Although uncommon, pediatric cubital tunnel syndrome does occur. Surgical release improves symptoms and return to activities. Nevertheless, some degree of symptoms often persists. Electrodiagnostic studies may be negative in many patients with an otherwise consistent history and examination. Level of Evidence This is a level IV therapeutic study.

scholarly journals Prophylactic antibiotics in soft-tissue procedures in children with cerebral palsy

2018 ◽  
Vol 12 (3) ◽  
pp. 279-281
Author(s):  
L. R. Perotti ◽  
O. Abousamra ◽  
K. J. Rogers ◽  
F. Miller ◽  
J. P. Sees
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Surgical Site Infections ◽  
Paediatric Population ◽  
Prophylactic Antibiotics ◽  
Level Of Evidence ◽  
Children With Cerebral Palsy ◽  
Antibiotic Group ◽  
Therapeutic Study

Purpose Data on the benefits of perioperative prophylactic antibiotics in the paediatric population are lacking. In this study, we aimed to assess the rate of infection after isolated soft-tissue procedures in patients with cerebral palsy with and without preoperative prophylactic antibiotics between 2009 and 2015. Methods We reviewed the records of all children with cerebral palsy who underwent isolated soft-tissue procedures (on the upper and lower limb) at our hospital between 2009 and 2015. Children with at least 30-day postoperative follow-up were included. Children who had groin incisions were excluded. Results Two groups were identified: the antibiotic group (77 children with 203 incisions and 343 procedures) had one surgical site infection; the no-antibiotic group (48 children with 102 incisions and 177 procedures) had no surgical site infections. Conclusion These results suggest that the use of preoperative antibiotics does not change the rate of postoperative surgical site infections. Level of Evidence Level III therapeutic study

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