scholarly journals Modified Judet’s Quadricepsplasty with patella traction for extension contracture of knee

2021 ◽  
Vol 13 (5) ◽  
pp. 115-120
Author(s):  
Bari MM ◽  
Islam Shahidul ◽  
Azad Mohammad Abul Kalam ◽  
Ashraf Mohammad Tanvir, ◽  
Bari A M Shayan R
Keyword(s):  
Range Of Motion ◽  
Revision Surgery ◽  
Clinical Result ◽  
Excellent Result ◽  
Knee Extension ◽  
Quadriceps Femoris ◽  
Knee Function ◽  
Fracture Treatment ◽  
Operative Care

To see the clinical result of Modified Judet’s Quadricepsplasty (MJQP) with patella traction at BARI-ILIZAROV ORTHOPAEDIC CENTRE for the treatment of knee extension contracture. Materials and methods: We received 16 patients with knee extension contracture treated by MJQP with patella traction from January 2015 to January 2021, at our BARI-ILIZAROV ORTHOPAEDIC CENTRE. The age at revision surgery was 25-58 years. The time between fracture treatment to MJQP was 4 to 20 months and our follow up was 10-30 months. We assessed pre-operative and post-operative range of motion (ROM). Results: Knee range of motion pre-operatively was 5-50 (35± 10)° and 35-85 (55±10)° after MJQP and in average of 0-35(18+10) °. We applied patella traction for 12-14 (10±3)° When we removed the patella traction the knee range of motion at that time was 95-110 (93±4)° and increase of 10-70 compared with the range of motion after release of all arthrofibrosis in the joint. Our follow up time was 12-35 (19±5) months. Knee range of motion at first follow up was 85-135 (105±13)°, an increase of 45-105 (70±15) ° compared with pre-operatively and of 10-45 (12±12)° compared with the range of motion after patella traction removed. Knee function was excellent in 12 cases (70%), good in 3 (27%) and fair in one (3%). Conclusion: MJQP with patella traction lengthens the contracted Quadriceps femoris gives excellent result with proper post-operative care and CPM therapy.

scholarly journals A Novel All-Inside Arthroscopic Technique for Radial-Sided Triangular Fibrocartilage Complex Tears: A Case Report and Review of Literature

Hand ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. NP166-NP169 ◽  
Author(s):  
Michael T. Edgerton ◽  
Robert C. Kollmorgen
Keyword(s):  
Case Report ◽  
Range Of Motion ◽  
Single Case ◽  
Excellent Result ◽  
Full Range ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Single Case Report ◽  
Triangular Fibrocartilage

Background: Triangular fibrocartilage complex (TFCC) injuries are a known cause of ulnar-sided wrist pain. Wrist arthroscopy is the gold standard for diagnosis of these lesions and is becoming a more frequent method of treatment. Isolated radial-sided tears are uncommon and treatment of these lesions is controversial. There are few reports on repair techniques. Here we report on a novel arthroscopic, all-inside technique for traumatic radial-sided TFCC tears that resulted in full range of motion, significant improvement in pain, and ultimately return to sport. Methods: This is a single case report describing an all-inside, arthroscopic repair of a radial-sided TFCC tear. The techniques and postoperative protocol are discussed. Clinical outcomes were reported at final follow-up of 3.5 months. Results: At final follow-up, our patient had full wrist range of motion, 95% strength, occasional 1/10 pain, and returned to sport at her previous level of play. There were no complications. Conclusion: Although just a single case report, our patient had an excellent result based on modified Mayo wrist score. When comparing our result and the previous literature, this technique seems to be a valid method for addressing radial-sided TFCC tears.

scholarly journals Functional Outcome of Revision Osteosynthesis after failed surgical treatment of patellar fractures

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Elena Müller ◽  
Karl-Heinz Frosch
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Revision Surgery ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Fracture Dislocation ◽  
Secondary Fracture ◽  
Patellar Fractures ◽  
Tegner Score

Aims and Objectives: Patellar fractures account for approximately 1% of all skeletal fractures. They are rare, but due to the crucial function of the patella in the extensor mechanism of the knee they can lead to a serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study is to asses the functional outcome of patients after revision surgery in case of secondary fracture dislocation or remaining articular incongruity. Materials and Methods: The study was designed as a retrospective observatory study. We included all patients who underwent a revision surgery because of a remaining articular incongruity or a secondary fracture dislocation or re-fracture from January 2010 until december 2016. Results: Sixteen patients of mean age 51,8 years were included in the study with a mean follow-up period of 28,8 months. Fifteen patients had AO type C fractures, within ten a C3 fracture. Thirteen were initially treated with tension band wiring via k-wires or cannulated screws. The reason for a revision surgery were 5 times a remaining articular incongruity, 11 times a secondary fracture dislocation or re-fracture. We analysed pain, satisfaction, range of motion, Böstman-Score, Tegner-Score and KOOS and could extract follow-up data from 15 of the patients. All fractures healed, no articular incongruity remained. Mean pain measured with the visual analogue scale (0-10) was at rest 0,57 (range 0-3,5), on exertion 2,79 (range 0-8). The measurement of the range of motion compared with the opposite knee showed a complete extension. Mean Flexion was 120°, in the opposite knee 136° (p = 0,05). Mean postoperative Böstman-Score and Tegner-Score were 25,11 (good, max. 30) and 78,67 (moderate, max. 100). KOOS: symptoms 66,8 points, pain 77,55 points, ADL 75,67 points and qualitiy of life 56,25 points. Conclusion: Early revision surgery in case of secondary fracture dislocation, re-fracture or remaining articular incongruity leads to statisfactory functional outcomes. Furthermore in case of complexe fractures the tension band wiring technique shouldn’t be the first choice, alternatives like the plate osteosynthesis should be considered.

Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair

2018 ◽  
Vol 46 (10) ◽  
pp. 2457-2465 ◽  
Author(s):  
James P. Bradley ◽  
Justin W. Arner ◽  
Sachidhanand Jayakumar ◽  
Dharmesh Vyas
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Range Of Motion ◽  
Revision Surgery ◽  
Return To Play ◽  
Female Sex ◽  
Bone Width ◽  
Posterior Shoulder ◽  
Rotator Cuff Injury

Background: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repair of the shoulder are currently not well defined. Hypothesis: Athletes who require revision arthroscopic posterior unidirectional capsulolabral repair will have poorer outcomes and return to play when compared with those undergoing primary procedures, with risk factors including younger age, injury size, bone loss, and anchor number. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 297 shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2-year follow-up were reviewed. In addition to surgical data, the American Shoulder and Elbow Surgeons scoring system with subjective stability, range of motion, strength, and pain scores as well as return to sport were compared pre- and postoperatively between those who did and did not require revision surgery. Magnetic resonance arthrogram measurements of glenoid labral, chondral, and bone version and labral and bone width were also compared. Results: Nineteen shoulders required revision surgery (6.4%) at 8.9-year follow-up. Significant risk factors included female sex ( P = .001), dominant shoulder ( P = .005), and concomitant rotator cuff injury ( P = .029). Patients with ≤3 anchors were more likely to require revision (odds ratio = 3.48). Smaller glenoid bone width was a risk factor for requiring future revision surgery ( P < .001), but glenoid labral, chondral, and bone version and labral width were not risk factors. All patients had significant improvements in American Shoulder and Elbow Surgeons, pain, range of motion, and strength scores after the original surgery; however, those who required revision surgery had less improvement ( P < .05). Stability improved significantly for nonrevisions ( P < .001) but did not for revisions ( P = .662). In the nonrevision group, 64.3% returned to sport at the same level, which was significantly higher than the 15.4% of the revision group ( P = .004). Overall, 78.6% of the nonrevision group and 61.6% of the revision group returned to sport at some level ( P = .280). Conclusion: Athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 6.4%. Revision patients had significantly poorer outcome scores and return to play when compared with those who did not undergo revision surgery with risk factors being dominant shoulder surgery, female sex, concomitant rotator cuff injury, the use of 3 or fewer anchors, and smaller glenoid bone width. These data are essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder instability failure requiring revision has not previously been evaluated.

Results of 1245 Endoscopic Carpal Tunnel Decompressions

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 111-116 ◽  
Author(s):  
S. A. McNally ◽  
P. F. Hales
Keyword(s):  
Upper Limb ◽  
Carpal Tunnel ◽  
Revision Surgery ◽  
Excellent Result ◽  
Senior Author ◽  
Digital Nerve ◽  
Open Procedure ◽  
Abnormal Anatomy ◽  
Important Structure

Between 1994 and 2000, the senior author performed 1245 endoscopic carpal tunnel decompressions. There were 291 bilateral cases. A telephone review was conducted of those patients who had not had an early excellent result, or conversion to an open procedure. Ninety-four per cent follow-up of patients in this group was achieved; 88% had an early excellent result with no subsequent problems. In 33 hands (3%) the carpal tunnel was opened, because of abnormal anatomy or poor view. A further 5% had a late excellent result. Seventeen hands (1%) have required subsequent open decompression, with adherence of the median nerve often found at revision surgery. Another 24 hands (2%) had a poor result. Fourteen hands (1%) had minor symptoms and 26 (2%) had another diagnosis of upper limb pathology. In contrast to other series, there was only one case of damage to an important structure — the radial digital nerve of the thumb.

scholarly journals Functional outcome of judet’s quadriceptoplasty in posttraumatic stiff knees.

2021 ◽  
Vol 28 (12) ◽  
pp. 1783-1787
Author(s):  
Latif Khan ◽  
Shehzad Ahmad ◽  
Irfan Qadir ◽  
Abaidurrehman ◽  
Atiq Uz Zaman ◽  
...  
Keyword(s):  
Cohort Study ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Retrospective Cohort ◽  
Knee Extension ◽  
Special Surgery ◽  
Time Of Operation ◽  
Study Setting ◽  
Hospital For Special Surgery

Objective: To evaluate functional outcomes of Judet’s Quadriceptoplasty in posttraumatic stiff knees according to Judet’s criteria and Hospital for special surgery score of knee. Study Design: Retrospective Cohort Study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan. Period: January 2015 to June 2017. Material & Methods: 74 patients 61 males and 13 femal with stiff knees underwent Judet’s Quadriceptoplasty and followed by 12 weeks of aggressive rehabilitation and followed by aggressive rehabilitation for 12 weeks. Range of motion was measured with goniometer at last follow up. Outcomes were measured in terms of Judet’s criteria and Hospital for special surgery score of the knee. Results: Mean age at time of operation was 33.70±10.66 years. According to Judet’s criteria 68.9% (51) patients have excellent range of motion, 21.6% (16) have Good, 6.8% (5) patients have fair, 2.7% (2) have poor outcome. According to Hospital for special surgery score of the knee (HSS) mean score was 86.68±5.92 (60-96). There were 83.8% (62), 13.5% (10) and 2.7% (2) cases in excellent, good and fair group respectively. Blood loss was minimum 250ml max 650ml mean 443ml. Conclusion: Judet’s quadriceptoplasty for knee extension contracture is a useful procedure to increase the range of motion of stiff knees.

scholarly journals Functional outcome of the treatment of AO-ASIF type C distal humerus fracture using Lambda plate

2020 ◽  
Vol 13 (2) ◽  
pp. 128-133
Author(s):  
Krishna Bahadur Bista ◽  
Rabeendra Prasad Shrestha ◽  
Bhola Shrestha ◽  
Ishwar Sharma Kandel ◽  
Rabi Mohan Dakal
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Distal Humerus ◽  
Humerus Fracture ◽  
P Value ◽  
Fracture Treatment ◽  
Distal Humerus Fracture ◽  
Number Of Patients ◽  
Type C

Introduction: Although the use of two plates for the treatment of type-C distal humerus fracture is popular, site of plate placement still is under debate. Use of Lambda plate for the fracture treatment can be easier and settle the dispute. This study aims to evaluate the functional outcome of the surgery using Lambda Plate. This can be a reference for surgeons and helps them make the decision about choice of implant for type C distal humerus fracture treatment among Nepalese people. Methods: This interventional study used Lambda plate for the treatment of type C fracture of distal humerus. Patients were examined at 4, 12, and 24 weeks respectively for the measurement of the outcome. Visual analogous scale was used for assessment of pain, range of motion for functional recovery and Mayo Elbow Performance Score was used for the assessment of functional outcome. Paired-samples t-test and linear regression was used to for data analysis. Results: Functional outcome at the last follow-up was excellent in 24(53.33%) patients, good in 18(40%) patients and fair in 3(6.67%) patients. Range of motion of elbow increased significantly with every follow-up (p-value <0.001). Average angle of flexion at last follow-up was 117.53°±11.74 while loss of extension was 7.53°±4.86. Average number of patients had their fracture union at 19.84±2.38 weeks. There was no association of age, sex and union weeks with functional outcome when measured with MEPS. Conclusion: Fixation of distal humerus fracture by using Lambda plate gave excellent and satisfying outcome in terms of pain, range of motion and objective functional outcome.  

The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis

2020 ◽  
pp. 1-10
Author(s):  
Dominic Amara ◽  
Praveen V. Mummaneni ◽  
Shane Burch ◽  
Vedat Deviren ◽  
Christopher P. Ames ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Pelvic Incidence ◽  
Secondary Analysis ◽  
Lumbar Interbody Fusion ◽  
Curve Correction ◽  
Surgery Rates

OBJECTIVERadiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve.METHODSA single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence − lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion.RESULTSA total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence − lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12–150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (−1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs −0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases.CONCLUSIONSMore levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

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