scholarly journals DIAGNOSIS AND TREATMENT OF RETAINED WOODEN FOREIGN BODIES IN THE EXTREMITIES USING ULTRASOUND

2018 ◽  
Vol 26 (3) ◽  
pp. 198-200 ◽  
Author(s):  
BARIŞ POLAT ◽  
YUNUS ATICI ◽  
TAHSIN GÜRPINAR ◽  
AYŞE ESIN POLAT ◽  
DOĞAÇ KARAGÜVEN ◽  
...  
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Case Series ◽  
Level Of Evidence ◽  
Erythrocyte Sedimentation ◽  
Ultrasound Evaluation ◽  
Delayed Extraction ◽  
The Mean ◽  
Palm Of The Hand ◽  
Time Of Admission

ABSTRACT Objective This study investigates ultrasonography as an effective tool for localizing and measuring the depth and size of wooden foreign bodies to perform less invasive and easier surgery without the need for any additional radiological techniques. Methods Fifteen patients were operated to remove foreign bodies in the extremities in 2016. The side of the affected extremity, the material, size, and location of the foreign body and time of admission after injury were noted, along with CRP, WBC, and erythrocyte sedimentation rate; length of incision, surgery duration, and complications were evaluated. Results The mean patient age was 39.66 (range: 6 to 68). Of the total, 8 of the foreign bodies were in the plantar surfaces of the feet, 3 were in the cruris, 2 were in the palm of the hand, and 2 were in the fingers. All patients underwent ultrasound evaluation before surgery. The surgeries lasted less than 10 min in 13 (87%) of the cases and from 10 to 20 min in 2 cases. No complications were observed in any of the patients. Conclusion Delayed extraction of foreign bodies can lead to local infections. Ultrasonography can be a reliable option for diagnosing and localizing radiolucent foreign bodies such as wooden objects. Level of Evidence IV; Case series.

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

scholarly journals A Novel Retensioning Technique for Arthroscopic Repair of PASTA Lesions: A Clinical and Radiologic Outcome Study of 24 Shoulders

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098688
Author(s):  
Su Cheol Kim ◽  
Jong Ho Jung ◽  
Sang Min Lee ◽  
Jae Chul Yoo
Keyword(s):  
Constant Score ◽  
Case Series ◽  
Tendon Healing ◽  
Shoulder Abduction ◽  
Level Of Evidence ◽  
Simple Shoulder Test ◽  
Shoulder Range Of Motion ◽  
Functional Scores ◽  
The Mean

Background: There is no consensus on the ideal treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions without tendon damage. Purpose: To introduce a novel “retensioning technique” for arthroscopic PASTA repair and to assess the clinical and radiologic outcomes of this technique. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed on 24 patients whose PASTA lesion was treated using the retensioning technique between January 2011 and December 2015. The mean ± SD patient age was 57.6 ± 7.0 years (range, 43-71 years), and the mean follow-up period was 57.6 ± 23.4 months (range, 24.0-93.7 months). Sutures were placed at the edge of the PASTA lesion, tensioned, and fixed to lateral-row anchors. After surgery, shoulder range of motion (ROM) and functional scores (visual analog scale [VAS] for pain, VAS for function, American Shoulder and Elbow Surgeons [ASES] score, Constant score, Simple Shoulder Test, and Korean Shoulder Score) were evaluated at regular outpatient visits; at 6 months postoperatively, repair integrity was evaluated using magnetic resonance imaging (MRI). Results: At 12 months postoperatively, all ROM variables were improved compared with preoperative values, and shoulder abduction was improved significantly (136.00° vs 107.08°; P = .009). At final follow-up (>24 months), the VAS pain, VAS function, and ASES scores improved, from 6.39, 4.26, and 40.09 to 1.00, 8.26, and 85.96, respectively (all P < .001). At 6 months postoperatively, 21 of the 24 patients (87.5%) underwent follow-up MRI; the postoperative repair integrity was Sugaya type 1 or 2 for all of these patients, and 13 patients showed complete improvement of the lesion compared with preoperatively. Conclusion: The retensioning technique showed improved ROM and pain and functional scores as well as good tendon healing on MRI scans at 6-month follow-up in the majority of patients. Thus, the retensioning technique appears to be reliable procedure for the PASTA lesion.

scholarly journals Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

2021 ◽  
Author(s):  
Francesco Luceri ◽  
Davide Cucchi ◽  
Enrico Rosagrata ◽  
Carlo Eugenio Zaolino ◽  
Alessandra Menon ◽  
...  
Keyword(s):  
Case Series ◽  
Radiographic Evaluation ◽  
Healthy Population ◽  
X Rays ◽  
The Novel ◽  
Level Of Evidence ◽  
Orthopaedic Surgeons ◽  
Joint Congruency ◽  
Radiological Parameters ◽  
The Mean

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

scholarly journals Foreign Body Reaction Associated With Artificial LARS Ligaments: A Retrieval Study

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881160 ◽  
Author(s):  
Zachary Paul Sinagra ◽  
Alan Kop ◽  
Moreica Pabbruwe ◽  
Jeremy Parry ◽  
Gavin Clark
Keyword(s):  
Foreign Body ◽  
Foreign Body Reaction ◽  
Fibrous Tissue ◽  
Case Series ◽  
Significant Degree ◽  
Level Of Evidence ◽  
Tissue Ingrowth ◽  
Artificial Ligaments ◽  
Clinically Significant ◽  
Improved Design

Background: Artificial ligaments have been developed and used in the treatment of ligamentous injuries since the 1970s. The early generation of artificial ligaments showed promising short-term results but resulted in high rates of rupture and inflammatory reaction in the surrounding tissues. Purpose: To determine whether the use of Ligament Augmentation and Reconstruction System (LARS) ligaments is associated with the development of intra-articular foreign body reaction. Study Design: Case series; Level of evidence, 4. Methods: LARS ligaments were explanted from 15 patients under 6 consultant orthopaedic surgeons at 8 surgical centers. Of these, 14 explanted samples were sent for macroscopic and histological analysis, with the 1 remaining sample sent for scanning electron microscopy, to assess for inflammatory change as well as the degree of fibrous tissue ingrowth. Results: We observed a foreign body reaction in 10 of 14 explanted LARS ligaments. Seven samples demonstrated fibrous tissue ingrowth, with 5 producing only focal or incomplete ingrowth. The 2 samples with extensive fibrous coverage were completely free of any foreign body reaction, while all 5 remaining samples with only focal or partial fibrous ingrowth were associated with at least some degree of harmful immune response. Conclusion: The LARS ligament is still associated with a clinically significant degree of foreign body reaction despite the LARS Company’s efforts to reduce complications through improved design. The development and completion of fibrous tissue ingrowth may work to reduce the occurrence of a foreign body reaction.

scholarly journals Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽  
2017 ◽  
Vol 05 (01) ◽  
pp. 021-026 ◽  
Author(s):  
Cosimo Tudisco ◽  
Salvatore Bisicchia ◽  
Sandro Tormenta ◽  
Amedeo Taglieri ◽  
Ezio Fanucci
Keyword(s):  
Case Series ◽  
Persistent Pain ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Mean Values ◽  
Center Edge ◽  
Patient Groups ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes

2016 ◽  
Vol 45 (2) ◽  
pp. 462-467 ◽  
Author(s):  
Maximiliano Ranalletta ◽  
Luciano A. Rossi ◽  
Hugo Barros ◽  
Francisco Nally ◽  
Ignacio Tanoira ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Closed Reduction ◽  
Functional Outcomes ◽  
Constant Score ◽  
Case Series ◽  
Return To Sport ◽  
Return To Play ◽  
Short Version ◽  
Level Of Evidence ◽  
The Mean

Background: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. Purpose: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. Results: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. Conclusion: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.

scholarly journals Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095914
Author(s):  
Justin C. Kennon ◽  
Erick M. Marigi ◽  
Chad E. Songy ◽  
Chris Bernard ◽  
Shawn W. O’Driscoll ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Ulnar Neuropathy ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Functional Scores ◽  
The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

scholarly journals Clinical and functional outcomes of tarsal coalition resection to correct rigid flat foot

2021 ◽  
Vol 15 (2) ◽  
pp. 115-119
Author(s):  
Rodrigo Guimarães Huyer ◽  
Mário Sérgio Paulillo Cillo ◽  
Carlos Daniel Cândido Castro Filho ◽  
Hallan Douglas Bertelli ◽  
Marcelo Morelli Girondo ◽  
...  
Keyword(s):  
Case Series ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Tarsal Coalition ◽  
Retrospective Case ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Flat Foot ◽  
Flat Feet ◽  
The Mean

Objective: This study used the AOFAS score to assess the clinical functional results of patients who underwent tarsal coalition resection. Methods: This was a retrospective case series of patients who underwent tarsal coalition resection to correct rigid flat foot. Clinical and functional assessment was performed with the AOFAS score before and 6 months after surgical treatment. Descriptive analysis was performed for 7 patients (11 operated feet) using measurements of position and dispersion (mean, standard deviation, minimum, median and maximum value) for continuous variables and frequency tables (absolute and relative) for categorical variables. Results: The mean patient age was 10 years, 7 months, and the majority (71.43%) were male. The most affected joint was the calcaneonavicular. The right side was affected in 54.55% of the cases. The most frequent type of coalition was osseous (81.82% of the cases). The mean pre- and postoperative AOFAS scores were 32.7 and 70.2 points, respectively, which was a significant increase. Conclusion: The increased scores after coalition resection was considered the main change between the two assessments. Thus, it can be concluded that in rigid flat feet without severe hind- or forefoot deformities for which conservative treatment failed, bar resection should be the surgical procedure of choice. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Tracheo-bronchial foreign bodies: our experience at a tertiary care hospital

2016 ◽  
Author(s):  
Shashidhar S. Suligavi ◽  
Mallikarjun N. Patil ◽  
S. S. Doddamani ◽  
Chandrashekarayya S. Hiremath ◽  
Afshan Fathima
Keyword(s):  
Foreign Body ◽  
Early Diagnosis ◽  
Foreign Bodies ◽  
Tertiary Care ◽  
Case Series ◽  
Team Work ◽  
Care Hospital ◽  
Retrospective Case ◽  
Presenting Symptoms ◽  
Case Series Study

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong>Tracheo- bronchial foreign bodies have always posed a challenge to the ENT surgeon as they present with varied symptomatology ranging from a simple cough and fever to more grave respiratory distress. It requires a strong suspicion, early diagnosis and timely intervention to reduce the overall morbidity and mortality .This study was undertaken to highlight our experiences in handling cases of tracheo- bronchial foreign bodies (FB) at our setup.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong>It is a retrospective case series study conducted in S. Nijalingappa Medical College between January 2011 and January 2015.  </p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong>Most commonly affected were children between 1year to 3years of age. Chronic cough and wheeze were the commonest presenting symptoms. Vegetative foreign body was found to be the commonest variety of foreign body. The mortality rate in our study was 4.7% (n=3).</p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong>A good clinical acumen, team work, early diagnosis and timely intervention are all needed to reduce the overall mortality and morbidity associated with tracheo- bronchial foreign bodies.</p>

Recurrence After Arthroscopic Labral Repair for Traumatic Anterior Instability in Adolescent Rugby and Contact Athletes

2018 ◽  
Vol 46 (12) ◽  
pp. 2969-2974 ◽  
Author(s):  
Emma Torrance ◽  
Ciaran J. Clarke ◽  
Puneet Monga ◽  
Lennard Funk ◽  
Michael J. Walton
Keyword(s):  
Recurrence Rate ◽  
Shoulder Instability ◽  
Case Series ◽  
Labral Repair ◽  
Shoulder Injuries ◽  
Adolescent Athletes ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Bony Bankart ◽  
The Mean

Background: Traumatic glenohumeral dislocation of the shoulder is one of the most common shoulder injuries, especially among adolescent athletes. The treatment of instability for young athletes continues to be controversial owing to high recurrence rates. Purpose: To investigate the recurrence rate of shoulder instability after arthroscopic capsulolabral repair for adolescent contact and collision athletes. Study Design: Case series; Level of evidence, 4. Methods: Sixty-seven patients aged <18 years underwent an arthroscopic labral repair over a 5-year period. The mean ± SD age of the cohort was 16.3 ± 0.9 years (range, 14-17 years) and consisted of 1 female and 66 males. All patients were contact athletes, with 62 of 67 playing rugby. Demographic, clinical, and intraoperative data for all patients with shoulder instability were recorded in our database. Recurrence rates were recorded and relative risks calculated. Results: At a follow-up of 33 ± 20 months, 34 of 67 patients had recurrent instability for an overall recurrence rate of 51% among adolescent contact athletes after arthroscopic labral repair surgery. The mean time to recurrence was 68.1 ± 45.3 weeks. All recurrences occurred as a result of a further sporting injury. Relative risk analysis demonstrated that athletes aged <16 years had 2.2 (95% CI, 1.2-2.1) times the risk of developing a further instability episode as compared with athletes aged ≥16 years at the time of index surgery ( P = .0002). The recurrence rate among adolescent athletes after bony Bankart repairs was 57.9% versus 47.9% for soft tissue labral repairs ( P = .4698). The incidence of Hill-Sachs lesions ( P = .0002) and bony Bankart lesions ( P = .009) among adolescent athletes was significantly higher than among adult controls ( P = .002). The presence of bone loss did not lead to a significant increase in recurrence rate over and above the effect of age. Conclusion: Adolescent contact athletes undergoing arthroscopic labral repair have an overall recurrence rate of 51%. Rugby players who undergo primary arthroscopic shoulder stabilization aged <16 years have 2.2 times the risk of developing a further instability episode when compared with athletes aged ≥16 years at the time of index surgery, with a recurrence rate of 93%.

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