COMPARISON OF LCP AND INTRAMEDULLARY NAIL OSTEOSYNTHESIS IN CALCANEAL FRACTURES

ABSTRACT Objective: This study compared groups of patients with calcaneal fractures of Sanders types II and III. One group was treated with ORIF using an LCP (plate), while the second was treated with a minimally invasive method using a C-Nail. Methods: The study included 217 patients in the ORIF group and 19 patients in the minimally invasive nail osteosynthesis group. Results: In the LCP group, the outcomes were excellent for 35.7% of the patients; good, 38.9%; satisfactory, 19.7%; and poor, 5.7%. In the C-Nail group, the outcomes were excellent for 36.9% of the patients; good; 31.6%; satisfactory, 21%; and poor, 10.2%. The mean values of the restoration of Böhler's angle from post-injury were 6.8° to 32.3° in the LCP group and 7.1° to 33.3° in the C-Nail group. After 12 months, there was only a minimal decrease in Böhler's angle to 29.2° in both the LCP and C-Nail groups. Conclusion: The outcomes obtained with C-Nail fixation are statistically identical to those obtained with LCP fixation. We conclude that osteosynthesis with a C-Nail is suitable as the first-choice treatment for Sanders types II and III fractures. Level of evidence IV, retrospective observational study.

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Treatment Of Intra-Articular Calcaneal Fractures Using Sinus Tarsi Approach And Only Screws

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000391 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Christian Urbina ◽

Cristian Olmedo ◽

Fernando Vargas Gallardo ◽

Leonardo Lagos ◽

Felipe Chaparro ◽

...

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Facet Joint ◽

Calcaneal Fractures ◽

Suitable Alternative ◽

Sinus Tarsi ◽

Sinus Tarsi Approach ◽

Joint Reduction ◽

The Mean ◽

Böhler’S Angle

Category: Hindfoot, Trauma Introduction/Purpose: Displaced intra-articular calcaneal fracture have been usually treated with open reduction and internal fixation using extensile lateral approach, however this management has been associated with high rates of soft tissues complications. Minimally invasive approaches might be an alternative to reduce these complications and improve the outcomes. Our aims were to describe the radiological and clinical outcomes of patients with intra-articular calcaneal fractures treated with a minimally invasive surgical technique. To determine if the Böhler’s angle is restored and maintained through the time. To determine the posterior facet joint reduction using CT scan. To report the frequency the soft tissue complications, days of hospitalization after the surgery, and the need of secondary procedures or additional admissions using this technique. Methods: Retrospective review of patients with intra-articular calcaneal fractures treated with sinus tarsi approach and fixation only with screws between January 2014 and July 2016. Twenty fractures in 15 patients were included. The clinical files and imagenology studies were analized. Results: The mean age was 47 years. Eighteen males and 2 females. One open fracture. Ten smoker patients. Two with diabetes mellitus. Ten cases were joint depression fractures and 10 were tongue fractures of the Essex Lopresti classification. Ten cases were Sanders II and 10 Sanders III. The mean Böhler’s angle was 2º preoperative, 22º in the postoperative and 19º at the last follow up. Postoperative posterior facet joint reduction was good o excellent in 19 cases. The mean days of hospitalization was 2.9. Two cases needed hardware removal. One patient had minor soft tissue complications. No patient had major complications. Conclusion: Our experience showed a low soft tissue complications rate, an adequate correction of the posterior facet joint reduction and adecuate correction and maintenance of the Böhler’s angle, few days of hospitalization after the surgery, and no need of secondary surgical procedures due to acute complications. We conclude this is a suitable alternative in order to reduce the soft tissue complications with accurate correction and preservation of the radiological parameters.

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Short-Term Radiographic Outcomes of Calcaneus Fractures Treated With 2-Incision, Minimally Invasive Approach

Foot & Ankle International ◽

10.1177/1071100719853872 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1060-1067

Author(s):

Snow B. Daws ◽

Kaitlin Neary ◽

Gregory Lundeen

Keyword(s):

Minimally Invasive ◽

Sensory Nerve ◽

Case Series ◽

Fracture Reduction ◽

Minimally Invasive Approach ◽

Invasive Treatment ◽

Level Of Evidence ◽

Invasive Approach ◽

Calcaneus Fractures ◽

Böhler’S Angle

Background: The treatment of displaced, intra-articular calcaneus fractures is controversial. The extensile lateral approach has been historically preferred because it provides excellent exposure and visualization for fracture reduction. However, soft tissue complications with this approach can lead to poor outcomes for patients. Recently, there has been an interest in the minimally invasive treatment of calcaneus fractures. The purpose of the present study was to determine the radiographic reduction of displaced, intra-articular calcaneus fractures and the rate of complications using a 2-incision, minimally invasive approach. Methods: A dual-incision, minimally invasive approach with plate and screw fixation was utilized for the treatment of 32 patients with displaced, intra-articular calcaneus fractures. Preoperative and postoperative calcaneal measurements were taken to assess fracture reduction. Additionally, a retrospective chart review was performed to assess for complications. Results: The mean preoperative Bohler’s angle measurement was 12.9 (range, –5 to 36) degrees and the final postoperative Bohler’s angle was 31.7 (range, 16-40) degrees. One patient (3.1%) had postoperative numbness related to the medial incision in the calcaneal branch sensory nerve distribution. Two patients (6.2%) had a wound infection treated with local wound care and oral antibiotics, while 1 patient (3.1%) had a deep infection that required a secondary surgery for irrigation and debridement. Two patients (6.2%) returned to the operating room for removal of symptomatic hardware. Conclusion: Operative fixation of displaced, intra-articular calcaneus fractures treated with a 2-incision, minimally invasive approach resulted in acceptable fracture reduction with a minimal rate of complications. Level of Evidence: Level IV, retrospective case series.

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Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

Foot & Ankle International ◽

10.1177/1071100716666365 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1333-1342 ◽

Cited By ~ 4

Author(s):

Prashant N. Gedam ◽

Faizaan M. Rushnaiwala

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Wound Complication ◽

Reconstruction Technique ◽

Level Of Evidence ◽

Invasive Approach ◽

Perioperative Morbidity ◽

The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

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

Joints ◽

10.1055/s-0037-1601411 ◽

2017 ◽

Vol 05 (01) ◽

pp. 021-026 ◽

Cited By ~ 1

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.

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

The American Journal of Sports Medicine ◽

10.1177/0363546516666816 ◽

2016 ◽

Vol 45 (2) ◽

pp. 462-467 ◽

Cited By ~ 6

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.

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Results and Lessons Learned on Robotic Assisted Kidney Transplantation

BioMed Research International ◽

10.1155/2020/8687907 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Mireia Musquera ◽

Lluis Peri ◽

Tarek Ajami ◽

Ignacio Revuelta ◽

Laura Izquierdo ◽

...

Keyword(s):

Kidney Transplantation ◽

Minimally Invasive ◽

Late Complications ◽

Lessons Learned ◽

Ureteral Stenosis ◽

Robotic Assisted ◽

Conversion To Open Surgery ◽

Invasive Method ◽

The Mean

Introduction. Nowadays, minimally invasive surgery in kidney transplantation is a reality thanks to robotic assistance. In this paper, we describe our experience, how we developed the robotic assisted Kidney transplantation (RAKT) technique, and analyze our results. Material and Methods. This is a retrospective study of all RAKTs performed at our center between July 2015 and March 2020. We describe the donor selection, surgical technique, and analyze the surgical results and complications. A comparison between the first 20 cases and the following ones is performed. Results. During the aforementioned period, 82 living donor RAKTs were performed. The mean age was 47.4±13.4 and 50 (61%) were male. Mean body mass index was 25±4.7 and preemptive in 63.7% of cases. Right kidneys and multiple arteries were seen in 14.6% and 12.2%, respectively. Mean operative and rewarming time was 197±42 and 47±9.6 minutes, respectively. Five cases required conversion to open surgery because of abnormal kidney vascularization. Two patients required embolization for subcapsular and hypogastric artery bleeding without repercussion. Three kidneys were lost, two of them due to acute rejection and one because venous thrombosis. Late complications requiring surgery included one kidney artery stenosis, one ureteral stenosis, two lymphoceles, and three hernia repairs. We noticed a significant reduction in time between the first 20 cases and the following ones from 248.25±38.1 to 189.75±25.3 (p<0.05). With a mean follow-up time of 1.8 years (SD 1.3), the mean creatinine was 1.52 (SD 0.7) and RAKT graft survival was 98%. Conclusions. The robotic approach is an attractive, minimally invasive method for kidney transplantation, yielding good results. Further studies are needed to consider it a standard approach.

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Restoring the Anatomy of Calcaneal Fractures: A Simple Technique With Radiographic Review

Foot & Ankle Specialist ◽

10.1177/1938640016679700 ◽

2016 ◽

Vol 10 (3) ◽

pp. 235-239 ◽

Cited By ~ 2

Author(s):

James M. Cottom ◽

Joseph S. Baker

Keyword(s):

Critical Angle ◽

Simple Technique ◽

Varus Deformity ◽

Mean Difference ◽

Calcaneal Fractures ◽

Articular Fractures ◽

Anatomic Reduction ◽

Surgical Fixation ◽

The Mean ◽

Böhler’S Angle

Displaced, intra-articular fractures of the calcaneus result in gross deformity of the hindfoot, which must be reduced during surgical fixation. Described techniques aimed at restoring the normal anatomy of the calcaneus have mostly been focused on percutaneous methods, which are not without complication. Described in this report is a method of anatomic reduction during open reduction and internal fixation of these injuries, which uses a lamina spreader to simultaneously reduce calcaneal varus, restore calcaneal height, reduce the subtalar joint, and restore normal calcaneal width. Additionally, 6 patients with 7 calcaneal fractures were identified that underwent this technique, and radiographic review was performed. Varus deformity of the calcaneus was measured as 93.8 ± 4.3° (range 88.1° to 100.5°) preoperatively and 83.3 ± 3.7° (range 77.8° to 89.4°) postoperatively, with a mean difference of 10.9 ± 5.6° (range 1.3° to 17.3°; P = .0564). Bohler’s angle was measured as 16.5 ± 16.9° (range −7.5° to 37.9°) preoperatively and 33.3 ± 12.5° (range 20.5° to 54.5°) postoperatively, the mean difference being 16.7 ± 15.0° (range 0.4° to 39.9°; P = .0288). Critical angle of Gissane was measured as 108.8 ± 14.0° (range 93.1° to 132.4°) preoperatively and 123.3 ± 6.6° (range 113.9° to 134.4°) postoperatively, with a mean difference of 16.2 ± 9.1° (range 5.8° to 29.7°; P = .0004). Levels of Evidence: Level IV: Retrospective

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Surgical Treatment of Calcaneal Fractures with Use of β-Tricalcium Phosphate Ceramic Grafting

Foot & Ankle International ◽

10.3113/fai.2008.1015 ◽

2008 ◽

Vol 29 (10) ◽

pp. 1015-1019 ◽

Cited By ~ 24

Author(s):

Sheng-Dan Jiang ◽

Lei-Sheng Jiang ◽

Li-Yang Dai

Keyword(s):

Surgical Treatment ◽

Internal Fixation ◽

Tricalcium Phosphate ◽

Open Reduction ◽

Clinical Results ◽

Statistical Correlation ◽

Calcaneal Fractures ◽

Retrospective Case ◽

Level Of Evidence ◽

The Mean

Background: The treatment of calcaneal fractures is challenging. Internal fixation and grafting with sintered β-tricalcium phosphate (β-TCP) ceramic is alternative to bone grafting in the treatment of calcaneal fractures. Methods: Seventy-four patients with intraarticular calcaneal fractures were treated with open reduction, internal fixation and grafting with sintered β-TCP ceramic. Followup was performed using the Maryland foot score as well as plain radiography. Results: All patients were followed for 15 (range, 12 to 26) months. Clinical results as assessed by the Maryland foot score were excellent in 40 of 74 cases (54.1%), good in 28 (37.8%), and fair in 6 (8.1%). Immediately after surgery, the mean Böhler angle was improved by 23 degrees, and 1 year after surgery, the mean Böhler angle decreased by 4 degrees. A similar change was also seen in Gissane angles and the height and width of the calcaneus. There was no statistical correlation between the severity of fracture and functional outcome in this series. All fractures healed. Conclusion: These findings suggest that use of β-TCP combined with open reduction and internal fixation is an effective and safe method for the surgical treatment of intra-articular calcaneal fractures. Level of Evidence: IV, Retrospective Case Study

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Minimally invasive cartilage myringoplasty: our technique and experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192557 ◽

2019 ◽

Vol 5 (4) ◽

pp. 866

Author(s):

Venkatesh C. Ballal ◽

Lohith Shivappa ◽

Subramanya B. Tmmappaiah ◽

Sphoorthi Basavannaiah ◽

Chandralekha T. V. Rangaswamy

Keyword(s):

Minimally Invasive ◽

Tympanic Membrane ◽

Tympanic Membrane Perforation ◽

Common Procedure ◽

Suppurative Otitis Media ◽

Tympanic Membrane Perforations ◽

Fascia Graft ◽

First Choice ◽

Important Health ◽

The Mean

Background: Chronic suppurative otitis media is an inflammatory process in the middle ear and is an important health problem in India. Myringoplasty is the most common procedure performed that aims to close the tympanic membrane perforation which is traditionally done with temporalis fascia graft under microscope. Recent studies using the transcanal cartilage “push-through” technique of myringoplasty have demonstrated that it to be very feasible and effective. The aims and objectives of the study was to analyze the results of endoscopic transcanal ‘push-through’ myringoplasty in dry small central perforations in cases of inactive mucosal type of chronic ottitis media.Methods: This retrospective study was conducted in 16 patients who underwent transcanal endoscopic cartilage ‘push through’ myringoplasty and patients were called for regular follow up for 12 weeks and results were statistically analysed. Results: A total of 16 cases were included in the present study. The graft uptake rate in the present study was found to be 93.75%. The mean preoperative air bone gap was 21.76 dB and the mean postoperative air bone gap was reduced to 12.6 dB. The air bone gap was 10 dB or less in 37.5% ears.Conclusions: Endoscopic push-through technique of cartilage myringoplasty is an effective, minimally invasive and feasible method and has good success rate in terms of graft uptake as well as hearing gain. It may also represent a first choice approach for small and medium sized tympanic membrane perforations.

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Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) of the Fifth Metatarsal for Bunionette Correction

Foot & Ankle International ◽

10.1177/1071100717745536 ◽

2018 ◽

Vol 39 (4) ◽

pp. 450-457 ◽

Cited By ~ 5

Author(s):

Kar Hao Teoh ◽

Kartik Hariharan

Keyword(s):

Minimally Invasive ◽

Callus Formation ◽

Case Series ◽

Clinical Results ◽

Osteotomy Site ◽

Retrospective Case ◽

Level Of Evidence ◽

Average Improvement ◽

The Mean

Background: Different osteotomies have been proposed for the treatment of bunionette deformity. Minimally invasive surgery is now increasingly popular for a variety of forefoot conditions. The aim of this study was to evaluate the outcome following fifth minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for bunionette deformity. Methods: Nineteen patients (21 feet) who had symptomatic bunionette deformity and failed conservative treatment between 2014 and 2016 were included in this retrospective study. Clinical data were recorded, and pre- and postoperative Manchester-Oxford Foot Questionnaire (MOXFQ) scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 28 months (range, 12-47). Results: The mean MOXFQ summary index score decreased from 71 (range, 59-81) preoperatively to 10 (range, 0-30) postoperatively. All 3 MOXFQ domains also improved. The average improvement in VAS score was 7. Forefoot swelling and some painful symptoms took an average of 3 months to settle. There were no wound or nerve complications. One patient required a dorsal cheilectomy for a symptomatic prominent dorsolateral callus formation. Conclusion: The minimally invasive fifth DMMO for bunionette deformity was a safe and effective technique. It had relatively few complications and led to good clinical results. We believe it is important to warn patients that the forefoot swelling will take months to settle compared to an osteotomy with fixation, and there is a 10% chance of a prominent callus over the osteotomy site. Level of Evidence: Level IV, retrospective case series.

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