scholarly journals PRELIMINARY RESULTS OF THE BIPOLAR TECHNIQUE IN THE TREATMENT OF NEUROMUSCULAR SCOLIOSIS

2021 ◽  
Vol 20 (3) ◽  
pp. 169-173
Author(s):  
ROBSON CRUZ DE OLIVEIRA ◽  
HELTON LUIZ APARECIDO DEFINO ◽  
HERTON RODRIGO TAVARES COSTA
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Neuromuscular Scoliosis ◽  
Level Of Evidence ◽  
Genetic Syndrome ◽  
Preliminary Results ◽  
Spine Deformities ◽  
Clinical And Radiological Results ◽  
Operation Results ◽  
Main Curve

ABSTRACT Objective To present the preliminary results of the bipolar technique for the surgical treatment of neuromuscular spine deformities. Methods Five patients with neuromuscular scoliosis (cerebral palsy – 3 patients, spinal amyotrophy – 1 patient, and genetic syndrome – 1 patient) underwent surgical treatment using the bipolar technique and were evaluated 12 months after the operation. Results General care and the ability to sit improved in all patients. The main curve ranged from 64.7 to 84.1 degrees (mean 70.58 ± 7.1) in the preoperative period and from 2.6 to 50.3 degrees (mean 25.50 ± 16.0) in the postoperative period with 64% correction. Corrections of pelvic obliquity (85%), T4-T12 kyphosis (43%), the Pisa angle (69%) and the sacroclavicular angle (60%) were observed 12 months following surgery. Postoperative infection (2 patients) and pneumonia (1 patient) were the complications observed. Conclusion The bipolar technique presented good clinical and radiological results associated with low morbidity in the treatment of neuromuscular spine deformities. Level of evidence IV; Case series.

scholarly journals EVALUATION OF THE VEPTR SYSTEM IN THE MANAGEMENT OF SPINAL DEFORMITIES BETWEEN 2008 AND 2014 AT THE ROOSEVELT INSTITUTE

2018 ◽  
Vol 17 (4) ◽  
pp. 266-269
Author(s):  
Carlos Segundo Montero ◽  
David Meneses ◽  
Fernando Alvarado ◽  
Wilmer Godoy ◽  
Maria Margarita Acosta ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Early Onset ◽  
Case Series ◽  
Deformity Correction ◽  
Congenital Scoliosis ◽  
Neuromuscular Scoliosis ◽  
Three Dimensions ◽  
Thoracic Wall ◽  
Level Of Evidence ◽  
Radiographic Images

ABSTRACT Objective: Traditional surgical treatments, such as on-site fusion and hemiepiphysiodesis, have not addressed chest deformity in its three dimensions, and are usually insufficient and unpredictable for the management of congenital and neuromuscular scoliosis. The application of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a technique developed to treat early-onset progressive scoliosis that elongates the spine and thoracic wall, allowing adequate lung development. Methods: A case series retrospective study was conducted. We included 23 patients, including fifteen females and eight males diagnosed with congenital and neuromuscular scoliosis, who were treated with VEPTR type implants between January 2008 and May 2014. We obtained data about the implant and pre and postoperative radiographic images to assess the magnitude of the curve, and we measured the Cobb angle and length after lengthening, as well as evaluating the complications found. Results: There was an improvement in the postoperative Cobb angle. In patients with congenital scoliosis, deformity correction was 8.6% (p=0.014), and in neuromuscular scoliosis, we observed deformity correction of 19.5% (p=0.009). Likewise, we found gains in thoracic height through the device, which results in an average 10% lengthening of the spine in congenital scoliosis. In this study, we identified complications such as material migrations, rib synostosis, pressure zones, rib fracture, hemothorax, and deep wound infection. Conclusion: The natural history of progressive spinal deformity was improved in most of the minors, through the use of VEPTR. This allows us to continue managing patients in the future, in order to make a deeper assessment of its performance in treatment of early onset scoliosis. Level of Evidence III; Therapeutic studies - Investigating the results of a treatment.

scholarly journals Fixation of Traumatic Chondral-Only Fragments of the Knee in Pediatric and Adolescent Athletes: A Retrospective Multicenter Report

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711775314 ◽  
Author(s):  
Peter D. Fabricant ◽  
Yi-Meng Yen ◽  
Dennis E. Kramer ◽  
Mininder S. Kocher ◽  
Lyle J. Micheli ◽  
...  
Keyword(s):  
Case Reports ◽  
Femoral Condyle ◽  
Tertiary Care ◽  
Case Series ◽  
Return To Sports ◽  
Adolescent Athletes ◽  
Patient Registries ◽  
Level Of Evidence ◽  
Bioabsorbable Implants ◽  
Clinical And Radiological Results

Background: While traditional biological principles have suggested that fragments consisting of cartilage alone cannot be reaffixed to bone with expectable long-term healing, case reports of successful healing after fixation in younger patients indicate that this concept remains incompletely explored. Purpose: To evaluate the presenting features, techniques, healing rates, and clinical and radiological results in a cohort of pediatric and adolescent athletes who underwent fixation of traumatic chondral-only fragments in the knee. Study Design: Case series; Level of evidence, 4. Methods: Patient registries at 2 tertiary care children’s hospitals were reviewed to identify patients ≤18 years old who underwent fixation of a “chondral-only” fragment in the knee, defined as the inability to visualize the fragment on injury radiographs or discern bone on the articular portion of a fragment intraoperatively. The mechanism of injury, fragment features, fixation technique, and postoperative clinical course, including timing of sports clearance, healing on postoperative magnetic resonance imaging (MRI), and any complications or reoperations, were assessed. Results: Fifteen patients with a median age at surgery of 12.7 years (interquartile range [IQR], 11.7-14.2 years) and median follow-up of 12.0 months (IQR, 6.0-19.2 months) were analyzed. All patients sustained an acute knee injury before surgery. The injured sites, as assessed on MRI, were the patella (n = 6), trochlea (n = 5), and lateral femoral condyle (n = 4). The median fragment surface area was 492.0 mm2 (IQR, 400.0-787.5 mm2). Fixation with bioabsorbable implants was performed in all patients at a median of 1.6 weeks (IQR, 1.0-2.6 weeks) after the injury. One patient (7%) sustained a fall 8 weeks postoperatively, requiring secondary surgery for excision of a dislodged fragment, and 1 patient (7%) underwent unrelated patellar stabilization surgery 3.4 years postoperatively, at which time the fragment was found to be stable. MRI was performed in 9 of 14 patients with retained fragments (median, 12.0 months postoperatively), with 5 patients (56%) showing restoration of the cartilage contour and the resolution of subchondral edema; 2 patients showed thinning but intact cartilage, 1 had cartilage thickening, and 1 had subchondral edema, fissuring, and cystic changes. The median time to return to sports for all 15 patients was 26.0 weeks (IQR, 22.8-40.9 weeks), including 2 patients who required second surgery and returned to sports at 26.1 and 191.1 weeks. Conclusion: Fixation of traumatic chondral-only fragments using bioabsorbable implants may result in successful short-term healing in the majority of pediatric and adolescent athletes.

Mini-Invasive Surgery for Distal Radius Fractures: A Double Incision under 12 mm

2020 ◽  
Author(s):  
Elisabete Ribeiro ◽  
Gustavo Campanholi ◽  
Marcelo Acherboim ◽  
Gustavo Mantovani Ruggiero
Keyword(s):  
Distal Radius ◽  
Surgical Techniques ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Radiological Results ◽  
Normal Ranges ◽  
Case Series Study ◽  
Clinical And Radiological Results

Abstract Background Distal radius fracture is one of the most common lesions in adults. Surgical techniques have evolved considerably with a clear tendency toward mini-invasive techniques. Objective Our aim is to push the limits to a 12 mm approach and evaluate its clinical and radiological results. Patients and Methods Ten fractures in nine patients were operated by a double incision with mean size 11.50 ± 3.41 mm (range 8.00–1.00) and using a specially designed volar distal locking plate. Results At the latest follow-up, visual analogue scale score for pain (0.20 ± 0.63 during rest and 0.60 ± 1.07 while making efforts) and quick DASH (quick Disabilities of the Arm, Shoulder and Hand) score (6.14 ± 7.43) were extremely low. All the range of motion parameters and grip strength were above the 95% barrier of the contralateral side, with exception of ulnar deviation. Radiological parameters obtained were located within the normal ranges. Time to return to independent daily tasks and work was 6.67 ± 5.15 and 10.14 ± 14.24 days, respectively. One case of transient carpal tunnel syndrome was solved with watchful waiting and one case of extensor tendons impingement was improved after plate removal. All patients were completely satisfied at the end of the treatment. Conclusion In conclusion, mini-invasive volar technique for distal radius fractures with special designed plates in carefully selected patients allowed us to obtain good clinical and radiological results, minimal complications, fast recovery, and high-satisfactory rates. Level of Evidence This is a Level IV, case series study.

scholarly journals Radiographic assessment of AO 44-B1 and -B2 ankle fractures

2021 ◽  
Vol 15 (1) ◽  
pp. 31-36
Author(s):  
Pedro Labronici ◽  
Fabricio Fogagnolo ◽  
William Belangero ◽  
Luiz Amorim
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
The Other ◽  
Ankle Fractures ◽  
Radiographic Assessment ◽  
Level Of Evidence ◽  
Radiographic Images ◽  
Other Hand ◽  
Lower Frequencies

Objective: To verify if there is a type of image that guides the surgeon in recommending surgical treatment for ankle fractures and assess whether this decision is associated with the evaluator’s age and experience, considering surgeons of different nationalities. Methods: We analyzed 3 different presentations of radiographic images of ankle fractures in 36 patients: anteroposterior and lateral views, true anteroposterior and lateral views, as well as the 3 grouped images. Images were assessed randomly and independently by 89 professionals of different nationalities, ages, and experience. Results: Among professionals from Ecuador, Argentina, Mexico, and Chile, surgery recommendations were more frequent when images were presented in true anteroposterior and lateral views. For professionals from Peru, Venezuela, Bolivia, Paraguay, Brazil, Colombia, Uruguay, and Guatemala, as well as globally, recommendations for surgery were more frequent when grouped images of the 3 positions were presented. In all countries and globally, we verified lower frequencies of surgery recommendations when presenting only anteroposterior and lateral views. Conclusion: In most countries, surgery recommendations were more frequent when grouped images of all 3 views were presented. On the other hand, the highest frequencies of surgery recommendations were observed when images were presented only in true anteroposterior and lateral views. Surgery recommendations were not associated with the experience (years since graduation) of the evaluating physician. Level of Evidence IV; Prognostic Studies; Case Series.

scholarly journals RESULTS OF TREATMENT OF PLICA SYNDROME OF THE KNEE

2021 ◽  
Vol 29 (2) ◽  
pp. 72-75
Author(s):  
GILBERTO LUIS CAMANHO ◽  
RICCARDO GOMES GOBBI ◽  
MARTA HALASZ DE ANDRADE
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Rehabilitation Program ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Results Of Treatment ◽  
Rehabilitation Period ◽  
Plica Syndrome ◽  
Synovial Fold ◽  
Non Surgical Treatment

ABSTRACT Objective: The synovial fold is an intra-articular structure found in more than 50% of the knees, which can cause symptoms similar to meniscal injuries. These symptoms are mostly related to hypertrophy of the synovial fold resulting from inadequate physical activity. Conservative treatment with readjustment of sports activity and muscle rebalancing solves most cases. Rare cases require surgical treatment, which is indicated due to the persistence of instability, blockage and pain. We present our experience in the treatment of this pathology. Methods: 58 patients (70 knees), with 62 knees treated conservatively and 8 treated surgically exclusively for the pathological synovial fold. Results: Description of the series and treatment results are reported. Conclusion: The non-surgical treatment of the pathological synovial fold of the knee provided good results within 60 days of rehabilitation program in almost 90% of the patients. Arthroscopic resection of the synovial fold is a surgery that has a longer and laborious rehabilitation period, despite good results in most cases. Level of Evidence IV, Case series.

scholarly journals LUMBAR SPINAL STENOSIS: EVALUATION OF PAIN AND LIFE QUALITY AFTER SURGICAL TREATMENT

2019 ◽  
Vol 18 (1) ◽  
pp. 37-42
Author(s):  
Gustavo Alvarenga ◽  
João Otávio Araújo Rotini ◽  
Leonardo Yukio Jorge Asano ◽  
Vinícius Alves de Andrade ◽  
André Evaristo Marcondes Cesar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Life Quality ◽  
Case Series ◽  
Level Of Evidence ◽  
The Mean ◽  
One Year ◽  
Lumbar Spinal

ABSTRACT Objective: The objective of this study was to present an analysis of progression of the quality of life and pain in patients undergoing surgical treatment of LSS and the potential correlations between individual factors and the clinical outcome observed. Methods: We studied 111 patients undergoing surgical treatment of LSS from January 2009 to December 2011 using the functional capacity (ODI) and pain (VAS) questionnaires. The preoperative data were compared statistically with the results obtained during the postoperative follow-up at one month, six months, one year, and two years. Results: The population consisted of 60 men and 51 women. The mean age was 61.16 years at the time of surgery, 33.33% were 60 years or older. When the questionnaires were applied, we found improvement in the progressive disability assessment with a mean drop of 23.65 ODI points after 6 months of the surgical treatment and 27.47 at the end of one year of surgery compared to preoperative for this scale. There was a decline of 3.84 points (mean) in the VAS at first postoperative month. Conclusion: Surgical treatment of LSS presented favorable postoperative evolution in a 2-year follow-up regarding pain and quality of life through VAS and ODI. Level of Evidence IV; Case series.

scholarly journals Interprosthetic Femoral Fractures Surgical Treatment in Geriatric Patients

2021 ◽  
Vol 12 ◽  
pp. 215145932110137
Author(s):  
Marios Loucas ◽  
Rafael Loucas ◽  
Nico Safa Akhavan ◽  
Patrick Fries ◽  
Michael Dietrich
Keyword(s):  
Surgical Treatment ◽  
Geriatric Patients ◽  
Standard Procedure ◽  
Weight Bearing ◽  
Case Series ◽  
Femoral Fractures ◽  
Full Weight Bearing ◽  
Level Of Evidence ◽  
Type Iv ◽  
Case Series Study

Background: Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods: A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results: We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion: Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence: Level III, Therapeutic study.

scholarly journals TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT

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.

scholarly journals Surgical treatment of hallux valgus using a modified Reverdin-Isham technique

2021 ◽  
Vol 15 (1) ◽  
pp. 49-53
Author(s):  
Luiz Lara ◽  
Lúcio Torres Filho ◽  
Gabriel Cervone ◽  
Juan Grajales ◽  
Glaucia Bordignon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Head ◽  
Level Of Evidence ◽  
Valgus Angle ◽  
Significant Correction ◽  
The Mean ◽  
American Orthopaedic

Objective: To evaluate the postoperative results of patients who underwent surgical treatment of hallux valgus with a modified Reverdin-Isham (RI) technique and to compare the achieved correction with that reported by studies using the original technique. Methods: This is a retrospective study with patients with mild to moderate hallux valgus who underwent surgery from June 2010 to July 2019. All patients were operated using the modified RI technique. Data were collected through the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire, in addition to pre and postoperative radiographic studies of the intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA). Results: The mean postoperative follow-up was 30.1 months, and the mean age of patients was 56.4 years. The median AOFAS score in the postoperative period was increased by 56 points. The mean HVA was reduced in 16.5°, the mean IMA was reduced in 4.3°, and the mean DMAA was reduced in 10°. There were no cases of displacement or deviation of the first metatarsal head during the postoperative follow-up. Conclusion: The modified RI technique provided considerable stability to the osteotomy, in addition to a significant correction of the measured angles and an improvement in AOFAS scores, demonstrating itself as an effective technique for correcting mild to moderate hallux valgus. Level of Evidence IV, Therapeutic Studies, Case Series.

scholarly journals SURGICAL TREATMENT OF FRACTURES OF THE ANKYLOSED SPINE

2020 ◽  
Vol 19 (1) ◽  
pp. 74-79
Author(s):  
MARTA ALEXANDRA CERQUEIRA SILVA ◽  
DANIELA VILAS BOAS ROSA LINHARES ◽  
JOÃO DUARTE MAGALHÃES COSTA E SILVA ◽  
MANUEL EDUARDO DA CRUZ RIBEIRO DA SILVA ◽  
NUNO SILVA DE MORAIS NEVES
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Vertebral Fracture ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Case Series ◽  
Neurological Status ◽  
Hospital Length Of Stay ◽  
Minor Trauma ◽  
Level Of Evidence ◽  
Surgical Interventions

ABSTRACT Objective We aim to identify retrospectively surgically treated patients with an ankylosed spine who sustained a vertebral fracture. Our goal is to evaluate the main outcomes and complications. Methods We selected patients through the database of surgical interventions in the setting of fractures of an ankylosed spine segment between January 1st 2008 and June 30th 2018. We collected data from digital medical records. The parameters analyzed include hospital length of stay, Intensive Care Unit (ICU) admission, perioperative and postoperative complications as well as neurological evolution. Results Fractures occurred in 14 patients with ankylosing spondylitis (82%) and 3 patients with diffuse idiopathic skeletal hyperostosis (18%). All patients were male and the mean age was 69 years. Fourteen fractures occurred after minor trauma (83%), of which 11 were due to falls from standing height or lower (65%). The cervical spine represents the majority of the levels involved (65%). Seven patients were admitted to the ICU (41%) and 11 suffered neurological damage. There was improvement of neurological status in less than 50% and there were high percentages of post-operative complications. Conclusion Patients with ankylosed spine diseases are at higher risk for vertebral fracture, even after minor trauma, and these are located predominantly in the cervical spine. The surgical treatment of these conditions is effective as it allows improvement of the patient’s neurological status. However, they still present higher morbidity and mortality, as well as increased post-op complications. Prevention of falls may drastically change patients’ outcome, neurological function and independence in activities of daily living. Level of evidence IV; A case series therapeutic study.

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