scholarly journals First metatarsal elevation after subtalar arthroeresis in children with flatfeet

2021 ◽  
Vol 9 (3) ◽  
pp. 297-306
Author(s):  
Andrey V. Sapogovskiy ◽  
Aleksey E. Boyko ◽  
Aleksey V. Rubtsov ◽  
Nataliya O. Rubtsova
Keyword(s):  
Surgical Treatment ◽  
Subtalar Joint ◽  
Clinical Manifestations ◽  
Deformity Correction ◽  
Metatarsal Bone ◽  
First Metatarsal ◽  
Flat Feet ◽  
Foot Arch ◽  
Locking Screw

BACKGROUND: Arthroereisis of the subtalar joint is a common surgical option for children with flat feet. Along with all the advantages of arthroereisis of the subtalar joint, the indications for surgery, the optimal age for surgical treatment, as well as secondary deformities of the forefoot that occur after treatment are debatable. AIM: The aim of this study was to analyze the frequency and degree of I metatarsal elevation after arthroereisis of the subtalar joint in children. MATERIALS AND METHODS: The study group included 106 patients / 202 feet who were treated at the H. Turner Pediatric Orthopedic Institute for the period from 2015 to 2019. The average age was 11 years (8; 13). Arthroereisis of the subtalar joint was performed in two variants: arthroereisis with a locking screw in the calcaneus 44 patients / 83 feet and arthroereisis with a locking screw in the talus 62 patients / 119 feet. An analysis was made of the incidence of I metatarsal elevation after arthroereisis of the subtalar joint. The relationship between the degree of elevation of the first metatarsal bone and the main clinical and radiological characteristics of the feet at different times after surgical treatment was analyzed. RESULTS: The frequency of elevation of the I metatarsal bone with the use of a calcaneal locking screw was 20.7%, and with the use of a talar locking screw, the frequency is 51.6%. Clinical manifestations of elevation of the I metatarsal bone took place when the amount of elevation was more than 65% of the size of the head of the I metatarsal bone. At a period of 23 years after the operation, elevation of the I metatarsal bone were noted in 15.9%. A statistically significant correlation (Spearman coefficient) was noted between the degree of elevation of the I metatarsal bone and the following parameters: anteroposterior Meary angle (0.360), lateral Kite angle (0.367), lateral Meary angle (0.378), foot arch angle (0.344), tibio-talar angle (0.351), Friedlands index (0.402). CONCLUSIONS: Incidence of the first metatarsal bone elevation reaches 51% of the in patients in the immediate follow-up period after performing arthroereisis of the subtalar joint. Elevation of the first metatarsal bone developed dorsal bunion with an elevation value of more than 65%. The degree of elevation of the first metatarsal bone has a positive correlation with the degree of planovalgus deformity correction. Elevation of the first metatarsal bone tends to decrease up to 15% in the long-term follow-up after surgical treatment.

scholarly journals The substantiation of chronic pancreatitis surgical treatment method selection

2007 ◽  
Vol 6 (3) ◽  
pp. 43-50
Author(s):  
V. A. Koubyshkin ◽  
I. A. Kozlov ◽  
N. I. Yashina ◽  
T. V. Shevchenko
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Gastric Resection ◽  
Clinical Manifestations ◽  
Pancreatic Head ◽  
Pain Syndrome ◽  
Treatment Method ◽  
Pancreas Head ◽  
Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

scholarly journals Alveolar Echinococcosis in Children

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Emilija Jonaitytė ◽  
Martynas Judickas ◽  
Eglė Tamulevičienė ◽  
Milda Šeškutė
Keyword(s):  
Surgical Treatment ◽  
Current Literature ◽  
Echinococcus Multilocularis ◽  
Cystic Echinococcosis ◽  
Alveolar Echinococcosis ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Diagnostic Methods

Alveolar echinococcosis (AE) is an infectious zoonotic disease that is caused by Echinococcus multilocularis. The disease is generally identified accidentally because of the long asymptomatic period, has a malignant behaviour, and mainly occurs in the liver. Usually it is diagnosed in adults and is very rare in pediatric patients. We report two cases of AE and 1 differential case between AE and cystic echinococcosis (CE) in children: two of them had lesions in the liver and one had rare extrahepatic presentation of a cyst in the spleen. All our patients received chemotherapy with albendazole because surgical treatment was not recommended. The children were followed-up from 10 to 30 months and no significant improvement was seen. In this report we discuss the difficulties we faced in the treatment and follow-up of these patients. We also review the main clinical manifestations, general diagnostic methods, and treatment options of AE according to the current literature.

scholarly journals THE USE OF NITINOL RODS IN SURGICAL TREATMENT OF DEGENERATIVE SCOLIOSIS. 2.5-YEAR FOLLOW-UP

2016 ◽  
Vol 15 (1) ◽  
pp. 22-25
Author(s):  
Natalia Sergeyevna Morozova ◽  
Dmitriy Aleksandrovich Kolbovsky ◽  
Arkadiy Ivanovich Kazmin ◽  
Sergey Vasilievich Kolesov
Keyword(s):  
Surgical Treatment ◽  
Interbody Fusion ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Control Group ◽  
Rigid Fixation ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbosacral Region ◽  
Pedicle Fixation

ABSTRACT Objectives: To compare the outcomes of surgical treatment with lumbar fixation using nitinol rods without fusion and with standard lumbar fixation with titanium rods and interbody fusion. Methods: Treatment results of 70 patients with degenerative lumbar scoliosis aged 40 to 82 were analyzed. In all cases pedicle screws and nitinol rods with a diameter of 5.5 mm were used. Thirty patients underwent fixation at L1-S1 and 40 patients underwent fixation at L1-L5. Spinal fusion was not performed. All patients had radiography, CT and MRI performed. The results were assessed according to the Oswestry scale, SRS 22, SF 36 and VAS. The minimum follow-up period for all patients was 2.5 years. For the control group, consisting of 72 patients, pedicle fixation with titanium rods and interbody fusion in the lumbosacral region were performed. Results: The average level of deformity correction equaled 25° (10° - 38°). The analysis of X-ray and CT-scans revealed a single patient with implant instability, two patients with bone resorption around the screws and one patient with rod fractures. Functional radiography 2.5 years after surgery showed an average mobility of the lumbar spine of 21° (15° - 30°). There were no problems at the adjacent levels. Conclusions: The use of nitinol rods in spinal deformity surgery is promising. This technology is an alternative to rigid fixation. Continued gathering of clinical data and its further evaluation is necessary.

Snowboarder's Talus Fracture

2005 ◽  
Vol 33 (6) ◽  
pp. 871-880 ◽  
Author(s):  
Victor Valderrabano ◽  
Thomas Perren ◽  
Christian Ryf ◽  
Paavo Rillmann ◽  
Beat Hintermann
Keyword(s):  
Surgical Treatment ◽  
Subtalar Joint ◽  
External Rotation ◽  
Sport Activity ◽  
Treatment Algorithm ◽  
Activity Level ◽  
Talus Fracture ◽  
Level Of Evidence ◽  
Lateral Process

Background Fracture of the lateral process of the talus is a typical snowboarding injury. Basic data are limited, particularly with respect to treatment and outcome. Hypothesis As the axial-loaded dorsiflexed foot becomes externally rotated and/or everted, fracture of the lateral process of the talus occurs. Primary surgical treatment may improve the outcome of this injury, reducing the risk of secondary subtalar joint osteoarthritis. Study Design Cohort study; Level of evidence, 2. Methods We recorded details of the treatment and evaluation of 20 patients (8 female and 12 male; age at trauma, 29 years [range, 17-48 years]) who sustained a lateral process of the talus fracture while snowboarding. The injury pathomechanism was documented. The patients were treated either nonsurgically or surgically based on a fracture-type treatment algorithm. The evaluation at most recent follow-up (mean, 42 months [range, 26-53 months]) included clinical and functional examination, follow-up of sport activity, and radiological assessment (radiograph, computed tomography scan). Results The injury mechanism included axial impact (100%), dorsiflexion (95%), external rotation (80%), and eversion (45%). Using the American Orthopaedic Foot and Ankle Society hindfoot score, the patients obtained a mean of 93 points; the surgically treated group (n = 14) scored higher (97 points) than did the nonoperative group (n = 6; 85 points) (P <. 05). Degenerative disease of the subtalar joint was found in 3 patients (15%; operative, 1 patient; nonoperative, 2 patients). All but 4 (20%, all after nonsurgical treatment) patients reached the same sport activity level as before injury. Conclusion The snowboarding-related lateral process of the talus fracture represents a complex hindfoot injury. In type II fractures, primary surgical treatment has led to achieving better outcomes, reducing sequelae, and allowing patients to regain the same sports activity level as before injury.

Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report

2013 ◽  
Vol 3 (1) ◽  
pp. 20-24
Author(s):  
James K DeOrio ◽  
James A Nunley ◽  
Constantine A Demetracopoulos
Keyword(s):  
Surgical Treatment ◽  
Preliminary Report ◽  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Resection Group ◽  
First Metatarsal ◽  
Posterior Tibial ◽  
Metatarsal Angle

ABSTRACT Background Posterior tibial tendon insufficiency plays a large role in the pathogenesis of adult acquired flatfoot deformity (AAFD) in select patients. Transfer of the flexor digitorum longus is indicated to compensate for the loss of posterior tibial tendon function; however the role of resection of the degenerated posterior tibial tendon remains unclear. The aim of this study was to determine the effect of posterior tibial tendon resection on pain relief following surgical treatment of stage II AAFD. Methods All patients who underwent surgical treatment for stage II AAFD and posterior tibial tendon insufficiency were retrospectively reviewed. Patients were divided into two groups based on whether the degenerated posterior tibial tendon was resected or left in situ. Twenty-seven patients with a mean follow-up of 13.3 months were included in the study. A visual analog scale (VAS) score for pain was recorded for each patient pre-operatively and at final follow-up. Concomitant surgical procedures and the incidence of postoperative medial arch pain were also reported. Preoperative deformity and postoperative deformity correction were assessed by measuring the anteroposterior talar-first metatarsal angle, the talonavicular (TN) coverage angle, the lateral talar-first metatarsal angle, and the calcaneal pitch onstandard weight bearing radiographs. Results Eleven patients underwent FDL transfer and resection of the posterior tibial tendon (PTT resection group), and 16 patients underwent FDL transfer without resection of the posterior tibial tendon (PTT in situ group). A greater percentage of patients in the PTT resection group underwent lateral column lengthening (100 vs 18.8%, p < 0.001), and a greater percentage of patients in the PTT in situ group had a medial displacement calcaneal osteotomy performed (93.8 vs 18.2%, p < 0.001). There was no difference in preoperative VAS pain scores between groups, and all patients demonstrated excellent pain relief postoperatively. No patient in either group reported medial arch pain postoperatively. Radiographic assessment revealed similar deformity preoperatively in both groups, and patients in the PTT resection group demonstrated a greater correction of the TN coverage angle (9.8 ± 4.6 vs 6.0 ± 4.1 degrees, p = 0.041). Conclusion Resection of the PTT did not significantly affect postoperative VAS scores at final follow-up. It did however, correlate with a slightly greater correction of the TN coverage angle. There were no instances of pain along the medial ankle or medial arch of the foot in either group postoperatively. Future prospective studies are needed to determine whether resection of the PTT is necessary at the time of surgery for stage II AAFD. Demetracopoulos CA, DeOrio JK, Nunley JA II. Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report. The Duke Orthop J 2013;3(1):20-24.

Surgical Treatment for First Metatarsal Joint Deforming Osteoarthrosis of Various Etiology

2012 ◽  
Vol 19 (4) ◽  
pp. 38-41
Author(s):  
M. Y Yezhov
Keyword(s):  
Surgical Treatment ◽  
Group Treatment ◽  
Metatarsal Bone ◽  
Treatment Results ◽  
Aseptic Necrosis ◽  
First Metatarsal ◽  
Total Arthroplasty ◽  
Group 12 ◽  
Custom Made ◽  
Group 2

Examination and treatment results were presented for 17 patients with deforming arthrosis of the first metatarsal joint. In the 1 st group (12 patients) total arthroplasty of the first metatarsal joint was performed using Total Toe System implants. Second group included 5patients with dysplas- tic osteoarthrosis of the first metatarsal joint and iatrogenic aseptic necrosis of the head of the first metatarsal bone resulted from excessive medial resection of the head. In 3 patients from group 2 custom made implants and specially designed instruments were used. All patients from the 1 st group were examined in 3—12 months postoperatively. Joint condition showed 82points by AOFAS scale compared to 31 before surgery. In patients from the 2 nd group treatment results made up 88 points by AOFAS scale.

scholarly journals Surgical treatment of kyphosis in children with scheuermann’s diseaseusing 3D-CT navigation

2015 ◽  
Vol 3 (1) ◽  
pp. 5-14
Author(s):  
Sergei Valentinovich Vissarionov ◽  
Dmitriy Nikolaevich Kokushin ◽  
Sergei Mikhailovich Belyanchikov ◽  
Vladislav Valerievich Murashko
Keyword(s):  
Surgical Treatment ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
3D Ct ◽  
Scheuermann’S Disease ◽  
Scheuermann's Disease ◽  
Transpedicular Fixation ◽  
Long Term Follow Up

The purpose of the study is to describe features of the surgical technique for correction of kyphotic deformity of the spine and to analyze the results of surgical treatment of juvenile kyphosis in children with the use of 3D-CT navigation.— Materials and methods. We observed 11 patientsaged 14-17 years old (2 girls and 9 boys) with kyphoticdeformity of the spine, developed on the backgroundof Scheuermann’s disease. The deformity amount aver-aged 73,9° (60 to 90°). Surgery was performed fromthe combined access, carring out discapophysectomyand corporodesis on top of kyphosis and fixing mul-tibasic corrective metal construction. For the insertionof pedicle screws we used 3D-CT navigation.— The results. After surgery kyphosis value decreasedto 32,6° (20 to 45°), the deformity correction averaged41,3° (30 to 50°). Hybrid systems were placed in 5 pa-tients, total transpedicular fixation - in 6 children.Number of fixed vertebrae with hybrid metal construc-tions averaged 14 (13 to 15), in patients with total pediclefixation - 13 (12 to 14). In all cases we observed the correct position of pedicle support elements. Postopera- tive follow-up period was from 1 year and 5 months to5 years and 4 months, on average - 3 years 5 months. The loss of the result achieved in the long-term follow- up period was observed in patients with hybrid metal constructions and averaged 7,2° (4 to 9°).— Conclusion. The use of pedicle screws for thecorrection of juvenile kyphosis in children allows forthe effective correction of the deformity, restoring thephysiological profiles of the spine, eliminating post-operative progression of curvature, and reducing thelength of metal fixation and save the result achievedin the long-term follow-up. The use of active optical3D-CT navigation allows carring out a correct inser-tion of pedicle screws in the vertebral bodies in chil-dren with juvenile kyphosis.— Keywords: Scheuermann’s disease, juvenile ky-phosis, transpedicular fixation, navigation, children,surgical treatment.

scholarly journals Evolution of surgical management for scoliosis with endocorrectors

1996 ◽  
Vol 3 (1) ◽  
pp. 10-12
Author(s):  
V. N. Shubkin ◽  
R. R. Gatiatulin ◽  
T. V. Boldireva ◽  
V. M. Myasoedov
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Deformity Correction ◽  
Treatment Method ◽  
Orthopaedic Clinic ◽  
New Device ◽  
Medical Academy

The stages of the development of surgical treatment for scoliosis with endocorrectors in traumatologic and orthopaedic Clinic of Krasnoyarsk Medical Academy are retraced. The treatment method with use of perfected design of Rodnyansky-Gupalov endocorrector is described. It is shown that new device allows to avoid the majority complications that occur when previously endocorrectors have been used as well as to preserve the achieved deformity correction at longterm follow up after operation. The data on 59 patients with II-III degree scoliosis are presented.

scholarly journals Temporary screw epiphyseodesis of the first metatarsal for correction of juvenile hallux valgus

2018 ◽  
Vol 12 (4) ◽  
pp. 375-382 ◽  
Author(s):  
C. Schlickewei ◽  
K. Ridderbusch ◽  
S. Breyer ◽  
A. Spiro ◽  
R. Stücker ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Treatment Option ◽  
Skeletal Maturity ◽  
Weight Bearing ◽  
Deformity Correction ◽  
Epiphyseal Plate ◽  
Hallux Valgus Deformity ◽  
First Ray

Purpose Juvenile hallux valgus deformity (JHVD) is rare but may be associated with symptoms or deformities that require surgical treatment. Literature recommends waiting to perform surgical treatment until maturity. However, if conservative treatment is not sufficient and the children’s psychological or physical suffering is particularly severe, earlier surgical treatment should be considered. The aim of this study was to evaluate the safety and efficiency of temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal as a new treatment option for JHVD during growth age. Methods Between June 2011 and November 2017, 33 patients (24 girls, nine boys; 59 feet) with a JHVD were treated by temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal. At the time of surgery mean age was 11.1 years SD 1.4 (8 to 15). Patients were followed clinically and with standing, weight-bearing radiographs of the feet in two planes. Results In all, 22 patients (39 feet) were included into this study. Mean follow-up was 27.8 months SD 9.9 (12 to 58). The hallux valgus angle changed from 26.5° SD 6.6° preoperatively to 20.2° SD 6.2° (p < 0.001) at time of follow-up. The intermetatarsal angle changed from 14.1° SD 5.4° to 10.5° SD 2.9° during this time (p < 0.01). In two patients (three feet) the screws were removed before the JHVD was fully corrected due to local tenderness over the screw head. In two patients screw migration away from the growth plate was observed, resulting in no further deformity correction in one patient and increasing deformity in the other patient. No other complications were seen. Conclusion Temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal seems to be an effective, safe, technically easy and minimally invasive early treatment option to correct JHVD in children with particularly severe suffering. Due to the individual correction rate, frequent follow-up visits are recommended until skeletal maturity. Level of Evidence IV

scholarly journals Experience of surgical treatment of infective endocarditis in children

2019 ◽  
pp. 67-83
Author(s):  
L. Prokopovуch ◽  
O. Golovenko ◽  
Y. Truba ◽  
M. Rudenko ◽  
O. Senyko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Heart Defects ◽  
Subcutaneous Fat ◽  
Clinical Manifestations ◽  
Infectious Endocarditis ◽  
Average Weight ◽  
Kaplan Meier ◽  
The Mean

Surgical treatment of infectious endocarditis in children, single-center experience. The paper analyzes the experience of surgical treatment of infectious endocarditis (IE) in children. In the period from January 1999 to July 2019, 69 children with IE were operated at National Amosov Institute of Cardiovascular Surgery of NAMS of Ukraine, 44 of them (63.8%) developed the disease on the background of congenital heart defects (CHD). The mean age of the patients at the time of surgery was 9.1 ± 6.1 years. The average weight is 31.5 ± 21.7 (3.6 to 85 kg). The duration of the disease at the time of hospitalization was 5.3 ± 1.1 months. The average duration of the fever before hospitalization was 10.2 ± 8.5 weeks. Among the causes of IE, we observed three groups of inflammatory diseases: infections of the skin and subcutaneous fat in 15 (21.7%) cases, pathology of ENT – organs – 14 (20.2%) and broncho-pulmonary diseases – 9 (13.1%) cases. The risk factors were: presence of CHD – 44 (63.7%) and also nosocomial factors. The microbiological spectrum of pathogens included gram-positive microorganisms – 33 (71.7%), gram-negative microorganisms 4 (8.7%) and fungal microflora 9 (19.6%). The mean values of bypass circulation were 111.5 ± 62.4 minutes, and the time of aortic clamping was 71.4 ± 43.9 minutes, respectively. Hospital mortality in the general group of patients was 4 (5.8%) cases. In the follow-up period, 59 patients were examined, representing 90.7% of those discharged at the hospital stage. The observation period lasted from one month to 19.4 years (9.6 ± 5.7 years). According to the Kaplan-Meier analysis, the cumulative survival rate of patients in the CHD group at one year after surgery was 97.1%, at 10 years – 93.5%; after 15 years – 93.5%. Survival in the non-CHD group at 5, 10, and 15 years was 100%. In the long term, two patients died (3.4%). The recurrence rate of IE in the distant period was 2 (3.4%) cases. The incidence of long-term reoperation was 8 (13.6%) cases, three were recurrent IE and five were non-recurrent. According to Kaplan-Meier analysis, the proportion of patients without recurrent surgery in the long-term follow-up at 5 years was 87.9%, at 10 years – 84.1%, after 15 years – 77.1% in the CHD group. In the group without CHD 5 years – 95.2%, 10 years – 95.2%, 15 years – 81.6%. In the long term, as a result of performed surgical interventions, the regression of clinical manifestations of heart failure was noted in the majority of patients.

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