scholarly journals Outcomes using the Ilizarov external mini-fixator for Monteggia fractures in children

2021 ◽  
Vol 27 (3) ◽  
pp. 319-321
Author(s):  
K. Li ◽  
◽  
S. Rong ◽  
C. Zheng ◽  
Y. Teng ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Radial Head ◽  
Fracture Reduction ◽  
Proximal Ulna ◽  
Compression Fractures ◽  
Fractures In Children ◽  
Ulnar Fracture

Objective To evaluate the use of Ilizarov external mini-fixation in the treatment of Monteggia fractures (dislocation of the radial head with an associated fracture of the proximal ulna) in children. Methods Children with proximal ulnar fracture were included and underwent fracture reduction surgery with Ilizarov external mini-fixators, followed by immobilization of the supinated forearm with plaster. The reduction was evaluated intra-operatively using arthrography. Mackay criteria were used to evaluate clinical outcomes at follow-up. Results A total of 15 children were included in the study. Mackay efficacy was 100 %, indicating excellent outcomes using the Ilizarov external mini-fixator. Conclusion Use of the Ilizarov external mini–fixator is particularly suitable in the treatment of children with comminuted and compression fractures of proximal ulna. It is easy to operate, low invasive and is worthy of promotion.

scholarly journals Tibial Tubercle Fractures in Children and Adolescents

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0013
Author(s):  
Daniel B. Haber ◽  
Frances Tepolt ◽  
Michael P. McClincy ◽  
Leslie Kalish ◽  
Mininder S. Kocher
Keyword(s):  
Children And Adolescents ◽  
Compartment Syndrome ◽  
Clinical Outcomes ◽  
Return To Sport ◽  
Adolescent Male ◽  
Tibial Tubercle ◽  
Valuable Insight ◽  
Type I ◽  
Fractures In Children

Objectives: To report patient characteristics, fracture types, treatment methods, and clinical outcomes of children and adolescents treated for tibial tubercle fractures. Methods: Patients age 19 and under treated for tibial tubercle fractures at a single institution from 1995 to 2015 were identified and their medical records were retrospectively reviewed. Clinical and radiographic outcomes were reported for patients with a minimum follow up of 6 months. Associations were tested using Fisher’s exact test. Results: Two-hundred thirty seven tibial tubercle fractures were identified in 229 patients; 198 (86%) male. There were 139 (59%) left sided injuries. Mean age was 14.3 years (range 4.9 - 19.8). Mean body mass index (BMI) was 25. Osgood-Schlatters was identified in 72 (30%) cases and was most commonly associated with Ogden type I fractures (p<0.001). Two-hundred and four (86%) fractures occurred while participating in athletics, most commonly basketball (87, 43%). Of the 228 cases for which mechanism of injury was identified, 69 (30%) occurred while landing, 60 (26%) resulted from a direct blow to the knee, and 51 (22%) occurred while jumping. Ogden III fractures were most common (96, 41%) followed by Ogden I fractures (67, 28%). Initial treatment was surgical for 158 (67%) fractures, of which 58 (37%) underwent reoperation, 53 (34%) for hardware removal. Ogden I fractures were most commonly treated non-operatively (91%) and Ogden II-V fractures were most commonly treated operatively (89%, p<0.001). Elevated BMI was associated with Ogden II-V fractures (p=0.003) and injuries requiring operative treatment (p<0.001). Compartment syndrome was identified in 4 (2%) injuries and required emergent fasciotomy. Prophylactic anterior and/or lateral fasciotomy was performed in 35 (15%) operatively treated injuries. Of the 117 (49%) patients for whom minimum 6-month follow up was documented, 103 (88%) returned to sports; among those treated operatively (87), 2 (2%) developed symptomatic limb length discrepancy, 1 (1%) developed tibial recurvatum, and 6 (7%) developed post-operative infection. At last follow up, 39 (45%) of surgical patients reported pain at the tibial tubercle, 23 (26%) reported pain with squatting, and 13 (15%) had patellar tendonitis. Thirty-seven (43%) complained of hardware prominence. Conclusion: Tibial tubercle fractures occur most commonly in adolescent male athletes and are associated with basketball, elevated BMI, Osgood-Schlatters, and a risk of compartment syndrome. Following treatment, most patients return to sport. As the largest single series of tibial tubercle fractures reported, this study provides valuable insight into injury epidemiology, relationship with Osgood Schlatters, and clinical outcomes.

scholarly journals 169 Clinical Outcomes of Radial Head Arthroplasty as Primary Treatment for Post-traumatic Mason Type 3 and 4 Fractures: A Long-term Follow-up

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Aslam ◽  
K Pearson ◽  
M Waseem
Keyword(s):  
Clinical Outcomes ◽  
Radial Head ◽  
Primary Treatment ◽  
Functional Restoration ◽  
Dash Score ◽  
Range Of Movement ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty

Abstract Aim Radial head arthroplasty (RHA) is the favoured treatment for complex radial head fractures, enabling functional restoration of elbow kinematics. However, study of long-term outcomes associated with RHA is largely neglected. This study aimed to fill the gap in the literature by firstly, assessing functional outcomes, and secondly, determining complications and rates of revision and/or removal of prosthesis associated with RHA, at our district general hospital. Method We retrospectively reviewed a consecutive single-surgeon series of patients receiving RHA as primary treatment for radial head fractures graded either 3 or 4 according to the Mason-Johnston classification between 2004 and 2009. Function at final follow-up was assessed using Quick Disabilities of the Arm, Shoulder and Hand (q-DASH) score and Mayo Elbow Performance Score (MEPS). Results 16 patients identified; 12 available for final follow-up. Mean follow-up time of 12.60 years (range: 10.67-16.08). Mean q-DASH score of 8.2 (range: 0-34.1). Mean MEPS of 85.83 (range: 50-100) with 11 (91.67%) reporting excellent/good results. All complications occurred within the first year post-operatively. Stiffness was the most common (50%) complication, but additional procedures improved objective range of movement in affected patients. Only one patient required implant revision throughout follow-up, which was due to prosthesis subluxation in the first month. Conclusions This study is amongst the first to examine clinical outcomes associated with RHA with an average follow-up &gt;12 years. Our results emphasise good functional restoration and low implant failure rate. Regular follow-up particularly in the early post-operative period is essential in detecting and resolving complications.

scholarly journals Retrograde Intramedullary Nailing for Proximal Monteggia Fractures in Children

2021 ◽  
Author(s):  
Grégoire Thürig ◽  
Raabe Ines ◽  
Maniglio Mauro ◽  
Philippe Vial ◽  
Moritz Tannast ◽  
...  
Keyword(s):  
Radial Head ◽  
Pediatric Patients ◽  
Case Series ◽  
Preoperative Imaging ◽  
Indirect Reduction ◽  
Retrograde Nailing ◽  
Monteggia Lesion ◽  
Fractures In Children ◽  
Anatomic Reduction ◽  
Ulnar Fracture

Abstract IntroductionMonteggia fractures are defined as fractures of the ulna’s proximal third with associated dislocation of the radial head and were further described and classified by Bado. They are very rare in adults and even rare in children reaching an incidence of 1.5 - 3% of all pediatric forearm fractures. The treatment’s primary goal is the anatomical reduction of the ulnar fracture, and with that, the following indirect anatomic reduction of the radial head. Different modalities for the treatment of Monteggia fractures in children are reported.We present possible closed reduction techniques and internal fixation based on the type of Bado classification in pediatric patients. We illustrate these techniques as a case series discussing the strengths, risks, and pitfalls of the ulna’s retrograde nailing.Materials and MethodsFor this case series, we included all pediatric patients who got surgical treatment at our institution for a Monteggia lesion from November 2000 to August 2019. Preoperative imaging consisted of conventional radiographs of the elbow and the forearm in two planes. Results This case series reports about six pediatric cases (age two to six years, two girls and four boys). They all had a proximal Monteggia fracture. In all cases, closed indirect reduction of the ulnar fracture and reposition of the radial head was achieved utilizing retrograde nailing of the ulna employing an intramedullary nail or Kirschner-Wire according to the instructions. No infection, vascular or nerve injuries, or other complications occurred. All were pain-free and regained full range of motion compared to the contralateral side.ConclusionIndirect reduction and intramedullary retrograde nailing are minimally invasive techniques that do not harm the blood supply to the bone and soft tissues. It may be a safe and effective procedure.

scholarly journals Anterior Dislocation of the Radial Head Combined with Plastic Deformity of the Ulnar Shaft in an Adult: A Case Report

2018 ◽  
Vol 21 (1) ◽  
pp. 42-47
Author(s):  
Sang Won Moon ◽  
Youngbok Kim ◽  
Young Chang Kim ◽  
Ji Wan Kim ◽  
Taiyeon Yoon ◽  
...  
Keyword(s):  
Plastic Deformation ◽  
Case Report ◽  
Radial Head ◽  
Full Range ◽  
Elbow Flexion ◽  
Anterior Dislocation ◽  
Proximal Ulna ◽  
Fishing Boat ◽  
Dorsal Angulation

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia, we reduced the radial head by posterior compression at 90° of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.

Unusual Forearm Deformity Solved by 3D Custom Made Guides

2019 ◽  
Vol 24 (04) ◽  
pp. 483-487
Author(s):  
Maria de los Angeles De la Red Gallego ◽  
Jose Couceiro Otero ◽  
Marta De Prado Tovar ◽  
Higinio Ayala Gutierrez ◽  
Manuel Ruben Sanchez Crespo
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
3D Model ◽  
Three Dimensional ◽  
Distal Ulna ◽  
Ulnar Head ◽  
Custom Made ◽  
Ulnar Fracture ◽  
Cutting Guides

We report a case of a symptomatic forearm deformity due to a premature distal ulnar fracture solved by 3D custom made cutting guides. Our patient is a sixteen years old girl referred to us due to a forearm deformity and a dysplasic ulnar head associated to pain at the dorsum of the distal ulna and at the radial head at the elbow. Using custom-made cutting guides on a 3D model, a both bone forearm osteotomy was performed. At 18 months of follow up, the range of motion did not improve significantly but our patient referred no pain and she was satisfied with the procedure. The accuracy of single cut osteotomies, utilizing three-dimensional planning and custom patient guides has been previously established. This technique helped with the pain in our case.

scholarly journals Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Lei Zhang ◽  
Laixu Wang ◽  
Shiyang Yu ◽  
Zhanhui Lv ◽  
Peng Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medial Collateral Ligament ◽  
Radial Head ◽  
Dash Score ◽  
Collateral Ligament ◽  
Anterior Capsule ◽  
Radial Head Fractures ◽  
Primary Operation ◽  
Valgus Instability

Abstract Background The objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation. Methods Thirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The median follow-up was 37.3 months (range, 15–53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up. Conclusions Radial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.

Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 497-504 ◽  
Author(s):  
Tom De Beule ◽  
Jan Vranckx ◽  
Peter Verhamme ◽  
Veerle Labarque ◽  
Marie-Anne Morren ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Arteriovenous Malformations ◽  
Clinical Success ◽  
Transarterial Embolization ◽  
Recurrent Bleeding ◽  
Complete Disappearance ◽  
Ethylene Vinyl Alcohol ◽  
Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

Conservative Treatment of Vestibular Schwannomas: A Follow-Up Study on Clinical Outcomes

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
M. Sadadcharam ◽  
R. Wormald ◽  
M. Javadpour ◽  
D. Rawluk ◽  
R. McConn-Walsh
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Vestibular Schwannomas ◽  
Follow Up Study

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

scholarly journals P-Cresyl Sulfate Is a Valuable Predictor of Clinical Outcomes in Pre-ESRD Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Chi-Feng Pan ◽  
Chih-Kuang Chuang ◽  
Fang-Ju Sun ◽  
Duen-Jen Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cardiovascular Event ◽  
Cox Regression ◽  
Medical Center ◽  
Serum Biochemistry ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Valuable Marker ◽  
Valuable Predictor

Background/Aims. Previous studies have reported p-cresyl sulfate (PCS) was related to endothelial dysfunction and adverse clinical effect. We investigate the adverse effects of PCS on clinical outcomes in a chronic kidney disease (CKD) cohort study.Methods. 72 predialysis patients were enrolled from a single medical center. Serum biochemistry data and PCS were measured. The clinical outcomes including cardiovascular event, all-cause mortality, and dialysis event were recorded during a 3-year follow-up.Results. After adjusting other independent variables, multivariate Cox regression analysis showed age (HR: 1.12,P=0.01), cardiovascular disease history (HR: 6.28,P=0.02), and PCS (HR: 1.12,P=0.02) were independently associated with cardiovascular event; age (HR: 0.91,P<0.01), serum albumin (HR: 0.03,P<0.01), and PCS level (HR: 1.17,P<0.01) reached significant correlation with dialysis event. Kaplan-Meier analysis revealed that patients with higher serum p-cresyl sulfate (>6 mg/L) were significantly associated with cardiovascular and dialysis event (log rankP=0.03, log rankP<0.01, resp.).Conclusion. Our study shows serum PCS could be a valuable marker in predicting cardiovascular event and renal function progression in CKD patients without dialysis.

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