scholarly journals Current approaches to treatment of patients with closed fractures of the patella

2021 ◽  
Vol 27 (5) ◽  
pp. 597-609
Author(s):  
Yu.D. Kim ◽  
◽  
D.S. Shitikov ◽  
N.A. Knyazev ◽  
N.E. Likholatov ◽  
...  
Keyword(s):  
Knee Joint ◽  
Early Mobilization ◽  
Functional Results ◽  
Infectious Complications ◽  
Kirschner Wires ◽  
Metal Implants ◽  
Results Of Treatment ◽  
Wire Cerclage ◽  
Closed Fractures ◽  
Patellar Fractures

Abstract. Introduction Treatment of patients with acute fractures of the patella is the task of the trauma and orthopedic service and should provide restoration of the integrity of the bone tissue and the extensor apparatus of the knee joint for its early mobilization. There is an opinion that conservative treatment cannot meet requirements of patients’ quality of life, and therefore, most traumatologists are inclined to surgically treat patellar fractures. Purpose Based on the available literature data, to determine the most rational way to treat patients with patellar fractures Materials and methods Available studies published in the last 10 years were analyzed. The databases NCBI Pubmed, Healio Orthopedics, Medline were searched. Results Such osteosynthesis methods as patella suture, osteosynthesis with plates, special internal devices, external fixation devices, Kirschner wires and wire cerclage, various screws were covered. The question of clinical application of patellectomy was touched upon; the contribution of the Department of Traumatology, Orthopedics and Urgent Surgery of the Krasnov Samara State Medical University to the development of operative techniques of osteosynthesis of the patella, the basic concepts of scientific research, and also the most optimal ways of treating patients with patellar fractures were described. Conclusion The conservative method of treating patients with patellar fractures is most relevant if there are contraindications to surgery. It inevitably leads to persistent arthrogenic contracture. The best functional results of treatment have been achieved with surgical treatment due to the possibility of early mobilization of the knee joint. According to the data of available studies, plates and screws as well as osteosynthesis with Kirschner wires and wiring cerclage show maximum stability. There is evidence of a direct correlation between the risk of developing infectious complications and pain in the postoperative period and the number of elements of subcutaneous metal implants. Thus, the most optimal way to treat closed fractures of the patella is osteosynthesis with the use of wires and wire cerclage according to the tension band principle.

scholarly journals Unstable Fractures Osteosynthesis of Malleoli and Posterior Edge of the Tibia Using Posterolateral Surgical Approach

2021 ◽  
Vol 27 (3) ◽  
pp. 29-42
Author(s):  
Igor’ G. Belen’kii ◽  
Boris A. Maiorov ◽  
Aleksandr Yu. Kochish ◽  
Gennadii D. Sergeev ◽  
Viktor E. Savello ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Surgical Approach ◽  
Early Mobilization ◽  
Functional Results ◽  
Medial Malleolus ◽  
Posterior Edge ◽  
Short Term ◽  
Results Of Treatment ◽  
Mid Term Results ◽  
Unstable Fractures

The malleoli fractures in combination with the fractures of posterior edge of the tibia are considered unstable injuries and present particular difficulties in surgical treatment. The aim of the study was to evaluate short-term and mid-term results of osteosynthesis on account of unstable fractures of malleoli and posterior edge of the tibia using posterolateral surgical approach. Materials and Methods. The analysis of short-term and mid-term results of the treatment of 29 patients with malleoli fractures types 44-B3 and 44-C1.3, C2.3 and C3.3 (according to the AO classification) with the involvement of the Volkman`s posterior tibia fragment was performed in traumatology departments of three hospitals during the period from January 2019 to September 2020. In all 29 cases the fracture of the posterior edge of the tibia was classified as type 1 according to the classification of N. Haraguchi et al. All patients underwent osteosynthesis of the posterior edge of the tibia and the lateral malleolus via posterolateral surgical approach. Combined fracture of the medial malleolus was fixed via classical medial approach. 5 patients (17.2%) with continued instability of the distal tibiofibular syndesmosis underwent fixation with positional screw. Functional results, as well as the range of motions in the ankle joint were evaluated with the use of AOFAS and Neer scales 3, 6 and 12 months after surgery. Results. Statistically significant improvement in functional outcomes over time was noted when evaluated on the AOFAS scale (p0.05) and on the Neer scale (p0.01). 12 months after the surgery these points were 83.213.4 and 87.816.8 respectively. Complications were noted in 5 patients (17.24%). Deep periimplant infection was registered just in one case, another patient had marginal necrosis of the operative wound. Three patients had clinically significant post-traumatic deforming arthritis of the ankle joint. Conclusion. Posterolateral surgical approach has advantages when performing osteosynthesis in patients of the studied profile and enables anatomical reduction and stable fixation of fragments of the Volkman`s posterior edge of the tibia, which provides the possibility of early mobilization of the ankle joint and has positive effect on the results of treatment.

scholarly journals Restoration of Knee Joint Stability with Cruciate Ligament Implants

2004 ◽  
Vol 11 (1) ◽  
pp. 40-44
Author(s):  
M A Malygina ◽  
N S Gavryushenko ◽  
V P Okhotskiy ◽  
O P Filippov ◽  
A M Nevzorov ◽  
...  
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Functional Results ◽  
Scientific Research Institute ◽  
Ligament Injury ◽  
Joint Stability ◽  
Human Knee ◽  
Results Of Treatment ◽  
Human Knee Joint ◽  
Different Types

At the Scientific Research Institute of Emergency Care named after N.V. Sklifosovskiy the modern cruciate ligament implants (France) have been successfully used since 1994. Physical mechanical and deformed characteristics of ligaments of human knee joint and synthetic prostheses of ligaments were tested by machine «Zwick-1464». New original endoprostheses of knee joint ligaments as well as instruments for optimization of the points of entrance and exit within condyles were elaborated. The methods for elimination of different types of knee joint instability in cruciate ligament injury using authors' endoprostheses were worked out. Authors proved that it could improve the functional results of treatment.

Complications Following Tension-Band Fixation of Patellar Fractures with Cannulated Screws Compared with Kirschner Wires

2013 ◽  
Vol 95 (7) ◽  
pp. 653-659 ◽  
Author(s):  
C. Max Hoshino ◽  
Wesley Tran ◽  
John V. Tiberi ◽  
Mary Helen Black ◽  
Bonnie H. Li ◽  
...  
Keyword(s):  
Tension Band ◽  
Cannulated Screws ◽  
Kirschner Wires ◽  
Patellar Fractures

Prosthetic Replacement of the Scaphoid Proximal Pole: Should It Be the Future?

Hand ◽  
2020 ◽  
pp. 155894472097412
Author(s):  
Matteo Ferrero ◽  
Enrico Carità ◽  
Francesco Giacalone ◽  
Julien Teodori ◽  
Alberto Donadelli ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Early Mobilization ◽  
Functional Results ◽  
Good Alternative ◽  
Proximal Row Carpectomy ◽  
Proximal Pole ◽  
Subjective Outcomes ◽  
Clinical Worsening ◽  
Pyrocarbon Implant ◽  
Over Time

Background Scaphoid proximal pole fractures with avascular necrosis represent a complex surgical problem. Many reconstruction techniques are based on osteosynthesis with a vascularized or nonvascularized bone graft. These procedures do not allow early mobilization and therefore sometimes lead to unsatisfying functional results. In some cases, it is possible to perform a scaphoid hemiarthroplasty using a pyrocarbon implant (adaptive proximal scaphoid implant [APSI]) in place of the necrotic proximal pole, allowing an early mobilization and delaying palliative treatments such as 4-corner arthrodesis or proximal row carpectomy. Methods In this study, we reviewed all patients who had undergone a scaphoid hemiarthroplasty using APSI in our institutions from 1999 to 2017; the F.U. was performed through radiographic, clinical, and subjective (Disabilities of the Arm, Shoulder, and Hand) analysis. Results The performances of scaphoid proximal pole implants are encouraging; radiographic, clinical, and subjective outcomes were good, and the functional recovery proved to be fast and reliable over time. Conclusions This study reports our experience in the use of APSI implants, which proved to be a good alternative to traditional techniques for treating avascular necrosis of the proximal pole, still allowing further surgical steps in case of clinical worsening over time (wrist osteoarthritis). These patients are usually young and present high functional demands. Our experience is promising, but we believe that further evaluation over time will be needed.

SURGICAL APPROACH FOR KNEE JOINT ARTHROPLASTY IN CHILDREN WITH CANCER: THE INTRODUCTION OF A LATERAL APPROACH FOR SEGMENTAL RESECTION OF THE PROXIMAL TIBIA

2021 ◽  
Vol 100 (3) ◽  
pp. 227-233
Author(s):  
N.A. Bolshakov ◽  
◽  
A.Yu. Artemov ◽  
A.S. Slinin ◽  
E.O. Bezdolnova ◽  
...  
Keyword(s):  
Knee Joint ◽  
Surgical Approach ◽  
Ewing’S Sarcoma ◽  
Rating Scale ◽  
Ewing's Sarcoma ◽  
Functional Results ◽  
Lateral Approach ◽  
Joint Arthroplasty ◽  
Lateral Side ◽  
Significant Difference

The aim of the study was to analyze our own experience of using the lateral approach in knee joint arthroplasty in children with oncopathology. Materials and methods of research: the results of a retrospective nonrandomized uncontrolled single-center study are analyzed, within the framework of which 97 endoprosthetics of the knee joint were performed in children and adolescents with oncological pathology over 7 years (2012–2018). Lateral approach was used in 28 patients. The functional results were assessed using the MSTS rating scale 6 and 12 months after the surgery. Postoperative complications were analyzed according to the Henderson classification (modified by the ISOLS committee). Results: when comparing the functional outcome depending on the surgical approach, no statistically significant difference was found either after 6 months (p=0,124) or after 12 months (p=0,755). There is no more frequent development of complications detected (p=0,551). The access used also did not affect overall survival in osteosarcoma (p=0,577), in Ewing's sarcoma (p=0,493), as well as on event-free survival in osteosarcoma (p=0,829) and in Ewing's sarcoma (p=0,886). Conclusion: the use of the lateral surgical approach for knee arthroplasty in children with oncopathology does not affect the treatment results, however, it provides the surgeon with greater variability of actions during preoperative planning. This is especially true for patients whose biopsy tract is located on the lateral side.

scholarly journals Study of outcome of knee joint in patients with fracture distal femur versus fracture ipsilateral femur and tibia

2021 ◽  
Vol 12 (2) ◽  
pp. 1174-1181
Author(s):  
Ravindra B Gunaki ◽  
Chitresh Mehta ◽  
Rahul Sharma ◽  
Swapnil Chitnavis
Keyword(s):  
Knee Joint ◽  
Distal Femur ◽  
Weight Bearing ◽  
Early Mobilization ◽  
Bony Union ◽  
Fracture Femur ◽  
Articular Fractures ◽  
Stay Time ◽  
A Prospective Study ◽  
Type Of Fracture

The posture on the two wheeler at the speed we travel, makes knee the vulnerable joint of all in any of the mishaps. We as orthopedic surgeons see the fractures around the knee joint as one of the most studied concept in the subject. This is a prospective study conducted, over 2 years, in Krishna Institute of Medical Sciences, Deemed to be University, Karad. In this study, 20 cases of fracture distal femur and 20 cases of ipsilateral fracture femur and tibia were studied to evaluate outcome of knee joint and post surgical stabilization of fractures. The fractured limb was stabilized with splinting the limb in Thomas splint or plaster slab. The type of fracture, type of fracture fixation, duration of hospital stay, time of union and time to start weight bearing are evaluated. According to Neer’s score, Good outcome was found in both Fracture Distal femur and Ipsilateral Fracture Femur and tibia. The functional outcome was found to be better in diaphyseal fractures femur and tibia treated with intramedullary interlock nailing which allowed early mobilization and weight bearing than in intra-articular fractures treated with plating. Bony union occurred early in closed, diaphyseal and simple transverse or oblique fractures and delayed in open, intraarticular and comminuted fractures. 

Evaluation clinical efficacy of immunotherapy in complex treatment of acute optic neuritis associated with herpesvirus infection

2021 ◽  
pp. 167-171
Author(s):  
D.А. Povalyaeva ◽  
◽  
V.V. Egorov ◽  
G.P. Smoliakova ◽  
L.P. Danilova ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Clinical Efficacy ◽  
Irrigation System ◽  
Functional Results ◽  
Complex Treatment ◽  
Herpesvirus Infection ◽  
Results Of Treatment ◽  
Acute Optic Neuritis ◽  
Key Words Optic Neuritis ◽  
Retrobulbar Space

Purpose. To study the clinical efficacy of complex treatment of optic neuritis (ON) associated with herpesvirus infection (HVI), including methods of immunotherapy. Material and methods. The clinical study involved 37 people (37 eyes) with acute ON associated with HVI. The treatment regimen for all patients within 10 days included delivery through irrigation system implanted into the retrobulbar space to optic nerve: solutions Dexamethasone on decreasing scheme, Emoxypine 1% 0.5 ml and Dicynone 12.5% 0.5 ml, in combination with administration of drugs neuroprotection. All patients were divided into 2 groups depending on characteristics of therapy. The 1st group consisted of 17 patients, who were treated according to the standard method. 2nd group consisted of 20 patients who received additional intramuscular Imunofan in the regimen and doses according to the manufacturer's instructions. Results. Analysis of obtained datas showed that more significant positive dynamics was noted in the clinical course of ON in patients of the 2nd group of observation in comparison with the 1st group. Conclusion. The strategy of etiotropic and pathogenetic immunotherapy at ON, associated with HVI infection, developed by us, allows to shorten recovery time and improve functional results of treatment in absence of relapses of disease within 1 year of follow-up. Key words: optic neuritis, herpesvirus infection, corticosteroid therapy, immunotherapy.

Long-term results of treatment of closed bone fractures in children

1980 ◽  
Vol 61 (5) ◽  
pp. 57-58
Author(s):  
D. N. Shamsutdinov
Keyword(s):  
Bone Fractures ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Results Of Treatment ◽  
Fractures In Children ◽  
Closed Fractures

We studied the long-term outcomes of the treatment of closed fractures in the period from 1 to 10 years after the injury in IZ children (boys - 78, girls - 35; age: up to 3 years - 9, from 4 to 7 years - 26, from 8 to 14 years - 68 , from -15 to 16 years-10).

scholarly journals Management Of Recent Elbow Dislocations: Functional Treatment Versus Immobilization; A Prospective Study About 60 Cases

2017 ◽  
Vol 11 (1) ◽  
pp. 452-459 ◽  
Author(s):  
Ndeye Fatou Coulibaly ◽  
Niane Mouhamadou Moustapha ◽  
Hamadi Hadji Djoumoi ◽  
Sarr Lamine ◽  
Gueye Alioune Badara ◽  
...  
Keyword(s):  
Prospective Study ◽  
Elbow Dislocation ◽  
Early Mobilization ◽  
Functional Results ◽  
Functional Treatment ◽  
Functional Rehabilitation ◽  
Dislocation Reduction ◽  
Group 3 ◽  
Group 2 ◽  
A Prospective Study

Objective: To determine our therapeutic posture trough a comparison of functional treatment results versus immobilization in two different periods. Introduction: For years, the treatment of recent elbow dislocations consisted of reduction and immobilization during 21 days. Given the frequency of stiffness other methods have been tried out. Method: A prospective study was carried out from January 2010 to December 2014. Sixty patients averaging 28.3 years of age underwent elbow dislocation reduction. They were categorized into three separate groups. Patients in the first group had their elbow immobilized for 21 days whereas Group 2 patients were immobilized for 10 days. Group 3 patients were applied a functional treatment followed by a functional rehabilitation. Patients were evaluated according to the Mayo Clinic Elbow Performance Index and the results analyzed with statistical software (SPSS, version 18). Results: During the first month, the functional results of the patients were excellent and good in 19%, 94.7% and 90% respectively for Groups 1, 2 and 3. The pain was intense (10 on the visual analogue scale) in group 3 associated with swelling. At day 90, the results of the patients in Groups 2 and 3 were excellent in 100% of the cases versus 90% for Group 1. At 6 months, all the results were the same. We have not noted any instability, or recurrence or periarticular ossification in our patients. Conclusion: The treatment of stable elbow dislocations remains orthopedic. The risk of instability and pain motivates a short 10-day immobilization period followed by early mobilization.

Sign in / Sign up

Export Citation Format

Share Document