Endoscopic management of retrocalcaneal pain: a prospective observational study

Background: In an effort to reduce morbidity and complications of open surgery, an endoscopic technique was used for the management of the conditions leading to retrocalcaneal pain. With this purpose, the current study was undertaken to evaluate results of endoscopic management of retrocalcaneal pain using American orthopaedic foot and ankle score (AOFAS).Methods: 20 patients (26 heels) in the age group 18-80 years presenting with retrocalcaneal pain not responding to conservative management underwent endoscopic decompression of the retrocalcaneal bursae and excision of bony spurs. Two portals were created, one laterally and one medially, over the posterosuperior portion of the calcaneus to gain access to the retrocalcaneal space. The inflamed bursal tissue was identified and removed, and the prominent bone was resected. The functional outcome was evaluated pre and postoperatively with the AOFAS.Results: 70% patients have retrocalcaneal bursitis, 20% Haglund’s deformity as confirmed on lateral view of ankle X-ray and only 10% of non-insertional tendinosis. Mean operative time was 54.95 minutes. Mean duration of hospital stay was 3.90±0.64 and the mean follow-up was 66 days (range 30-180 days). The average AOFAS score improved from 65.60 points pre-operatively to 96.80 points at final follow-up. There were fifteen excellent results, seven good results, two fair results and two poor results.Conclusions: Endoscopic procedure for retrocalcaneal bursitis and Haglund deformity seemed to be a safe and efficacious option for surgical treatment of retrocalcaneal pain.

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An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

SAGE Open Medicine ◽

10.1177/20503121211040954 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110409

Author(s):

Ali Varol ◽

Yunus Oc ◽

Bekir Eray Kilinc

Keyword(s):

Bone Grafting ◽

Plate Osteosynthesis ◽

Locking Plates ◽

Foot And Ankle ◽

Calcaneal Fractures ◽

Type Iii ◽

Heel Height ◽

The Mean ◽

American Orthopaedic

Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden’s view. Preoperative and postoperative values were evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

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Haglund’s disease: surgical outcome of calcaneal osteotomy

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170786 ◽

2017 ◽

Vol 3 (2) ◽

pp. 278 ◽

Cited By ~ 1

Author(s):

Veerabhadra Javali ◽

Virupaksha N. Reddy

Keyword(s):

Conservative Treatment ◽

Surgical Outcome ◽

Surgical Intervention ◽

Lateral Approach ◽

Lateral View ◽

Aofas Score ◽

Postoperative Score ◽

Calcaneal Osteotomy ◽

The Mean

Background: The aim of the present study was to assess the surgical outcome of Haglund’s disease by calcaneal osteotomy.Methods: 23 cases of Haglund’s disease who failed to respond to conservative treatment were considered for surgery. Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.Results: 23 cases of Haglund’s disease were treated with this procedure and 21 were available for follow up. The mean follow-up was 15 months. The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative score of 88.71 points (SD= 3.92) was obtained. Three minor complications were noted. Conclusions: The results of the current study suggest that calcaneal ostectomy produces outcomes that justify surgical intervention in cases of Haglund’s disease.

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Endoscopic Resection of Different Types of Talocalcaneal Coalition

Foot & Ankle International ◽

10.1177/1071100718770625 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1082-1088 ◽

Cited By ~ 4

Author(s):

Wael Aldahshan ◽

Adel Hamed ◽

Faisal Elsherief ◽

Ashraf Mohamed Abdelaziz

Keyword(s):

Endoscopic Resection ◽

Nonoperative Treatment ◽

Level Of Evidence ◽

Vas Score ◽

Talocalcaneal Coalition ◽

Short Term Study ◽

Different Types ◽

The Mean ◽

American Orthopaedic

Background: The purpose of this study was to describe the technique of endoscopic resection of talocalcaneal coalition (TCC) by using 2 posterior portals and to report the outcomes of endoscopic resection of different types and sites of TCC. Methods: An interventional prospective study was conducted on 20 feet in 18 consecutive patients who were diagnosed by computed tomography to have TCC for which nonoperative treatment had failed and endoscopic resection was performed. The patients were divided into groups according to the site of the coalition (middle facet or posterior facet) and according to type (fibrous, cartilage, or bony). The mean follow-up period was 26 months (range, 6-36). Results: The average preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 57.7 (range, 40-65), and the average preoperative visual analog scale (VAS) score was 7.8 (range, 6-8). The average postoperative AOFAS hindfoot score was 92.4 (range, 85-98; P < .01). The average postoperative VAS score was 2.4 (range, 1-4). All patients showed no recurrence on postoperative lateral and Harris-Beath X-ray until the end of the study. Conclusions: Endoscopic resection of TCC was an effective and useful method for the treatment of talocalcaneal coalition. It provided excellent outcomes with no recurrence in this short-term study. Resection of the fibrous type had a better outcome than resection of cartilage and bony types. Endoscopic resection of the posterior coalition had a better outcome than resection of the middle coalition. Level of Evidence: Level III, comparative study.

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Evaluation of functional outcome following ORIF of bimalleolar fractures of the ankle-A prospective study of 30 patients

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3272 ◽

2020 ◽

Vol 11 (4) ◽

pp. 6051-6055

Author(s):

Yeshwanth subash ◽

Vishnu S ◽

Damodharan

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Surgical Intervention ◽

Early Mobilization ◽

Foot And Ankle ◽

The Mean ◽

American Orthopaedic ◽

A Prospective Study ◽

Mean Time

Bimalleolar fractures are common injuries, and stable fracture patterns can be treated conservatively, while complicated, unstable fractures would require surgical intervention. This study aimed to evaluate the functional outcome following ORIF (Open reduction and internal fixation) of these fractures. This was a study of 30 patients with bimalleolar fractures who presented between January 2013 to January 2016 treated with ORIF with a follow-up period of 3 years. Functional outcome was performed with the AOFAS (American Orthopaedic Foot and ankle society) score. The mean age of the patients was 41.6 years. There was a female preponderance seen in our study with the left side being more commonly affected. The mean time to fracture union was 12.13 weeks, and we had excellent outcomes in 18 patients, good in 10, while two patients had a fair result. We did not lose any of our patients to follow up. All of our patients were happy with the functional outcome achieved. No significant complications were seen in our study. ORIF in bimalleolar fractures enables restoration of the ankle mortise to an anatomical position and facilitates early mobilization of the ankle resulting in good functional outcomes.

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The effect of a modified chevron osteotomy for hallux valgus patients: A five-year follow-up study

10.21203/rs.3.rs-929642/v1 ◽

2021 ◽

Author(s):

Shiyong Zhang ◽

Xue Wang ◽

Tiannan Chen ◽

Chengwei Wang ◽

Jie Wang

Keyword(s):

Hallux Valgus ◽

Analog Scale ◽

Aofas Score ◽

Intermetatarsal Angle ◽

Follow Up Study ◽

Chevron Osteotomy ◽

Vas Scores ◽

The Mean ◽

American Orthopaedic

Abstract Purpose This study aimed to detect the effect of a modified chevron osteotomy on hallux valgus (HV) deformity at five-year follow up. Methods Twenty patients with symptomatic HV who underwent modified chevron osteotomy between June 2014 and January 2016 were included in the present study. The follow-up duration was more than five years. Each patient was evaluated preoperatively, six weeks postoperatively and five years postoperatively using the visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) score and cosmetic and radiological outcomes. Results The AOFAS score improved from 54.40 (± 4.58) preoperatively to 94.30 (± 2.15) six weeks postoperatively (p < 0.001) and 96.95 (± 1.54) five years postoperatively (p < 0.001). The VAS scores decreased from 6.30 (± 1.17)preoperatively to 0.15 (± 0.37) five years postoperatively (p < 0.001). The mean intermetatarsal angle improved from 16.00° (± 2.20°) preoperatively to 4.15° (± 1.22°) six weeks postoperatively (p < 0.001) and 4.40° (± 1.39°) five years postoperatively (p < 0.001). The mean HV angle also improved, from 32.70° (± 5.34°) preoperatively to 4.80° (± 1.40°) six weeks postoperatively (p < 0.001) and 5.20° (± 1.32°) five years postoperatively (p < 0.001). The cosmetic results were either excellent or good in 19 patients (95%). There was no recurrence in this study during the five postoperative years. Conclusion A modified chevron osteotomy can achieve successful correction of moderate-to-severe HV, with excellent outcomes at five-year follow up.

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Nurse-Led Neonatal Follow-Up Clinic: A New Emerging Concept in a Developing Country

Journal of Neonatology ◽

10.1177/0973217920936434 ◽

2020 ◽

Vol 34 (1-2) ◽

pp. 19-23

Author(s):

Poonam Joshi ◽

Bindu Sarojini ◽

Meena Joshi ◽

Anu Thukral

Keyword(s):

Developing Countries ◽

Prospective Observational Study ◽

Tertiary Care ◽

Newborn Care ◽

Care Facility ◽

Essential Newborn Care ◽

Tertiary Care Facility ◽

Neonatal Assessment ◽

The Mean

Objective: To investigate the feasibility and acceptance of nurse-led neonatal follow-up clinic (NLNFC) in a tertiary care facility. Materials and Methods: In a prospective observational study, total 105 stable mother-neonate dyads were independently followed up in both nurse led and neonatologist run follow-up clinics. The outcome was measured in terms of agreement between the nurse and neonatologist in the domains of neonatal assessment, counselling mothers on essential newborn care (ENC) and giving advice ( P < 0.05) and mothers’ acceptability for NLNFC. Results: Agreement between the trained neonatal nurse and neonatologist varied between 87 and 100%. The most unanimity was observed in neonatal assessment and counselling on ENC (93.3%-100%) followed by prescribing treatment (87%). The mean acceptability scores of the mothers for NLNFC was 33.13 ± 2.6 (25-35, maximum possible score 35). Conclusion: Establishing NLNFCs in developing countries is feasible. Nurses can be entrusted with the responsibility of following up stable neonates here and mothers will surely be satisfied with this type of clinic.

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Is cementing technique the cause of early aseptic loosening of the tibial component in total knee arthroplasty? A report of 22 failed tibial components

Orthopedic Reviews ◽

10.4081/or.2011.e5 ◽

2011 ◽

Vol 3 (1) ◽

pp. 5 ◽

Cited By ~ 3

Author(s):

Stefan Endres ◽

Axel Wilke

Keyword(s):

Aseptic Loosening ◽

Tibial Component ◽

Lateral View ◽

Cementing Technique ◽

Revision Procedure ◽

Osteolytic Lesions ◽

Cement Penetration ◽

The Mean ◽

Loosening Rate

Despite excellent results of bicondylar knee resurfacing when both the tibial and femoral components are cemented, loosening of the cemented tibial component (surface cementing) occurs in approximately 10% of the implants within a 4-year interval after the procedure. Based on our own experience, we want to report of early failed tibial components in 22 patients after a mean follow up of 51 months, necessitating a revision procedure. We analysed retrospectively 22 cases of failed tibial components in patients after a mean follow up of 51 months, necessitating a revision procedure. This raised the question of whether the cementing technique was implicated in the loosening. Every correlation between early loosening and clinically relevant covariates were investigated. All patients were evaluated for radiolucency and osteolytic lesions at the bone–cement interfaces by radiographic assessment according to Rossi et al. (a.p. view and lateral view divided into two zones). The mean radiographic cement penetration in anterior-posterior view was 1.2 mm (SD 0.8) in zone 1 and 1.6 mm (SD 0.9) in zone 2. The mean radiographic cement penetration in lateral view was 1.1 mm (SD 0.4) in zone 1 and 1.3 mm (SD 0.3) in zone 2. Osteolytic lesions were seen in all cases around the implant after a mean of 51 months. In all cases a revision procedure was done. Based on clinical presentation, haematological screening, joint aspiration (synovial fluid diagnostic, microbiological analyses) and histological evaluation of intraoperative samples an infection was excluded. The authors have a critical attitude toward a loosening rate of almost 10% as stated by the recent literature within the first 4 to 5 years and consider that a reduction of the loosening rate when using the full cementation technique /cementing the stem) will mean a greater benefit for patients than the possible advantage of a better bone stock in case of revision surgery. Apart from this aspect, the question of whether early aseptic loosening is still acceptable nowadays from the medical economic aspects also warrants discussion.

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Incidence of and Functional Significance of Floating Toe After Weil Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011419891956 ◽

2019 ◽

Vol 4 (4) ◽

pp. 247301141989195

Author(s):

Emilio Wagner ◽

Luis A. O’Connell ◽

Ruben Radkievich ◽

Nathaly Caicedo ◽

Pablo Mococain ◽

...

Keyword(s):

Clear Correlation ◽

Functional Scale ◽

Level Of Evidence ◽

Patient’S Satisfaction ◽

Significant Difference ◽

The Mean ◽

American Orthopaedic ◽

Toe Deformity

Background: The most frequent complication after Weil osteotomies is a floating toe deformity, but there are no reports about its effect on the patient. In this study, we analyzed the consequences of floating toe deformities after the performance of a modified Weil osteotomy (MWO) or a modified Weil osteotomy with interphalangeal fixation (MWOIF). Methods: We performed a retrospective review with a prospective follow-up of 50 patients (98% women, 120 rays) who underwent MWO (65 rays) or MWOIF (55 rays), with a mean age of 54 ± 12 years and a minimum follow-up of 4 years (mean of 6 years). We analyzed the presence of floating toe deformity in MWO and MWOIF and the outcomes measured by the subjective satisfaction, Lower Extremity Functional Scale (LEFS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and quality of prehension force between patients with or without floating toe deformity. Results: The mean floating toe incidence was of 57%, with no significant difference between operative techniques (48% MWO, 67% MWOIF; P = .053). Our analysis did not show differences in satisfaction, LEFS and AOFAS scores, or grip strength between the group of patients with or without floating toes. Conclusion: The presence of a floating toe deformity was more frequent than generally believed but did not have a meaningful impact on the patient’s satisfaction or functional outcomes measured by the AOFAS and LEFS scales. There was no clear correlation between operative technique, floating toe, and quality of prehension force. Level of Evidence: Level III, retrospective comparative series.

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DOZ047.110: Recurrent tracheoesophageal fistula tracheoscopic chemocauterization with trichloroacetic acid

Diseases of the Esophagus ◽

10.1093/dote/doz047.110 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

D P R Lara ◽

L V M Riveros ◽

L R S Pineda ◽

P O Padilla ◽

I C Cañón ◽

...

Keyword(s):

Trichloroacetic Acid ◽

Tracheoesophageal Fistula ◽

Primary Repair ◽

Endoscopic Management ◽

High Morbidity ◽

Medical Reason ◽

Endoscopic Techniques ◽

Number Of Patients ◽

The Mean

Abstract Objective The aim of this study was to report the experience of two centers in the treatment of recurrent tracheoesophageal fistula (RTEF), by tracheoscopic chemocauterization with trichloroacetic acid (TCA). A surgical approach to RTEF has high morbidity and mortality. Some endoscopic techniques have been developed but nevertheless, optimal treatment is still not determined because of the low number of patients, short term of follow-up, and different techniques. Materials and Methods From January 2016 to March 2019, 12 patients with RTEF were selected for endoscopic management in two centers. Eleven had RTEF after primary repair of esophageal atresia/TEF and one had a second fistula with misdiagnosis, all of them by a thoracotomy approach. In all cases the diagnosis was confirmed by clinical evaluation, esophagram, and bronchoscopy. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope telemonitoring was used to localize and refresh the fistula with a small endoscopy brush of 2–3 mm. Cotton soaked with 50% TCA was applied on the fistula for 30 seconds. The procedure had to be repeated two times. Results Fistulae were closed in 10 patients. The closure was confirmed by esophagram or bronchoscopy after 2 months of the procedure. It remains completely obliterated and the patients are asymptomatic. There were only two patients with progressive decrease in the diameter of the fistula; one patient died for some other medical reason and another patient is being treated. The mean number of procedures in each patient was 1.3, and the follow-up was 12 months on average (2–36). Two patients had bronchospasms as postoperative complication. Conclusion The tracheoscopic chemocauterization of RTEF with the use of 50% TCA is a minimally invasive, safe, and effective technique. It has fewer complications and avoids the morbidity of open surgery.

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Implementation of a novel prehospital advance directive protocol in southeastern Ontario

CJEM ◽

10.1017/s148180350001513x ◽

2007 ◽

Vol 9 (04) ◽

pp. 250-259 ◽

Cited By ~ 4

Author(s):

Rose P. Mengual ◽

Michael J. Feldman ◽

Gord R. Jones

Keyword(s):

Prospective Observational Study ◽

Small Sample Size ◽

Small Sample ◽

Decision Makers ◽

Prehospital Setting ◽

Do Not Resuscitate ◽

Surrogate Decision Makers ◽

The Mean ◽

Surrogate Decision

ABSTRACTIntroduction:Do not resuscitate (DNR) orders are commonly accepted in most health care settings, but are less widely recognized in the prehospital setting. We describe the implementation of and satisfaction with a prehospital DNR protocol that allows paramedics to honour verbal and non-standard written DNR requests.Methods:This prospective observational study reviewed all cardiac arrests in southeastern Ontario between March 1, 2003 and September 31, 2005. Following a verbal or non-standard written DNR request, paramedics completed a questionnaire and a follow-up structured telephone interview was conducted with surrogate decision makers (SDMs).Results:There were 1890 cardiac arrests during the study period, of which 86 met our inclusion criteria. Paramedic surveys were available for 82 cases (95%), and surrogate decision makers (SDMs) were successfully contacted in 50 (58%) of them. Two SDMs declined to be interviewed. The mean patient age was 72.7 (standard deviation 13.8) years and 65% were male. Sixty-three (73%) of DNR requests were verbal, and 23 (27%) were written. The mean paramedic comfort was rated 4.9 on a 5-point Likert scale (with 5 being “very comfortable” ) (95% confidence interval [CI] 4.9–5.0). The mean SDM comfort was rated by paramedics as 4.9 (95% CI 4.8 –4.9). SDMs reported comfort in withholding CPR in 47 of 48 cases (98%), and with paramedic care in all cases. One SDM stated that although it was consistent with the patient's wishes, she was uncomfortable having to make the DNR request.Conclusions:Satisfaction with this novel prehospital DNR protocol was uniformly high among paramedic and SDM respondents. It appears that such a protocol is feasible and acceptable for the prehospital setting. Our conclusions are limited by a small sample size, the lack of a comparison group, and limited follow-up.

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