scholarly journals Role of orthoptics and scoring system for orbital floor blowout fracture: surgical or conservative treatment

2021 ◽  
Vol 14 (12) ◽  
pp. 1928-1934
Author(s):  
Juraj Timkovic ◽  
◽  
Katerina Janurova ◽  
Petr Handlos ◽  
Jan Stembirek ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Scoring System ◽  
Treated Patient ◽  
Orbital Floor ◽  
Ocular Motility ◽  
Blowout Fracture ◽  
A Prospective Study

AIM: To assess the role of orthoptics in referring patients with orbital floor blowout fracture (OFBF) for conservative or surgical treatment and based on the results, to propose a scoring system for such decision making. METHODS: A retrospective analysis of 69 patients with OFBF was performed (35 treated conservatively, 34 surgically). The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated, the factors with the highest significance for decision making were identified, and a scoring system proposed using Logistic regression. RESULTS: According to defined criteria, the treatment was unsuccessful in 2 (6%) surgically treated and only in one (3%) conservatively treated patient. The proposed scoring system includes the defect size and several values resulting from the orthoptic examination, the elevation of the eyebulb measured on Lancaster screen being the most significant. CONCLUSION: The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder (with or without binocular diplopia) in OFBF patients. The proposed scoring system could, following verification in a prospective study, become a valuable adjunctive tool.

Management of Orbital Floor Fractures

2019 ◽  
Vol 35 (06) ◽  
pp. 633-639 ◽  
Author(s):  
Tom Shokri ◽  
Mark Alford ◽  
Matthew Hammons ◽  
Yadranko Ducic ◽  
Mofiyinfolu Sokoya
Keyword(s):  
Decision Making ◽  
Surgical Repair ◽  
Operative Intervention ◽  
Orbital Floor ◽  
Ocular Motility ◽  
Orbital Volume ◽  
Facial Contour ◽  
Orbital Floor Fractures ◽  
Craniomaxillofacial Trauma

AbstractFractures of the orbital floor represent a common yet difficult to manage sequelae of craniomaxillofacial trauma. Repair of these injuries should be carried out with the goal of restoring normal orbital volume, facial contour, and ocular motility. Precise surgical repair is imperative to reduce the risk of long-term debilitating morbidity. This article aims to review concepts on the management of orbital floor fractures in the hope of further elucidating perioperative evaluation and decision-making regarding operative intervention.

scholarly journals Surgical treatment of orbital floor blowout fracture in children: A case report

2015 ◽  
Vol 72 (9) ◽  
pp. 841-844 ◽  
Author(s):  
Sasa Tabakovic ◽  
Ivana Ilic-Dimitrijevic
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Functional Results ◽  
Orbital Floor ◽  
Traumatic Lesion ◽  
Blowout Fracture ◽  
Orbital Floor Fracture ◽  
Aesthetic Appearance ◽  
Orbital Floor Reconstruction ◽  
Craniofacial Complex

Introduction. Orbital floor blowout fracture is a common traumatic lesion of the craniofacial complex, but rarely in children population, consequently representing challenge in surgical treatment. Timely diagnosis and surgical treatment prevent the probability of the occurrence of the functional complications. Case report. We presented surgical treatment of on 8-year-old girl with a blowout orbital floor fracture one month after the injury. The predominant symptoms were: ocular bulb motility disorder with consecutive strabismus and double vision. Orbital floor reconstruction was made by an autogenous mandibular symphyseal graft. A year after the orbital floor reconstruction additional correction of strabismus was performed due to functional disorder of the bulbomotor muscles. Conclusion. Delayed surgical treatment of blowout orbital floor fracture in children leads to unsatisfactory functional results in the majority of cases. In such a situation surgical correction of strabismus is necessary in order to obtain functionally quality vision and satisfactory aesthetic appearance.

Surgical treatment satisfaction among women with breast cancer: The role of preferences regarding shared decision making

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 6033-6033 ◽  
Author(s):  
P. M. Lantz ◽  
N. K. Janz ◽  
A. Fagerlin ◽  
M. Mujahid ◽  
B. Salem ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Shared Decision Making ◽  
Treatment Satisfaction ◽  
Shared Decision

scholarly journals Prospective Randomized Controlled Pilot Study on Orbital Blowout Fracture

2018 ◽  
Vol 11 (3) ◽  
pp. 165-171 ◽  
Author(s):  
Babak Alinasab ◽  
Karl-Johan Borstedt ◽  
Rebecka Rudström ◽  
Michael Ryott ◽  
Abdul Rashid Qureshi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pilot Study ◽  
Infraorbital Nerve ◽  
Ocular Motility ◽  
Posterior Edge ◽  
Blowout Fracture ◽  
Randomized Controlled ◽  
Observational Group ◽  
Orbital Rim ◽  
Surgical Group

To clarify the conflicting recommendations for care of blowout fracture (BOF), a prospective randomized study is required. Here, we present a prospective randomized pilot study on BOF. This article aimed to evaluate which computed tomography (CT) findings predict late functional and/or cosmetic symptoms in BOF patients with ≥ 1.0 mL herniation of orbital content into maxillary and/or ethmoidal sinuses. It also aimed to evaluate which patients with BOF would benefit from surgical treatment or observational follow-up. Twenty-six patients with BOF ≥ 1.0 mL herniation were randomized to observational ( n = 10) or surgical treatments ( n = 16) and were followed up for functional and cosmetic symptoms for at least 1 year. The results from CT scan measurements were correlated to the patients’ symptoms and clinical findings which we report in this pilot study. Of the 10 patients randomized to observation, five had an inferomedial BOF with a herniation of ≥ 1.3 mL and all patients developed cosmetic deformities and required surgery. The remaining five patients in the observational group had inferior BOF and one of them had a distance of 3.3 cm from the inferior orbital rim to the posterior edge of the fracture and developed a cosmetic deformity but was unwilling to proceed to surgical treatment, and four patients had a median distance of 2.9 cm from the inferior orbital rim to the posterior edge of the fracture and did not develop cosmetic deformities. The median time from injury to surgery was 13 (3–17) days for the surgical group and 37 (17–170) days for the patients who underwent surgery in the observational group. The surgical results were similar for all the operated patients at the final control. Diplopia decreased and remained partly in one patient in the surgical group and in two patients in the observational group. Hypoesthesia of the infraorbital nerve decreased in nonsurgically treated patients, but surgery seemed to induce hypoesthesia. In this prospective randomized controlled pilot study on BOF, all patients in the observational group with inferomedial fractures developed visible deformity. Diplopia in BOF, without ocular motility limitation, is believed to be due to edema. Diplopia is not an indication for surgery as long as it reduces over time.

scholarly journals PRP and Articular Cartilage: A Clinical Update

2015 ◽  
Vol 2015 ◽  
pp. 1-19 ◽  
Author(s):  
Antonio Marmotti ◽  
Roberto Rossi ◽  
Filippo Castoldi ◽  
Eliana Roveda ◽  
Gianni Michielon ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Platelet Rich Plasma ◽  
Case Series ◽  
Cartilage Defects ◽  
Platelet Concentrates ◽  
Therapeutic Tool ◽  
Complex Scenario

The convincing background of the recent studies, investigating the different potentials of platelet-rich plasma, offers the clinician an appealing alternative for the treatment of cartilage lesions and osteoarthritis. Recent evidences in literature have shown that PRP may be helpful both as an adjuvant for surgical treatment of cartilage defects and as a therapeutic tool by intra-articular injection in patients affected by osteoarthritis. In this review, the authors introduce the trophic and anti-inflammatory properties of PRP and the different products of the available platelet concentrates. Then, in a complex scenario made of a great number of clinical variables, they resume the current literature on the PRP applications in cartilage surgery as well as the use of intra-articular PRP injections for the conservative treatment of cartilage degenerative lesions and osteoarthritis in humans, available as both case series and comparative studies. The result of this review confirms the fascinating biological role of PRP, although many aspects yet remain to be clarified and the use of PRP in a clinical setting has to be considered still exploratory.

scholarly journals Clinicopathological evaluation of acute appendicitis and the role of ultrasound in diagnosis: a prospective study

2019 ◽  
Vol 6 (5) ◽  
pp. 1471
Author(s):  
Tony Mathew ◽  
Amit Shivshankar Ammanagi
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Prospective Study ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Scoring System ◽  
Lower Abdominal Pain ◽  
Negative Appendicectomy ◽  
A Prospective Study

Background: Acute appendicitis is the most common acute surgical condition of the abdomen. Delay in treatment of acute appendicitis causes lot of complication. Study was done with the objective to study the clinical and pathological presentations of acute appendicitis, to evaluate the role of ultrasound in early diagnosis of acute appendicitis and to reduce negative appendicectomy in patients.Methods: This is a prospective study done on 100 patients with acute right lower abdominal pain clinically presumed to be of appendicular origin. A thorough history, clinical examination and ultrasound scan, was done for all cases. All ultrasound positive cases were subjected to surgery and some negative cases were also taken for surgery based on clinical suspicion. The ultrasound diagnosis was compared with clinical findings, operative findings and histopathological examination reports.Results: The overall accuracy of clinical diagnosis (Alvarado scoring system) with histopathology findings was 72%. The overall sensitivity and specificity was 70.3% and 81.3% respectively and positive predictive value of was 95.2% whereas the negative predictive value was 34.2%. The overall accuracy of ultrasound with histopathology report was 93%, with a sensitivity of 96.4%, specificity of 75%, and a positive predictive value of 95% and a negative predictive value of 80%. Negative appendicectomy rate was 8.82% in females and 3.63% in males.Conclusions: The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and inexpensive way of confirming acute appendicitis thus reducing negative appendicectomy rate.

Surgical treatment satisfaction among women with breast cancer: The role of preferences regarding shared decision making

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 6033-6033
Author(s):  
P. M. Lantz ◽  
N. K. Janz ◽  
A. Fagerlin ◽  
M. Mujahid ◽  
B. Salem ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Shared Decision Making ◽  
Treatment Satisfaction ◽  
Shared Decision

The outcome of conservative treatment of spiral metacarpal fractures and the role of the deep transverse metacarpal ligaments in stabilizing these injuries

2014 ◽  
Vol 40 (1) ◽  
pp. 59-62 ◽  
Author(s):  
A. Khan ◽  
G. Giddins
Keyword(s):  
Conservative Treatment ◽  
Prospective Study ◽  
Early Mobilization ◽  
Level Of Evidence ◽  
Fracture Fragment ◽  
Excellent Outcome ◽  
Metacarpal Fractures ◽  
Distal Fracture ◽  
A Prospective Study

We carried out a prospective study to assess the outcome of spiral metacarpal fractures treated with early mobilization even in the presence of malrotation. We treated 30 patients of whom we assessed 25. Of these, 23 had an excellent outcome and two had good outcomes. Objectively all the fractures united with some shortening of between 2–5 mm. Only two cases reported mild dysfunction: one patient had a residual malrotation of 5° and one had some discomfort when boxing. We also carried out simple biomechanical studies on a cadaver and two patients undergoing ray amputations. These showed that, as the distal fracture fragment migrates proximally, any malrotation in a closed injury with intact deep transverse metacarpal ligaments corrects with flexion, which also helps to limit the shortening. Spiral metacarpal fractures, whether central or border, whether single or multiple, can usually be treated reliably with early mobilization as any malrotation corrects with flexion and the degree of shortening is limited. Level of evidence – IV

scholarly journals Detecting Binocular Diplopia in Orbital Floor Blowout Fractures: Superiority of the Orthoptic Approach

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 989
Author(s):  
Juraj Timkovic ◽  
Jiri Stransky ◽  
Petr Handlos ◽  
Jaroslav Janosek ◽  
Hana Tomaskova ◽  
...  
Keyword(s):  
Screen Test ◽  
Motility Disorder ◽  
Orbital Floor ◽  
Ocular Motility ◽  
Blowout Fracture ◽  
True Value ◽  
Color Filters ◽  
Binocular Diplopia ◽  
Indication Criterion ◽  
Important Indication

Background and Objectives: In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical therapy. However, the accuracy of the traditional test for detecting binocular diplopia/ocular motility disorder using a moving pencil or finger (hereinafter, “finger test”) has been generally accepted as correct and has not been subject to scrutiny so far. Hence, its accuracy relative to full orthoptic examination is unknown. Materials and Methods: In this paper, the results of the “finger test” were compared with those derived from a complex examination by orthoptic tests (considered “true” value in patients with OFBF). Results: “Finger test” detected ocular motility disorder in 23% of patients while the full orthoptic examination proved much more efficient, detecting ocular motility disorder in 65% of patients. Lancaster screen test and test with color filters were the most important tests in the battery of the orthoptic tests, capable of identifying 97.7% and 95.3% of patients with ocular motility disorder, respectively. Still, none of the tests were able to correctly detect all patients with ocular motility disorder in itself. Conclusions: As the presence of ocular motility disorder/binocular diplopia is an important indication criterion for the surgical solution of the orbital floor blowout fracture, we conclude that a complex orthoptic evaluation should be always performed in these patients.

scholarly journals Application of ASTLOF Scoring System in the Treatment of Acute Symptomatic Thoracolumbar Compression Fractures

2020 ◽  
Author(s):  
Qing-Da Li ◽  
Jun-Song Yang ◽  
Chao Jiang ◽  
Yi-Fan Ma ◽  
Xin Tian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Vertebral Body ◽  
Vertebral Fractures ◽  
Scoring System ◽  
Compression Fractures ◽  
Better Than

Abstract Background: Osteoporotic vertebral compression fracture (OVCF) is a common injury in the elderly, often caused by low-energy injuries. Improper treatment will not only affect the stability and balance of the spine, but in severe cases will lead to neurological damage and increase the risk of death. This retrospective study aims to explore the principles of treatment of patients with the assessment system of thoracolumbar osteoporotic fracture (ASTLOF) in acute symptomatic thoracolumbar compression fractures when the ASTLOF score = 4 points.Methods: The clinical data of patients with acute symptomatic thoracolumbar compression fractures admitted from February 2018 to February 2020 were retrospectively analyzed. Each patient was evaluated according to the ASTLOF scoring system, and patients with ASTLOF score = 4 were selected, a total of 108 patients. According to different treatment methods, they were divided into 32 cases in the non-surgical treatment (NST) group and 76 cases in the surgical treatment (ST)group. The visual analog score (VAS), Oswestry disability index (ODI), the recovery of injured vertebral body height, and the incidence of adjacent segment fractures were used for comprehensive evaluation.Results: During the follow-up, the VAS score and ODI score showed that the early pain relief and functional improvement of the surgical treatment group were better than those of the conservative treatment group (P<0.05); the Cobb angle of the surgical treatment group was 3 months and 6 months after the operation, and the vertebral body was injured. The degree of improvement of margin height was better than that of the conservative treatment group (all P<0.05); in the surgical treatment group, 6 cases of adjacent vertebral fractures occurred after surgery, accounting for 7.89%, and 2 cases of the conservative treatment group had adjacent vertebral fractures, accounting for 6.25% There was no statistically significant difference between the two groups (P>0.05).Conclusions: When the ASTLOF scoring system is used in the treatment of acute symptomatic thoracolumbar compression fractures, patients with ASTLOF score =4 should be treated with surgery in time, which can relieve pain early and quickly, perform functional exercises as soon as possible, and reduce complications related to long-term bed rest. Whether it increases the risk of adjacent vertebral fractures requires long-term follow-up studies in a large number of cases.

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