A Commentary on “Clinical and Functional Outcomes of Ulnar Lengthening in the Treatment of Masada Type I Forearm Deformities in Hereditary Multiple Osteochondromas”

2020 ◽  
Author(s):  
Alireza Moharrami ◽  
Hamid Arabi
Keyword(s):  
Functional Outcomes ◽  
Type I ◽  
Multiple Osteochondromas ◽  
Ulnar Lengthening

The article's abstract is not available.

Clinical and Functional Outcomes of Ulnar Lengthening in the Treatment of Masada Type I Forearm Deformities in Hereditary Multiple Osteochondromas

2020 ◽  
Vol 45 (9) ◽  
pp. 876.e1-876.e7
Author(s):  
Soroush Baghdadi ◽  
Hamid Arabi ◽  
Amirreza Farhoud ◽  
Alireza Moharrami ◽  
Taghi Baghdadi
Keyword(s):  
Functional Outcomes ◽  
Type I ◽  
Multiple Osteochondromas ◽  
Ulnar Lengthening

scholarly journals Gradual ulnar lengthening in Masada type I/IIb deformity in patients with hereditary multiple osteochondromas: a retrospective study with a mean follow-up of 4.2 years

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuchan Li ◽  
Zhigang Wang ◽  
Mu Chen ◽  
Haoqi Cai
Keyword(s):  
Retrospective Study ◽  
Radial Head ◽  
Elbow Flexion ◽  
Type I ◽  
Multiple Osteochondromas ◽  
External Frame ◽  
The Mean ◽  
Carrying Angle ◽  
Ulnar Lengthening

Abstract Background Gradual ulnar lengthening is the most commonly used procedure in the treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children. This study aims to evaluate the clinical and radiological outcomes of ulnar gradual lengthening in our clinic. Methods We retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, 2 months after external frame removal, and at the last follow-up. Results The current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at the index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37 ± 8 to 30 ± 7° initially (p = 0.005) and relapsed to 34 ± 8° at the last follow-up (p = 0.255). There was a minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). At the last follow-up, the mean forearm pronation and elbow flexion increased significantly (p < 0.001 and p = 0.013, respectively), and the mean carrying angle also improved significantly (p < 0.001). No patient with type IIb deformity achieved a concentric radial head reduction. Conclusions Gradual ulnar lengthening significantly reduces cosmetic deformity and improves function in patients with Masada type I/IIb deformity. Our results supported early ulnar lengthening for patients with a tendency of dislocation of the radial head.

scholarly journals Management of Masada type I/IIb forearm deformity by gradual ulnar lengthening in patients with hereditary multiple osteochondromas

2020 ◽  
Author(s):  
Yuchan Li ◽  
Zhigang Wang ◽  
Mu Chen ◽  
Haoqi Cai
Keyword(s):  
Treatment Protocol ◽  
Elbow Flexion ◽  
Individual Treatment ◽  
Type I ◽  
Daily Life Activities ◽  
Multiple Osteochondromas ◽  
The Mean ◽  
Carrying Angle ◽  
Ulnar Lengthening

Abstract Background Gradual ulnar lengthening is the most commonly used procedure in treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children and only slightly handicapped of daily life activities in untreated adult patients. The aim of this study was to evaluate mid-term clinical and radiological outcomes of ulnar gradual lengthening in our clinic. Methods We retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. Patients with less than two years of follow-up were excluded. The surgical procedures consisted of ulnar lengthening by external fixator and/or excision of the osteochondroma at the distal ulna. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, two months after external frame removal, and at the last follow-up. Results The current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37.3 ± 7.9° to 29.8 ± 6.5° initially (P = 0.003) and relapsed to 34.4 ± 7.6° at the last follow-up (p = 0.234). There was minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). The elbow flexion and forearm pronation were improved significantly at last follow-up (p < 0.001 and p = 0.024, respectively). The mean carrying angle improved significantly from − 6.3 ± 7.4 ° preoperatively to 7.4 ± 11.1° at last follow-up (p < 0.001). Conclusions Gradual ulnar lengthening significantly reduces cosmetic deformity and improves function; it is recommended for patients with Masada type I/IIb deformity. Therefore, we advocated aggressive individual treatment protocol for patients with Masada type I/IIb deformities.

scholarly journals Functional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring

2019 ◽  
Vol 107 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Hanjo Ko ◽  
Joseph E. Bavaria ◽  
Andreas Habertheuer ◽  
John G. Augoustides ◽  
Mary A. Siki ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Functional Outcomes ◽  
Aortic Ring ◽  
Aortic Valve Repair ◽  
Type I ◽  
Valve Repair

scholarly journals Origin of craniopharyngiomas: implications for growth pattern, clinical characteristics, and outcomes of tumor recurrence

2016 ◽  
Vol 125 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Yun Bao ◽  
Jun Pan ◽  
Song-tao Qi ◽  
Yun-tao Lu ◽  
Jun-xiang Peng
Keyword(s):  
Growth Pattern ◽  
Functional Outcomes ◽  
Growth Patterns ◽  
High Rate ◽  
Pituitary Function ◽  
Delayed Puberty ◽  
Neurosurgical Procedures ◽  
Type I ◽  
Imaging Features ◽  
Recurrent Tumors

OBJECT Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma's complex topographical relationship with surrounding structures. The aim of this study was to define the determinative role of the site of origin on the growth pattern and clinical features of recurrent craniopharyngiomas. METHODS The authors performed a retrospective analysis of 52 patients who had undergone uniform treatment by a single surgeon. For each patient, data concerning symptoms and signs, imaging features, hypothalamic-pituitary function, and recurrence-free survival rate were collected. RESULTS For children, delayed puberty was more frequent in the group with Type I (infradiaphragmatic) craniopharyngioma than in the group with Type TS (tuberoinfundibular and suprasellar extraventricular) lesions (p < 0.05). For adults, blindness was more frequent in the Type I group than in the Type TS group (p < 0.05). Nausea or vomiting, delayed puberty, and growth retardation were more frequent in children than in adults (p < 0.05). Overall clinical outcome was good in 48.07% of the patients and poor in 51.92%. Patients with Type TS recurrent tumors had significantly worse functional outcomes and hypothalamic function than patients with the Type I recurrent tumors but better pituitary function especially in children. CONCLUSIONS The origin of recurrent craniopharyngiomas significantly affected the symptoms, signs, functional outcomes, and hypothalamic-pituitary functions of patients undergoing repeated surgery. Differences in tumor growth patterns and site of origin should be considered when one is comparing outcomes and survival across treatment paradigms in patients with recurrent craniopharyngiomas.

scholarly journals Modified Osteotomy for Treatment of Forearm Deformities (Masada IIb) in Hereditary Multiple Osteochondromas: A Retrospective Review

2021 ◽  
Author(s):  
Ge Yan ◽  
Guoxin Nan
Keyword(s):  
Distraction Osteogenesis ◽  
External Fixator ◽  
Wrist Joint ◽  
Elbow Flexion ◽  
Wrist Flexion ◽  
Ilizarov External Fixator ◽  
Multiple Osteochondromas ◽  
Before And After ◽  
Ulnar Lengthening ◽  
Flexion And Extension

Abstract Purpose: Approximately 30% of patients with hereditary multiple osteochondromas (HMO) have forearm deformity and dysfunction. The aim of this retrospective study was to review our experience with the surgical treatment of children with HMO and Masada IIb forearm deformities.Methods: Data of eight children treated for HMO Masada IIb forearm deformity at our hospital between 2015 and 2019 were collected from the hospital records and retrospectively reviewed. All patients underwent ulnar lengthening by distraction osteogenesis using either the Orthofix or Ilizarov external fixator. Range of movements at the elbow and wrist joints, and forearm supination/pronation, before and after the operation were recorded. Radiographs were evaluated by the Fogel method, and wrist joint function by the Krimmer method.Results: Follow-up radiographs showed significant improvement in relative ulnar shortening after treatment (pre-operative 9.23 ± 5.21 mm; post-operative 0.33 ± 4.13 mm). Changes in radial articular angle (pre-operative 33.55° ± 3.88° to 32.78° ± 6.57°) and carpal slip (pre-operative 45.00% ± 19.09%; post-operative 43.13% ± 16.68%) were not significant. Elbow flexion and extension, wrist flexion and extension, ulnar and radial deviation at wrist, and forearm rotation were significantly improved after surgery. Wrist function was graded as excellent in seven patients and as good in one patient. One patient treated with the Ilizarov external fixator had poor radial head reduction.Conclusion: Ulnar lengthening with distraction osteogenesis is an effective treatment for HMO Masada IIb deformities. The optimum site for ulnar osteotomy appears to be at the proximal one-third to one-fourth of the ulna.

Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis

2020 ◽  
Vol 45 (7) ◽  
pp. 679-686 ◽  
Author(s):  
Marc Olivier Gauci ◽  
Thomas Waitzenegger ◽  
Pierre-Emmanuel Chammas ◽  
Bertrand Coulet ◽  
Cyril Lazerges ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Revision Surgery ◽  
Functional Outcomes ◽  
Type I ◽  
Type Ii ◽  
Level Of Evidence ◽  
Wrist Motion

We retrospectively compared results of 27 wrists with bicolumnar arthrodesis with mean follow-up of 67 months to 28 wrists with three-corner arthrodesis adding triquetral excision with mean follow-up of 74 months in 54 patients (55 wrists). Minimal follow-up was 2 years for all patients. Capitolunate nonunion occurred in three wrists with bicolumnar arthrodesis and six wrists with three-corner arthrodesis, and radiolunate arthritis developed in four wrists with three-corner arthrodesis. Among patients with bicolumnar arthrodesis, hamatolunate arthritis occurred in seven wrists, all with a Viegas type II lunate; and pisotriquetral arthritis occurred in three wrists. At mean 5 years after surgery, 45 wrists had not needed revision surgery, and both groups had similar revision rates. The wrists with three-corner arthrodesis and bicolumnar arthrodesis had similar functional outcomes, and range of wrist motion was not significantly different between the two groups. We concluded that bicolumnar arthrodesis results in greater longevity than three-corner arthrodesis for a type I lunate. We do not recommend bicolumnar arthrodesis for type II lunate. We also concluded that three-corner arthrodesis has a greater incidence of radiolunate arthritis and capitolunate nonunion. Level of evidence: III

scholarly journals Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 10 ◽  
Author(s):  
Tamer A. EL-Sobky ◽  
Shady Samir ◽  
Ahmed Naeem Atiyya ◽  
Shady Mahmoud ◽  
Ahmad S. Aly ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Patient Characteristics ◽  
Control Group ◽  
Publication Date ◽  
Disease Characteristics ◽  
Multiple Osteochondromas ◽  
Paediatric Orthopaedic ◽  
Ulnar Lengthening

Introduction: This systematic review aims to answer three research questions concerning the management of hereditary multiple osteochondromas of forearm in children: What is the best available evidence for the currently employed surgical procedures? What patient characteristics are associated with better prognosis? What disease characteristics are associated with better prognosis? Methods: We searched the literature using three major databases with no publication date restrictions. To enhance search sensitivity and maintain precision we used keywords/subject terms correlating with patient population, problem and interventions. We used strict inclusion/exclusion criteria to improve validity evidence. Results: The search process yielded 34 eligible studies with a total of 282 patients (315 forearms). We comprehensively analysed study and patient demographics and interventions and outcomes. Eleven studies (32%) had a long-term follow-up and 31 studies (91%) were retrospective. Of the total number of forearms, ulnar lengthening +/− associated procedures was used in 210 forearms (66.7%), isolated osteochondroma excision in 65 forearms (20.6%) and isolated distal radius hemiepiphysiodesis in 15 forearms (4.7%) among others. Discussion: Ulnar lengthening can restore radiologic anatomy, improve appearance and to a lesser extent objective clinical parameters like joint range of motion on the short/intermediate term. Isolated osteochondroma excision can relief pain and satisfy cosmetic concerns occasionally. There is poor evidence to suggest that surgery improves quality of life or function. Predictors of surgical success in regard to patient and disease characteristics remain elusive. Natural history and prospective randomized control studies where the control group receives no treatment should be rethought. They have the potential for bias control and identification of the ideal surgical candidate. The complex interplay between the confounding variables has undermined the capability of most studies to provide well-grounded evidence to support and generalize their conclusions. Valid quality of life scales should supplement objective outcome measures.

scholarly journals Outcomes of Type I Tympanoplasty using a Cartilage Shield Graft

2020 ◽  
pp. 100-104
Author(s):  
Murad Ghazi Ahmed ◽  
Said M. Said Aljaff ◽  
Hiwa Asaad Abdulkareem
Keyword(s):  
Hearing Loss ◽  
Tympanic Membrane ◽  
Functional Outcomes ◽  
Neck Surgery ◽  
P Value ◽  
Type I ◽  
Tympanic Membrane Perforations ◽  
Type I Tympanoplasty ◽  
Mean Differences ◽  
Anatomical Outcome

Background: Type I tympanoplasty surgery is an effective routine technic that had been used for tympanic reconstruction to improve hearing. Objectives: The aim was to measure the effect of type I tympanoplasty surgery using the cartilage shield graft (CSG) in term of graft uptake (anatomical outcome) and hearing gains (functional outcomes) of patients with poor prognostic factors. Method and Materials: In this study, 20 patients with perforation exceeded 50%, but limited to the tympanic membrane were recruited for type I tympanoplasty surgery. The study was conducted in the Otolaryngology/Head and Neck surgery training center in Sulaimani Teaching Hospital in Sulaimani city for one year period. Bellucci classification was used to evaluate otorrhea risks. Results: The majority of patients were female (90%), with a mean ± SD (standard deviation) of ages of 37.15 ± 14.01 years. Most of the patients (40%) were presented with a mild hearing loss of 26-40 decibels (dB). Type I tympanoplasty surgery using the cartilage shield graft (CSG) had significantly decreased the hearing loss and air-bone gap (p-value = 0.046 and 0.006, respectively). The mean differences in hearing loss and air-bone gap were 5.05 dB and 6.75 dB, respectively. Conclusions: CSG in type I tympanoplasty surgery is an effective solution in anatomical outcome (Graft uptake) and functional outcomes (hearing gains) which had been reflected in reducing hearing loss and air-bone gap (average hearing gain of 5dB) in patients presented with tympanic membrane perforations. No improvement in the functional outcomes was observed in patients presented with severe hearing loss pre-operatively.

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